Permanent Supportive Housing

A Comprehensive Solution to Homelessness

Supportive Housing PhotoExecutive Summary
A change in how we, as a society, relate to our wealth and power and practical compassion lie at the heart of a solution to homelessness. To reduce or even eliminate a social issue as pervasive as homelessness will take the combined efforts of government, philanthropic, corporate, and private organizations along with a change in how we, as a society, view our relationship with our fellow human beings and our relationship to wealth and power.

Permanent supportive housing, as proposed here, is designed to meet the needs of the whole person, from the social and emotional to the physical and practical. There is a need for funding at the local, state, and, eventually, the federal level to support pilot programs as the framework is adapted to the needs of various cities.

This framework not a one-size-fits-all solution, nor is it all-or-nothing. The framework can adapt to local needs, including existing programs for the homeless that are already in place. City officials, agencies, and corporations can take the good work they are already doing and amplify it with the proposed aspects.

To put a stop to homelessness, solutions have to consider the needs of the whole person, from their physical and practical to the psychological. For this framework to take hold and succeed, we need everyday citizens, corporate organizations, and philanthropic entities and lobbyists for low income housing to advocate for low-cost, affordable housing. When we look to our brothers and sisters on the street and see them for the unique and worthy human beings they are, the obstacles seem smaller and rewards bigger.

Background: Compassionate Support for the Whole Person

On an inner level of potentially profound hope, change starts in how we, as a society, view wealth and power and our relationship to it. An overvaluing of wealth causes people to link their personal self-worth with their personal wealth. Subconsciously (and sometimes consciously), that can devalue those with less wealth. It creates a subconscious attitude that those in poverty are there because of their own choices.

That may be true in some cases, but without adequate access to health care, education, job training, transportation, and social support, those in poverty may not have opportunities for a better life. If the person belongs to a minority or other marginalized group, getting out of and staying out of poverty becomes even more difficult. Permanent supportive housing creates a framework to give people choices and opportunities. If they take them, and unfortunately, some will not, they can have equal access to the “pursuit of happiness” envisioned in the Declaration of Independence. 

And we know it is possible. There are examples from around the globe and within the United States that have drastically reduced homelessness. Their programs are not all identical, but they do have something in common—compassion for and treatment of individuals as a whole person.

The city of Trieste, Italy, embraces the homeless population as a valuable part of their community. Consequently, there are very few people living on the streets. There are housing and treatments for the mentally ill and a system in place to make sure those in need have access to physical and mental health care, adequate nutrition, and skills or job training.[i] Trieste’s program provides clinical services and the sometimes overlooked supportive services needed to develop the skills to re-enter society. These two types of care are sides of the same coin. When both are a part of the solution to homelessness, no matter the side the coin lands on, the community wins.

Italy is not the only country that is changing how they address social problems. Germany’s prison system has gained attention for both its low number of inmates and low recidivism rates. The homeless certainly are not prisoners, but there is much to learn from the German approach treatment.

The German system is built upon principles of re-socialization and rehabilitation.[ii] Inmates work with professionals to understand their past, how it affects their anger and current behaviors, and what they can do to make different life choices. There are opportunities for education as well as vocational and professional training. Inmates can earn opportunities to work outside of the prison facility or leave for a few days to spend time with family. Compassion and insight into the whole person lie at the center of the entire system.

The United States has a few successful supportive housing programs as well. The People Concern in Lancaster, California, created the Kensington Campus, an apartment complex for the homeless or homeless with disabilities.[iii] Through other programs run by The People Concern, those living in the complex have access to mental health care, medical care, domestic violence services, life skills training, and substance use services.

Austin, Texas, has Community First!, a 51-acre community for those escaping chronic homelessness.[iv] Here, community members have access to shared community spaces for recreation and training, a cinema, art house, and other facilities meant to help people enjoy where they live.

A similar center point—opportunities to grow, re-socialization, supportive care—lie at the heart of the proposed permanent supportive housing framework. Each of these communities, from Trieste to Austin, incorporates elements of the proposed framework. However, this framework is unique in the breadth and depth of services addressed and provided. It is not designed to replace successful programs but to help existing programs fully blossom and provide a starting point for cities that are building their solution from scratch. 

Solution: Permanent Supportive Housing—A Framework for Change

Strategic Social Considerations

Human beings are social creatures. They are meant to survive and thrive together. That does not mean individuals cannot survive alone, but there are specific psychological, emotional, and physical benefits that come from living in a community. Not just any community, but a community where individuals feel valued, understood, and like a contributing member. The proposed permanent supportive housing framework supports both sides of the coin, addressing long-term clinical and supportive care.

