Pathways to Housing

Innovative New York City Program tackles homelessness by providing housing first.

By Pam Barratt

When you think of homeless people, you may think of soup kitchens, people who spend their days recycling cans and bottles, programs that counter substance abuse, raids on campsites, job training, illegal lodging tickets, assessments, or intakes.  Do you ever hear about housing?  I am not talking about shelters, halfway homes, or a fortnight in a ghetto hotel, but actually, a private, legal place that a homeless person can call home. 

Traditional programs, in most cities, expect the homeless to work first, before they get the reward of a home.  But, as Douglas McGray, in the January/February 2005 issue of Mother Jones Magazine puts it, when the chronically homeless are "faced with a bunch of strict conditions for housing and lots of ways to get kicked out, many assume they will fail, so they reject help.  And the costs of these refusals are steep.  On any given night, this group occupies half of the nation's emergency shelter beds, even though they make up only about 10 percent of the homeless population.  By living, and often dying, on the street they also run up enormous bills for federal and local law enforcement agencies, social service providers, prisons, and hospitals.  In 1997, the University of California, San Diego Medical Center followed 15 chronically homeless residents for 18 months and tallied 417 emergency room visits between them, at a cost of more than $1 million." 

Pathways to Housing reverses the order.  This program was initiated in New York City by Sam Tsemberis in 1992.  Under Pathways, a homeless person is given an apartment without any hoops to jump through.  Once in the apartment, the program offers treatment and support services.  Housing is permanent for as long as the clients want it.  Tenants pay no more than 30% of income - the standard government definition for affordable housing.  The apartments are rented from private landlords scattered throughout the city.  The tenants have all the usual rights and responsibilties found in a standard lease.

Christina McCarroll of the Christian Science Monitor says that nationally, for every 100 people seeking affordable housing, there are only 38 available units.  So, programs that offer housing only when clients are "clean," often find they have no housing, to give when clients are finally ready.  The Pathways to Housing program, on the other hand, seeks chronically homeless people- those with serious mental illness, 90% of whom also have a history of drug and alcohol use.  These are people who have been homeless for long periods of time.

Tsemberis explains that "with so many homeless and mentally ill people and so few program slots, traditional housing providers tend to choose only applicants who are the most likely to be good tenants."  The irony is that, if you look at a person who is on the street and the way they have to take their things from one place to another; figure out what soup kitchens are open on what days; and find their mail: they are managing an entire life out there.  In addition, they take care to choose a safe warm spot where they can sleep and find other people that they can trust on the street who won't take advantage of them.  There's a whole set of skills that they are using.  You can appreciate that moving into an apartment of their own is not a big complicated things for these people."

Within 13 years, Pathways has placed 450 such people in apartments in New York City.  The Corporation for Supported Housing (CSH) reports that "in a recent study, comparing 225 homeless individuals with psychiatric disabilities randomly assigned to either the Pathways program or to traditional New York City services, at the end of 12 months, 80% of the clients assigned to Pathways to Housing were stably housed compared to 23% for the comparison group.  It is noteworthy that there were no differences in the levels of substance abuse or psychiatric symptoms between the two samples."

According to CSH, to be eligible for the Pathways program, an individual must be homeless, must have a psychiatric impairment that results in disability, must agree to meet with a case manager a minimum of twice a month during the first year of tenancy, as well as pay 30% of their income towards this rent.  Refusal to participate in sobriety or other treatment programs, however, does not disqualify an individual, nor does a history of violence or prison time.

Pathways to Housing is now setting up a program in Washington, D.C. First, it raises money from foundations and government grants.  Then the rest of the funds needed are drawn from the client's individual federal and state benefits.  As McGray explains, "Disabled and desperately poor individuals are eligible to claim benefits but don't because they can't navigate the system.  They may not have an ID or mailing address, or they may not know that certain benefits exist."  When a homeless person accepts the offer of an apartment, Pathways collects their benefits and puts them in a bank account.  Each month, the rent money is withdrawn, but the spending of the rest of the money is left to the client's discretion.  Pathways offers friendly budgeting advice.

Once an apartment is selected, the Pathways participant goes on a shopping trip with a staff person to purchase apartment furnishings.  The budget for that is $1,200.  Pathways is a client-driven program.  Participants are "respected as individuals who can make an informed choice about what they want, the sequence they want it in, and for how long they want the service.  Typically, clients say that housing is what they want first." One Pathways client puts it this way: "Living on the streets can make you crazy.