Craig WillseCenter for Ideas & Society

UC Riverside

cwillse@gmail.com

From Housing First to Chronic HomelessnessThe Neoliberal Governance of Surplus Life

From Housing Firstto Chronic Homelessness

I. Historical Background

II. Housing First

III. Chronic Homelessness

IV. Conclusions: Investing in Death

From Housing Firstto Chronic Homelessness

I. Historical Background

II. Housing First

III. Chronic Homelessness

IV. Conclusions: Investing in Death

Historical Developmentof Mass Homelessness

• Post-war: Emergence of Skid Row districts• 1960s to present: “Urban renewal” and the destruction of Skid Row housing

• Neoliberal economic restructuring• Shift of industrial production out of U.S.• Development of domestic knowledge and service industries

• Rollback of public assistance programs• Late 1970s: Mass homelessness emerges as a “surplus population”

• 1987: McKinney-Vento Homeless Assistance Act

✓ More than three hospitalizations or emergency room visits in a year

✓ More than three emergency room visits in the previous three months

✓ Aged 60 or older ✓ Cirrhosis of the liver ✓ End-stage renal disease ✓ History of frostbite, immersion foot,

or hypothermia ✓ HIV+/AIDS ✓ Tri-morbidity: co-occurring psychiatric,

substance abuse, and chronic medical condition

Project 50: Vulnerability Index

Developed by Boston Health Care for the Homeless Program

From Housing Firstto Chronic Homelessness

I. Historical Background

II. Housing First

III. Chronic Homelessness

IV. Investing in Death

From Housing Firstto Chronic Homelessness

I. Historical Background

II. Housing First

III. Chronic Homelessness

IV. Investing in Death

I think there’s just this really old-fashioned treatment approach to things, where you have to earn your way to housing. I can’t really say that I’ve ever seen any kind of formal funding requirement of sobriety or anything like that. You basically worked your way up the Continuum. People thought that they needed to have folks that were clean and sober. It was sort of just a requirement that was handed down but never really written anywhere.

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So we focused on going out to the folks on the street. They started to ask people, “Will you work with us toward permanent housing?” They didn’t talk to them about, like, you need to get clean, you need to go into [emergency] shelter, you need to get mental health services. The first question was, “Will you work with us towards permanent housing? Your own apartment—your own place with a door that locks. And if you’re willing to work with us, we will stick with you until it happens.” And that’s how they were able to reduce [street] homelessness.

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If this person goes back on the streets then you the housing provider need to realize that you failed the individual. It’s not the individual that has failed himself, but we have failed to figure out how to work with him. And you need to be confident that you have exhausted the possibilities. I think too much still we just give up on people and say, “Well, they didn’t jump through all the hoops we wanted them to, so they clearly don’t want this housing.” Well that’s nonsense, nobody wants to go to sleep back on the street.

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From Housing Firstto Chronic Homelessness

I. Historical Background

II. Housing First

III. Chronic Homelessness

IV. Conclusions: Investing in Death

From Housing Firstto Chronic Homelessness

I. Historical Background

II. Housing First

III. Chronic Homelessness

IV. Conclusions: Investing in Death

• Death rates twice as high• 11x more likely to contract tuberculosis• Rates of HIV twice as high• 16x more likely to contract HIV

• 75 new HIV cases / 100,000 adults in NYC• 1,241 new HIV cases / 100,00 adults in shelter system

• 2,815 homeless deaths• Average age of death 48.1 years old (vs. 77.2 years old)

• Average life expectancy 36% shorter• For Latina females, 49% shorter

“chronic homelessness”

“chronically homeless”

Dennis CulhaneRandall Kuhn

• “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data”

• “Patterns and Determinants of Public Shelter Utilization Among Homeless Adults in New York City and Philadelphia”

The ‘chronically homeless’ population could be characterized as those persons most like the stereotypical profile of the Skid Row homeless. These are people who are likely to be entrenched in the shelter system, and for whom shelters are more like long-term housing than an emergency arrangement.

Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)

In general, being older, of black race, having a substance abuse or mental health problem, or having a physical disability, significantly reduces the likelihood of exiting shelter.

Dennis Culhane and Randall Kuhn,“Patterns and Determinants of Public Shelter Utilization Among Homeless Adults in New York City and Philadelphia” (1998)

Voice of America NewsBroadcast July 30, 2008

The term ‘chronic homeless’ treats homelessness with the same language, and in the same fashion, as a medical condition or disease, rather than an experience caused fundamentally by poverty and lack of affordable housing.

National Coalition for the Homeless (2002)

Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)

Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)

Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)

Malcolm Gladwell, “Million Dollar Murray”The New Yorker, February 13, 2006

• 119 chronically homeless in Boston for 5 years• 18,834 emergency room visits• Minimum cost: $1,000 / visit

• 15 “chronically homeless inebriates” in San Diego for 18 months• 417 emergency room visits• Total average bill: $100,000 / person

From a conservative’s perspective, it saves taxpayers money. Research has even shown it’s cheaper in the long run to fund [housing] programs because it reduces recidivism rates. And it’s really expensive to go from shelter to street to psych hospital to jail to community courts, through all these revolving doors. So that’s what I use sometimes when I’m talking to a government type. I’ll talk about how it’s really beneficial for people, but then if I’m really trying to sell somebody on it who hates homeless people, that’s what I’ll tell them about it.

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From Housing Firstto Chronic Homelessness

I. Historical Background

II. Housing First

III. Chronic Homelessness

IV. Conclusions: Investing in Death

From Housing Firstto Chronic Homelessness

I. Historical Background

II. Housing First

III. Chronic Homelessness

IV. Conclusions: Investing in Death

I think we have the same interests. The business community in downtown, some of the leaders are a little bit ... hard to swallow. But we have the same interests, right? I mean, I don’t think they give a crap about homeless people, but they wanna see no one sleep on the street and we wanna see no one sleep on the street.

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