This permanent supportive housing framework can be implemented from the ground up, as a whole package to create new programs, or in parts to enhance and expand existing programs. It acts as a model that focuses on both solutions to logistic and economic issues associated with homelessness, as well as the deep, personal needs of each individual living without a home.

There are many who believe that the homeless community will not willingly leave the streets. In many cases, there is resistance to leave familiar locations and connections, creating a barrier to temporary shelter at motels, hotels, or temporary trailers.[v] People are hesitant to leave the comforts they have like a pet or fear being separate from a partner who isn’t a spouse.

However, my associates and I have provided services to the homeless community for close to twenty years. In our years of work together, we’ve engaged with hundreds of those to whom we’ve provided health care kits and always experienced strong supportive enthusiasm and interest in moving to a community that could be permanent if it was safe, supportive, and gave opportunities to grow and learn new skills, and receive health care. Each community can decide how to address individual concerns to overcome initial resistance and doubt. Those who believe that there will be permanent resistance to any kind of move off of the streets by the majority of homeless people may need to envision the real offering of a permanent shelter that focuses on the whole person in a permanent setting.

Separate, Individual Communities Based on Member Similarities

As addressed in previous white papers, a diverse group of people can be homeless at any one time—veterans, single mothers, families, recently released former inmates, and those with severe mental illness are only a few. Dividing the homeless population into eight to ten distinct groups or communities based on the members’ similarities creates a group of people who innately understand the challenges and trials of their neighbors. Even if their backgrounds are completely different, veterans understand the familial loyalty of fellow service members, and single mothers understand what it is like to raise a child alone.

Funds can be used more efficiently when services target specific groups. Communities for the severely mentally ill can spend more funds on staff training and security measures, while communities designed for families can use more funds towards transportation programs or job training. A framework focused on understanding and support opens the door for people to enjoy their homes and neighbors.

The value of a safe, cohesive community cannot be stressed enough. When people are in smaller communities where they relate to their neighbors, they experience less fear and anxiety, giving them the mental freedom to focus on self-esteem, confidence, and healing. Most, if not all, people experiencing homelessness have forms of healing to do. The option to heal and reclaim their capacity to be more self-sufficient presents an alternative that has largely been missing from other solutions to homelessness.

Enjoyable Communities with Attractive Common Spaces

The word ‘enjoy’ is one that should carry over into every aspect of permanent supportive housing. The goal is always to meet people’s physical needs—shelter, food, personal healing, evolution, and safety. But the social and supportive aspects of these communities let people experience a happiness and joy that may have been missing from their lives for a long time.

Attractive common spaces where neighbors can gather together for classes, training, and social activities wherever possible will be part of each community. Every person will be encouraged to contribute when and how they can. As they gain greater self-sufficiency, they can contribute more and help others on their own journey.

Choice, Contribution, and Belonging: Building Permanence into the Plan

Not only will this framework provide a place where people want to live, but they will have the option to stay. The transitional nature of shelters or transitional housing solutions can’t, by their very nature, eliminate all of the anxiety and fear that comes from not having the ability to plan where or what one will be doing in the next few months, weeks, or even days.

This permanent supportive housing framework gives each person the option of staying in the community. Some will choose to move on, re-entering the world outside of the community, while others will find that they have better support within the community.

Cities can decide if they want to have an option for people who receive SSI and SSDI to live in the communities and contribute a portion of their income as room and board. It is one way to build self-sustaining practices into the homelessness solution. The state or the federal government could potentially provide $1000/month to individuals recommended and qualified by a doctor, psychotherapist, and vocational expert. The psychological and economical value to the individual and society greatly outweighs the cost. 

Practical Financial Considerations

The social needs and benefits of a permanent supportive housing framework must also include practical financial considerations. It will take government agencies, non-profit foundations, and private businesses coming together to fully offer the needed treatment and services. Local, state, and eventually, federal funding will be needed to develop pilot programs and support these communities as they get started. But when they do, there is an opportunity for cost reduction and more efficient use of funds.

Professional Mental Health Care that Focuses on Guidance and Companionship

Homelessness and mental health have a close relationship. The numbers vary by study, location, how homelessness is defined, but 2019 statistics by the U.S. Department of Housing and Urban Development estimate that approximately 27 percent of the homeless population has a mental illness in contrast to 5 or 6 percent of the total adult population in the United States.[vi] However, those numbers vary with the Treatment Advocacy Center putting the number closer to 33 percent.[vii] Unfortunately, many of the conditions surrounding homelessness, such as poor nutrition, excessive chronic stress, and lack of health care only increase those numbers.

Yet there is a resource that is untapped in many large metropolitan areas. Colleges and universities have psychology masters students hungry for real-world training and internships. Establishing a program wherein students receive class credit for spending a specified number of hours working in one of these communities provides a financially efficient way to access specialized treatment.

