Chronic homelessness is not an issue that will be solved by only treating the symptoms through temporary shelters and meal programs. Decisive action needs to be taken in order to get the chronically homeless off of the streets and into permanent housing where they can receive treatment. Nashville is one of the many cities who are starting to look at options that do not just make a temporary fix.

At the beginning of the summer of 2005, Gerri Robinson, Director of Nashville Metropolitan Social Services, called the Child and Family Policy Center to ask for some help with the newly formed Homelessness Commission. After the creation of Nashville's 10 Year Plan to End Chronic Homelessness, she wanted know more about best practice models in other cities that the Commission could use to build a program for Nashville. I began working on this project as soon as I started my internship that June. I spoke with various homeless advocates, looked at reports from national advocacy centers, and talked to homeless care providers in other cities in order to find out what options would work best for Nashville .

I learned many things through my research but perhaps the most important of these was that homelessness is not an issue that is confined to a particular area of a city or a particular stratum of society. Beyond being a humanitarian issue, it is a social issue that affects us all. Studies have shown that the chronically homeless take up a disproportionate amount of government resources. Police spend more time dealing with them than with the average citizen. They are also more likely to visit the ER without insurance to receive medical treatment. Both police and medical services are funded in part by state and local taxes, thus if the chronically homeless can be moved off of the streets and into some sort of care, resources are freed up for others who are temporarily homeless such as young people, families, and those who have just run into a hard situation. This is why chronic homelessness should be a concern of everyone regardless of how often they encounter homeless individuals on a day-to-day basis.

Though many people agree that homelessness, and especially chronic homelessness, is a social issue that needs to be addressed, there is a variety of conflicting viewpoints on how to solve the problem. In practice, however, this variety of opinions can be gathered into two overarching schools of thought. The first, usually referred to as “Continuum of Care”, has been the main approach for many years. This is based on the belief that a chronically homeless person has a problem that prevents him or her from functioning in society. This may be a substance abuse problem, an emotional or mental issue, or some other problem that needs to be addressed before the homeless person can work in normal society. Continuum of Care programs usually require that the individual pass through a program that addresses these issues before they are allowed to live in permanent housing.

The other side of homeless care is often referred to as the “Housing First” method. This is an approach that has been gathering support in recent years, based on the belief that the individual is not so much the one who has failed, but rather the society has failed to serve the needs of that individual. In practice, Housing First programs try to place chronically homeless people into permanent supportive housing (PSH) before they receive their first treatment. Services such as counseling and medical treatment are carried out while the individual lives in the PSH. Advocates of the Housing First approach say that putting the individual in a permanent living situation gives him or her the self-confidence and responsibility on which other treatment such as counseling can build.

Through my research I have seen detailed evaluations of superior outcomes in many programs built on the Housing First approach and became convinced that it should be the focus of any initiative to end chronic homelessness. Though there are many programs across the country that have proved the merit of the Housing First method, one stood out in its efforts to deal with homelessness. Created in 1998, the San Francisco Department of Public Health's (SFDPH) Direct Access to Housing (DAH) program provides permanent housing with on-site supportive services for approximately 400 formerly homeless adults, many of whom have concurrent mental health, substance use, and chronic medical conditions. Many of the units the SFDPH runs are acquired through master leasing. This enables them to rapidly bring units on-line and rely on private capital for upfront renovation costs. Each site has several case managers who provide services to those staying in the complex. Since 1998, over two-thirds of its residents have remained housed in the program while of those who left, one-third went to market rate housing, other supportive housing, or to housing with family and friends.

After a long period of having a vast majority of Continuum of Care programs, Nashville is starting to move in the Housing First direction. The Homelessness Commission has been continuing in the spirit of the 10 Year Plan craft as they craft a new pilot project due to be unveiled in the coming weeks. It will include, among other things, an outreach program that will connect chronically homeless people with federal benefits and get them into housing so that they can immediately start receiving services. I fully support this Housing First initiative in Nashville as it not only helps the chronically homeless get off the street and into treatment as quickly as possible, but it frees up more resources so that the city can also concentrate on preventing others from becoming chronically homeless.