As a housing support case manager in Minneapolis for the last six years, I can personally say that Housing First is failing. We need a treatment-first approach because drug addiction is currently the biggest driver of homelessness. Over the past two and a half years, three of my own clients have died of drug overdoses while living in Housing First apartments. We urgently need more treatment centers and mandatory attendance rather than continuing to rely on harm reduction.
Just last week, I refused the referral of a man who has lived in Higher Ground site-based units for over 13 years. He has diminished mental capacity secondary to chronic meth and alcohol addiction, and he relies on a setup where he shares a bathroom and kitchen. This client is completely dependent on on-site case managers who take care of getting food for him, completing his county recertification paperwork, and everything he needs to stay in the shelter. He was pressured into requesting to move to scattered-site housing by his addicted brother who is living on the streets, a move that would have stripped away the vital structure keeping him housed for years. Transitioning to an unmanaged independent apartment posed a severe risk of him returning to homelessness and substance abuse on the streets.
Living downtown, I see this reality every weekend on the Nicollet Mall and in Loring Park when the businesses are closed. The "fentanyl walk" is rampant. Encampment residents—like those living under the I-35W and Hiawatha overpass—frequently choose encampments over traditional housing because, without mandatory intervention, the drug will always take precedent over shelter.
As the host article highlights regarding the state's severe shortage of psychiatric beds and infrastructure investment, housing programs must evolve alongside changing drug crises.
In Minnesota, the Professional Statement of Need (PSN) required for housing programs through Hennepin County currently includes substance abuse as a primary disabling condition right alongside permanent mental and physical disabilities. By treating addiction simply as a passive checkbox for eligibility rather than a condition that mandates treatment, our system ensures Housing First cannot work. If we want to solve homelessness, addiction treatment must be mandated, not just subsidized.
Thank you for sharing your personal experience. It highlights the heart of this situation. Your work in the field is extremely important and necessary. It makes me think about how much the caregivers in this field must carry. I hope you have the love and support you need to keep working.
According to the google machine, substance abuse is a factor in about 37% of homelessness. I'm curious how much effort is being placed on prevention rather than treatment. The same google machine told me that for every dollar spent on preventative measures, society saves about $26.
The more I learn about the issue, the more I'm in the camp of mandatory treatment for addicts. But I'd sure prefer people to not become hooked in the first place.
Longer term treatment for addiction and mental illness has been needed for a long time. We already know that just supplying housing to people that are not able to make wise decisions with their life is a losing system, so why continue? We need a better argument than "we have always done so".
Hennepin county has already been sliding into this reversal of thought but it has been slow because too many are of the belief that most homelessness is a choice rather than a result. Any success we have achieved is due to combining the services, analyzing the circumstances and trying for an end goal rather than a bandaid. The assistance has to match the person because it is not a one size fits all. Some will always require help maintaining a home, and there will be a few in the end that just will not be able to conform to sobriety and treatment. The idea is to improve life for more.
How does housing first policy “pencil out” when the going price for new low income housing is $1000/sqft? Housing first for people with addiction and/or serious mental health issues seems like a pipe dream especially if politicians are really serious about addressing the real shortage of affordable housing for working people, the elderly, and a wide range of otherwise functional people.
If I had to put forth an idea it would likely not be practical enough. But it seems people try to tackle these issues with to blunt of a club. When we likely need a scalpel. Let's take the substance abuse issue in relationship to homelessness. I will make up some percentages FOR ILLUSTRATIVE PURPOSES.
Let's say:
50% might need treatment before they can be successfully housed and make progress .
30% maybe could do okay with housing first, with the goal of eventually getting clean. Mostly.
20% are going to die while still actively addicted and unhoused. Regardless of what you do.
Again made up numbers . Add or subtract 10-20% to each for your world view.
Imagine if the city, County, state, and Feds could get the assessment for each person close enough that the triage worked to help place people correctly. And be flexible enough to change modality as needed.
Note: only heard the first 1/3 of this interview. If he covers this, apologies for the duplication.
Candidates love to make promises during election campaigns and when they are duly elected they will be making the effort to keep their promises. But when the money gets tight and cuts are required they try to cut the cost without totally cutting the service. One thing or the other, and sometimes both, will fail. This is why a great deal more care should be taken by government when considering whether they should even be involved.