Similar programs are already in the works and are ready to become a part of a permanent supportive community. For example, the Airport Marina Counseling Service in Los Angeles, California, works with trained professionals to provide mental health services at an affordable price.[viii] They also provide training opportunities for post-masters students who work free of charge as part of their internship.

It is a win-win situation because the students get specialized training under the supervision of licensed professionals, and the person receiving the counseling gets services tailored to them. For example, those training in family counseling can work in a family-focused community. The same method can be used to treat PTSD, addiction, trauma, depression, and anxiety. This kind of arrangement could provide better care at a much lower cost than having a trained-licensed professional treating a wide number of patients.

However, all counseling and mental health treatment will include and revolve around guidance and companionship through clinical and supportive therapies based on individual needs.

Access to Health Care at All Levels

Along those same lines comes better access to health care. The homeless often use costly ambulatory and emergency services as their first line of treatment. In an individual community where there is transportation or access to preventative care, health care costs go down because there are fewer emergency room visits, shorter hospital stays, and fewer untreated health conditions.[ix]

For some of these communities, like those serving the most severely mentally ill or addicts, health care will be an integral part of their community. They would need to be close to medical facilities and live near and work with highly trained staff. But not every community will need that level of health care. The permanent supportive housing model allows resources to be used where they are needed most.

Onsite Training and Work Opportunities to Maximize Self-Sufficiency

There is an opportunity to partner with organizations that provide training to underserved populations. Trash Prophets, a non-profit organization that trains homeless people in how to use recyclable trash to save CRV, for example, offers fast training with access to bikes and other equipment.[x] The program brings in money while individuals train for a more permanent occupation.

GRID Alternatives, a non-profit that provides solar industry training for underserved communities, trains and provides solar installations for underserved populations.[xi] People learn skills in the growing solar energy industry while installing solar products that could be installed within the permanent supportive community. Excess energy could then be developed in the field to provide energy for the whole community and, in some cases, be sold back to the surrounding power company for another way to support the community and increase self-sufficiency.

Central Meal Programs

Employment is not the only way to connect more people with non-profit organizations. Programs like EveryTable, a B-corporation with a charter that puts social welfare as the first priority and profit second, connect people to fresh, nutritious food.[xii] They serve many different types of communities but adapt their pricing based on the community location. Prices are dramatically lower in underserved communities, for example. People can donate meals to those in need as well. Many of these programs, like Trash Prophets and EveryTable, can be developed through satellite programs and training.

Reduced Construction/Renovation Costs

We cannot talk about reducing costs without addressing permanent physical housing. Cities in the United States have built shelters or renovated or built apartment buildings or motel/hotels at the cost of roughly $250,000 to $445,000.[xiii] However, there are other more feasible and financially attractive options.

Tiny homes, manufactured homes, and travel trailers can cost around $25,000 per unit. Drastically saving money and providing much-needed privacy. Of course, in places where shelters, apartments, or hotel renovations are already in progress, there is no need to buy tiny homes. Other parts of the permanent supportive housing framework can still be implemented based on existing housing structures. But with these small individual units as an option, it can save 90 percent of the money and provide a unique solution to housing.

Extend Low-Cost Living Options 

A solution to a problem as large as homelessness requires cooperation from every sector, especially the government and business communities. There’s potential for the state or federal government to create a program that qualifies low-income individuals, like those receiving SSI or SSDI, to live in the communities and contribute a portion of their living expenses, approximately $1,000, to pay for their housing, food, and access to the community’s amenities and programs. By qualifying individuals, the state or federal government adds tremendous incentive for the homeless to move into safe permanent housing.

The communities then could be created as an investment opportunity for B-corps, entities that put social welfare first and profit second in their business ventures. With private sector investment and the economic contributions of financially able community members, the communities have an opportunity to become self-sufficient and pay back the original housing costs.

Logistics of Bringing the Homeless into the Fold

A plan of the scope of permanent supportive housing requires close attention to logistics. The where’s and how’s are not small. They will be unique to each city and each community within that city based on demographics, socio-economic diversity, landscape, and dozens of other factors. It is a framework, not a definitive course of action, as can be seen in how cities decide where to locate each of their permanent supportive communities.

Creating a Place for Affordable Housing

Many city councils and elected officials are on the hunt for places to house the homeless, but property and new builds are expensive. City, county, state, and federal officials can partner with real estate property management companies to find desirable locations.

Empty city-owned lots, a municipal golf course, or park could serve as a location for some of the communities with the least risk and maintain the greatest distance from residential neighborhoods. This would likely include women, single mothers, families, and other populations that pose little to no threat to any surrounding residents and can easily blend with the surrounding neighborhood. Public properties owned on the outskirts of the city could potentially be used for more at-risk populations. 

