Housing First, Not Housing Only - Our Efforts Week 4

A while back, I met a man named James at one of our outreaches. He had been living on the streets for more years than he could count.

He was older and tired in a way that goes beyond sleep. It was the kind of exhaustion that settles into your bones after too many days trying to navigate a world that doesn’t quite have a place for you anymore. He was also carrying a lot both literally and figuratively. He stored all of his early possessions in a grocery cart that he refused to part with. He also carried deep trauma and sleep deprivation that led to severe mental illness and a level of overwhelm that made even simple activities feel disproportionately complex.

On paper, James qualified for help. He was eligible for Social Security assistance. There were a number of additional government programs designed for people in his exact situation, but he couldn’t access any of them because the system required something he didn’t have the capacity to give. 

The process would require multiple phone calls, stacks of paperwork, follow-ups, and appointments, with each step depending on the one before it. It required consistency, organization, advocacy, and most importantly, stability. And James didn’t have that.

He didn’t feel safe in shelters, so he stayed outside. Which meant he wasn’t in one place long enough for caseworkers to reliably find him. Paperwork got lost, appointments got missed, and momentum disappeared as quickly as it started.

So even though help technically existed, it remained out of reach. That gap between eligibility and accessibility is where people like James get stuck. Which brings us to one of the most talked-about approaches to homelessness: Housing First.

Housing First began in the early 1990s through the work of Sam Tsemberis in New York City. At the time, most programs required people to prove they were “housing ready” before being given access to permanent housing.

Housing First flipped that.

Instead of requiring people to get stable before getting housed, it prioritized immediate access to housing with supportive services offered, but not required. The idea was that it’s nearly impossible to stabilize your life while living on the street, and for someone like James, that idea was more obvious than it was theoretical.

Until he has a roof over his head to store his documents and somewhere he could consistently be reached, everything else is working uphill. Housing First recognizes that, and in many ways, it works.

You can see that most clearly in places like Finland, which has made Housing First the backbone of its national strategy. Over the past decade, Finland has significantly reduced long-term homelessness by pairing housing with strong social support and a coordinated national system.

Closer to home, cities like Salt Lake City saw early success using Housing First, reporting dramatic reductions in chronic homelessness in the 2010s. But over time, those gains proved harder to sustain as housing costs rose, population growth increased demand, and support systems struggled to keep pace.

More recently, Houston has been held up as a leading example—using a Housing First approach alongside strong coordination, data tracking, and targeted placements to reduce homelessness at scale.

So yes, Housing First can work.

But here’s where the conversation gets more honest. Housing First doesn’t struggle because the idea is flawed. It struggles because we haven’t built the ecosystem it needs to succeed.

First, there isn’t enough housing that is truly affordable. In high-cost cities, you can prioritize housing all you want, but if the supply doesn’t exist at a price people can sustain, the model hits a ceiling.

Second, there’s growing hesitation among taxpayers. For many, the idea of “giving” someone housing feels unfair, especially when they’re struggling themselves. That perception shapes public will, and ultimately, policy.

And third, we consistently underfund the very thing that makes Housing First work: wraparound support like mental health care, addiction services and case management. These aren’t extras. They’re essential.

As my friend and co-author of the book Housing First: Ending Homelessness, Transforming Systems, and Changing Lives, Deborah Padgett put it, “Housing First was never meant to be housing only.” And yet, too often, that’s exactly how it’s implemented.

So yes, Housing First is incredibly effective at getting people inside.

But what happens next depends on everything around it. Without enough housing, it’s hard to scale. Without public trust, it’s hard to sustain. Without support, it’s hard to succeed.

And at the same time, without Housing First, many people like James never get inside at all. Both of those things can be true. Which is why the goal isn’t to debate the model. It’s to understand it well enough to do it right.

Because homelessness isn’t one problem. It’s an ocean fed by many rivers. And no single approach can carry the full weight on its own. Housing matters. Support matters. Access matters. Consistency matters.

And if we’re serious about making progress, we need systems built around real people—not ideal scenarios. People like James.

Next week, we’ll look at a different approach—Shelter First—and how it fits into this larger conversation.

Grateful you’re in this with me,

Josiah Haken

City Relief, CEO