As a housing support case manager in Minneapolis for the last six years, I can personally say that Housing First is failing. We need a treatment-first approach because drug addiction is currently the biggest driver of homelessness. Over the past two and a half years, three of my own clients have died of drug overdoses while living in Housing First apartments. We urgently need more treatment centers and mandatory attendance rather than continuing to rely on harm reduction.
Just last week, I refused the referral of a man who has lived in Higher Ground site-based units for over 13 years. He has diminished mental capacity secondary to chronic meth and alcohol addiction, and he relies on a setup where he shares a bathroom and kitchen. This client is completely dependent on on-site case managers who take care of getting food for him, completing his county recertification paperwork, and everything he needs to stay in the shelter. He was pressured into requesting to move to scattered-site housing by his addicted brother who is living on the streets, a move that would have stripped away the vital structure keeping him housed for years. Transitioning to an unmanaged independent apartment posed a severe risk of him returning to homelessness and substance abuse on the streets.
Living downtown, I see this reality every weekend on the Nicollet Mall and in Loring Park when the businesses are closed. The "fentanyl walk" is rampant. Encampment residents—like those living under the I-35W and Hiawatha overpass—frequently choose encampments over traditional housing because, without mandatory intervention, the drug will always take precedent over shelter.
As the host article highlights regarding the state's severe shortage of psychiatric beds and infrastructure investment, housing programs must evolve alongside changing drug crises.
In Minnesota, the Professional Statement of Need (PSN) required for housing programs through Hennepin County currently includes substance abuse as a primary disabling condition right alongside permanent mental and physical disabilities. By treating addiction simply as a passive checkbox for eligibility rather than a condition that mandates treatment, our system ensures Housing First cannot work. If we want to solve homelessness, addiction treatment must be mandated, not just subsidized.
Thank you for sharing your personal experience. It highlights the heart of this situation. Your work in the field is extremely important and necessary. It makes me think about how much the caregivers in this field must carry. I hope you have the love and support you need to keep working.
According to the google machine, substance abuse is a factor in about 37% of homelessness. I'm curious how much effort is being placed on prevention rather than treatment. The same google machine told me that for every dollar spent on preventative measures, society saves about $26.
The more I learn about the issue, the more I'm in the camp of mandatory treatment for addicts. But I'd sure prefer people to not become hooked in the first place.
Longer term treatment for addiction and mental illness has been needed for a long time. We already know that just supplying housing to people that are not able to make wise decisions with their life is a losing system, so why continue? We need a better argument than "we have always done so".
Hennepin county has already been sliding into this reversal of thought but it has been slow because too many are of the belief that most homelessness is a choice rather than a result. Any success we have achieved is due to combining the services, analyzing the circumstances and trying for an end goal rather than a bandaid. The assistance has to match the person because it is not a one size fits all. Some will always require help maintaining a home, and there will be a few in the end that just will not be able to conform to sobriety and treatment. The idea is to improve life for more.
How does housing first policy “pencil out” when the going price for new low income housing is $1000/sqft? Housing first for people with addiction and/or serious mental health issues seems like a pipe dream especially if politicians are really serious about addressing the real shortage of affordable housing for working people, the elderly, and a wide range of otherwise functional people.
If I had to put forth an idea it would likely not be practical enough. But it seems people try to tackle these issues with to blunt of a club. When we likely need a scalpel. Let's take the substance abuse issue in relationship to homelessness. I will make up some percentages FOR ILLUSTRATIVE PURPOSES.
Let's say:
50% might need treatment before they can be successfully housed and make progress .
30% maybe could do okay with housing first, with the goal of eventually getting clean. Mostly.
20% are going to die while still actively addicted and unhoused. Regardless of what you do.
Again made up numbers . Add or subtract 10-20% to each for your world view.
Imagine if the city, County, state, and Feds could get the assessment for each person close enough that the triage worked to help place people correctly. And be flexible enough to change modality as needed.
Note: only heard the first 1/3 of this interview. If he covers this, apologies for the duplication.
Candidates love to make promises during election campaigns and when they are duly elected they will be making the effort to keep their promises. But when the money gets tight and cuts are required they try to cut the cost without totally cutting the service. One thing or the other, and sometimes both, will fail. This is why a great deal more care should be taken by government when considering whether they should even be involved.
But landlords might prohibit drug use