In the past five years a new philosophy has replaced old attitudes about serving the homeless. The old view was: provide addiction treatment; provide detox; provide medical care; provide anti-psychotic drugs; provide temporary shelter in a hospital or other care facility that can access all these services.
Today the watchword is Permanent Housing First.
One of the beginnings of this new strategy was a close look in New York at the emergency medical costs of a couple of alcoholic men who lived on the street – more than a hundred thousand dollars, each in a single year. Because New York City paid these bills, the city looked at an oddball suggestion: Get these men off the street and into stable housing.
Without first addressing their addiction? Yes.
Without first diagnosing possible mental illness? Yes.
What if they bring alcohol into their apartment? They have a right to do that.
What if they bring dangerous people into the building? We can hire a doorman.
What if they don't take their medications or don't go to the doctor? We can provide a caseworker to help them.
Won't this be expensive? Not as expensive as emergency room health care for homeless street alcoholics.
And that has proved to be true. It is much cheaper and significantly safer for the person and for the public to provide housing first and then address all the other issues. It is also more respectful. And it turns out that when people have the opportunity to live in safe housing, they get a better handle on their own lives.
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