The Housing First Model shifts how housing resources are distributed. One critical change, which is closely connected to the Low Threshold Admissions Policy, is the reduced service requirements in Housing First programs. In traditional programs, access to housing was earned through measures of housing readiness like abstaining from drugs and alcohol, getting a job, or engaging in regular medical care. In a Housing First program with reduced service requirements, people are not expected to jump through hoops to prove they are worthy of housing. There is no mandate to attend peer support groups, group therapy, inpatient treatment, psychiatry appointments, or other services. The options are offered and explored, but the decision to participate is left up to the participant. Service requirements in the strongest Housing First programs are limited to regular contact with a case manager. That case manager engages with the participant about issues they face and increases contact with them when they first move in and again later if they are struggling to maintain housing.
One fear of providers shifting to the Housing First approach is that people will not take care of themselves if they aren’t forced to do it. An early study of Pathways to Housing disproved this notion. The study compared a group of people who were homeless and entered two housing programs—one based on participation in substance use treatment and requiring abstinence (Control group) and the other using Housing First (Experimental group). Although a greater number of people in the Control group engaged in treatment (after all, they were required to do it in order to access housing), there were no significant differences in the rates of substance use or mental health symptoms between the two groups. The Housing First participants obtained housing faster and reported greater levels of perceived choice and autonomy.
Research shows that choice matters in recovery. As one study explains, “providing people with more choices predicts better outcomes for people with severe mental illness.” Stigma around mental health and addiction fuels a false notion that people living with these conditions lack the ability to make rational choices. Housing First disproves that assertion and emphasizes consumer choice at every turn—from housing selection to service participation. Participants are not burdened with benchmarks to meet in order to access or maintain their housing. Instead, housing maintenance is based on meeting the terms of their lease like everybody else. Their participation in services is based on their own choice. As one Housing First staff member explained, “It actually puts a lot of responsibility on the consumer.”
In our trainings on motivational interviewing, we often reference a quotation from Blaise Pascal, who said, “People are generally better persuaded by the reasons they themselves have discovered than by those which have come in to the mind of others.” Just as people are more inspired by their own reasons, Housing First believes people are more committed to goals and solutions they develop for themselves. While we may be able to force someone to make a change for a short time in order to get into a housing program, that isn’t the recipe for creating lasting change. We trust that people are motivated to improve their own lives and best equipped to decide how to do it. Housing creates stability which enables people’s pursuit of positive change. People don’t change because we want them to; change happens when people are ready and find the solutions that work best for them.
As discussed in an earlier blog post, the Housing First model is based on the principle that housing is a human right. If that’s true, it means that we shouldn’t create conditions that limit access to housing. As much as we want to support individuals in pursuing their goals by engaging in additional services, it should not be mandated in a Housing First program. When people feel like they are respected and their perspective is valued, they are more likely to pursue other supportive services. Housing First encourages access and choice to promote positive change.