Location Matters

Part of the purpose of separating the homeless into smaller, individual communities is to place them near services that best serve community members. A community for those with severe mental illness would need to be near or on medical facilities with both trained medical staff and security personnel to protect the community members and the surrounding neighborhoods. Ideally, such a community would not be located near residential areas. However, a community for single mothers or families should be located near schools, shopping centers, grocery stores, transportation hubs, and places of potential employment.

A Safety Net and Safe Haven During Future Pandemics

These kinds of communities also solve logistical issues during pandemics. There is no denying that this pandemic or future pandemics may become a regular part of our future. The proposed communities support the kind of privacy that allows for inexpensive social distancing measures while providing access to health care should illness break out among the homeless and underemployed population. At the same time, there is some relief that comes from knowing that even if one loses a job or home due to a pandemic, all is not lost, and the streets are not the only place to find shelter.

Conclusion: Sensible, Practical Compassion and Action Supports the Vulnerable and Strengthens Us All

Permanent supportive housing offers a dynamic solution to care for a vulnerable population. It will take a broader city, county, state, national, and global community to eventually eradicate homelessness. But when we have compassion and realism for our most vulnerable and in need, we all benefit.

This framework is not an all or nothing solution. Directors or board members of existing programs are encouraged to implement any aspect of the framework to strengthen what’s already working. The goal is to expand and enhance programs to meet the diverse needs of the whole person.

However, it is not just the homeless that benefit from this solution. When we all come together, the benefits of solving homelessness extend beyond those actually living without a home. It reaches everyone. There is an immeasurable psychological benefit that comes from caring for our fellow human beings. But it takes many committed organizations and people from the public and private sector to coordinate and work toward lasting change—the kind of change that can help people build self-sufficiency, independence, and, ultimately, joy and happiness.

 

Robert Strock is a teacher, psychotherapist, author, and humanitarian and has developed a unique approach to communication, contemplation, and inquiry. He promotes national and international conversations on healing, having been a featured speaker at the UN, contributed in global documentaries, and runs a thriving private practice for business, non-profit, entertainment industry, and government leaders, as well as caregivers in a variety of fields.

Robert is an innovator in the field of psychology and is sought after for presentations, trainings, and consultation in corporate settings, non-profits, and with media audiences providing emotional and leadership guidance in times of global strife and uncertainty.

Open the Dialogue: The issues surrounding homelessness are many and complex. I invite all those who are interested in ending homelessness, addressing our relationship as a society to wealth, and other issues raised in this white paper to please reach out. Contact me at robertstrock.org.

 

Post-related online resources
Community First! Village
The People Concern
Airport Marina Counseling Center
Trash Prophets
GRID Alternatives
EveryTable 

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1] Waters, R. (2020). A new approach to mental health care, imported from abroad. Health Affairs. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00047

[1] Subramanian, R., et al. Sentencing and prison practices in Germany and the Netherlands: Implications for the United States. Vera Institute of Justice Center on Sentencing and Corrections.

[1] The People Concern – Homeless Services. https://www.thepeopleconcern.org/homeless-services/

[1] Community First! Village – https://mlf.org/community-first/

[1] Donley, A.M. et al, (2012). Safer outside: A qualitative exploration of homeless people’s resistance to homeless shelters. Journal of Forensic Psychology Practice. 12(4), pp. 228-306. https://www.researchgate.net/publication/254362874_Safer_Outside_A_Qualitative_Exploration_of_Homeless_People’s_Resistance_to_Homeless_Shelters

[1] HUD 2019 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations. https://files.hudexchange.info/reports/published/CoC_PopSub_NatlTerrDC_2019.pdf

[1] Features and News Treatment Advocacy Center. https://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/2596-how-many-people-with-serious-mental-illness-are-homeless

[1] The Airport Marina Counseling Service. https://www.amcshelps.com/about

[1] Kerman, N. et al. (2020). Effectiveness of housing first for homeless adults with mental illness who frequently use emergency departments in a multisite randomized controlled trail. Administration and Policy in Mental Health and Mental Health Services Research. 47, pp. 515-525. https://link.springer.com/article/10.1007%2Fs10488-020-01008-3

[1] Trash Prophets About. https://www.trashprophets.com/about

[1] GRID Alternatives – What We Do. https://gridalternatives.org/what-we-do

[1] EveryTable – Mission. https://www.everytable.com/mission/

[1] Kreiser, M. (2020). These tiny apartments for Sacramento homeless will cost more to build than a luxury house. The Sacramento Bee. https://www.sacbee.com/news/local/homeless/article245547415.html

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