Snapshot

Pathways to Housing, founded in 1992, serves New York City’s homeless, mentally ill population.  The program seeks out the most visible and vulnerable segment of New York’s homeless—persons living on the streets or other public places who have psychiatric disabilities, co-occurring substance abuse disorders, or other difficulties.  It offers them immediate access to an apartment of their own, because that is what they want, without requiring participation in treatment or sobriety.

Transforming Madness, Jay Neugeboren’s book describing successful treatment programs for the seriously mentally ill, states that Pathways to Housing was the first agency in New York State to employ ACT Teams and then it became“the first program in the United States to offer homeless street-dwelling men and women with dual (and triple, and quadruple, and quintuple) diagnoses immediate access to independent apartments of their own.”

"Street life,” an early Pathways to Housing mission statement explains, “renders people incapable of managing the most basic daily routines, and affords people little room to contemplate matters such as treatment or recovery.” For these reasons, Pathways to Housing provides people with an apartment of their own first, so that they may find a reprieve from the war zone that is homelessness.  Assistance is provided every step of the way so that tenants have all the support necessary to move into and integrate into their community and to begin the long journey through the recovery and rehabilitation process.

In most other programs that serve homeless men and women who have coexisting psychiatric and substance abuse problems, clients move along a linear continuum of care, primarily living in congregate supervised settings, where they must constantly earn their freedom and privileges, and can “graduate” to independent, supported housing based upon their demonstrations, to staff, of an increasing adherence to fixed sets of rules, expectations, and behaviors.  In other programs, clients are rejected for housing and removed from housing for violating rules: not taking their medications; taking and selling drugs; being charged with a criminal offense.  In the Pathways to Housing program, clients lose their housing the same way any tenant loses housing: not paying their bills; running a drug den; acts of violence; creating disturbances intolerable to neighbors; or other violations of a standard lease.

Pathways to Housing separates housing from treatment.  It treats homelessness by providing people with individual apartments, and then treats mental illness by intensive and individualized programs that seek out and actively work with clients as long as they need, in order to address their emotional, psychiatric, medical and human needs, and on a twenty-four hour, seven-day-a-week basis.  Ultimately, Pathways to Housing is dedicated to working with those people whom others reject or dismiss as beyond the possibility of treatment or recovery.

Pathways to Housing--unique in its sequencing of housing first, has demonstrated success in several studies over the past few years.  In a two-year study comparing the outcomes of individuals receiving services-as-usual in the New York City mental health system, 84% of the Pathways' clients remained housed as compared to 47% of the city sample (Tsemberis & Eisenberg, 2000).  The most recent comparisons were made in a federally funded study using a randomized, intent-to-treat longitudinal design.  225 homeless individuals were assigned to either Pathways to Housing (N=99) or to NYC programs serving the same population but using the treatment first method (N=126).  Results showed that after 12 months, 80% of the Pathways group were living in stable housing, compared to only 24% of the control group (Shinn, Tsemberis, Asmussen, & Moran, under review).  Continuing evaluation research will provide guidance about needs for alterations, if any, and keep Pathways to Housing attuned to its true impact on clients.

Total program costs include: the fair market value of the housing, and the local area salaries and costs required to staff and operate an Assertive Community Treatment team.  In New York City, this is approximately $22,500 per person per year.  This compares very favorably with any other alternative residential program widely used for this population: $65,000 for a community residence, $40,000 for an SRO with services; $27,000 for a cot in a public shelter; $85,000 for a bed in a jail cell; and $175,000 for a bed in a State Hospital.

The Pathways to Housing housing first approach has been featured in many publications and television programs as an effective solution to the problem of chronic homelessness, including: 

• The New York Times
• AM New York
• The Wall Street Journal
• PBS NOW with David Brancaccio
• Mother Jones
• The Lancet
• The San Francisco Chronicle
• The Las Vegas Sun
• The Salt Lake Tribune, and others