Reducing homelessness and meeting the emergency needs of individuals and families experiencing homelessness

Homelessness and housing policy

For most people, homelessness is a temporary state. Having an episode of homelessness does not distinguish a family or an individual from other households with incomes at the well-below-poverty levels characteristic of people who enter emergency shelters. Most people living in poverty or deep poverty do not fall into homelessness, even in high-cost cities. Analysts have found it very difficult to predict which people in a city will experience homelessness, with the single best predictor of eventual homelessness in some cities being a previous shelter stay.^[1] The pathway into homelessness seems to be a combination of an immediate crisis, such as eviction or family conflict, and having almost no income. A common misconception is that substance use and/or serious mental illness cause homelessness, though research suggests that there is no unidirectional causal relationship between behavioral health conditions and homelessness.^[2] Rather, a combination of economic fragility, weak family or social safety net supports, and “bad luck” leaves people no option for a place to stay other than a shelter or the “street.”^[3]

However, strong empirical evidence confirms that homelessness is essentially a housing problem. Rates of homelessness are greater in cities, towns, and counties with few available and affordable rentals, and lower in cities, towns, and counties with relatively high levels of housing assistance targeted to people living in poverty.^[4] Given that homelessness is a housing problem, the most effective approach to addressing homelessness is to provide housing to people experiencing homelessness without preconditions —  an approach called Housing First.^[5] The underlying principle of a Housing First approach is that housing stability is a critical first step for individuals to achieve other outcomes, such as employment or treatment for health conditions. Housing First is a proven model: compared with other approaches that require individuals to meet preconditions such as sobriety or psychiatric care before accessing housing (known as Treatment First), Housing First is far more effective at ensuring long-term housing stability and reducing future returns to homelessness.^[6] Housing First can also be more cost-effective for municipalities than other approaches, as the increased housing costs for individuals under this model are offset by reduced healthcare and criminal justice costs resulting from lower returns to homelessness.^[7]

A key program within the Housing First approach is permanent supportive housing (PSH), which links people in stable, permanent housing to services provided in a community setting.^[8] While transitional housing programs should play a role in a municipality’s homelessness response, and can be useful for supporting specific demographics, including transitional-age youth, evidence suggests that PSH is the most effective program for reducing chronic homelessness.^[9] At the same time, there is also evidence to suggest that permanent supportive housing is most effective at ensuring housing stability when programs are fully funded and provide greater resources and on-site services for residents.^[10] Some individuals and families may not qualify for PSH because they lack a documented disability or have not experienced homelessness long enough.  However, a Housing First approach may still be used to connect them to other permanent housing programs. These programs offer shorter-term rental assistance and “light touch” case management to reduce homelessness and increase stability. 

Importantly, a Housing First approach is also proven to be effective in supporting people with serious mental illness and substance use disorders experiencing homelessness. People who experience homelessness generally have higher rates of serious mental illness and substance use than the general population, and being homeless can exacerbate or cause these behavioral conditions. Results from the California Statewide study of People Experiencing Homelessness indicated that 42 percent of adults surveyed who reported current regular illicit drug use only began regular use after they first experienced homelessness, and of those who reported having a psychiatric hospitalization at some point in their life, nearly half were hospitalized after their first episode of homelessness.^[11] But the existence of a behavioral health condition does not inherently mean that someone isn’t ‘housing ready’ or cannot achieve housing stability, as studies have shown that the vast majority of people with serious mental illness or substance use disorders can achieve housing stability under a Housing First approach.^[12] Additionally, longitudinal studies have shown that populations with serious mental illness or substance use disorder who enter PSH programs are not more likely to be using alcohol or substances compared to those in Treatment First housing programs 48 months after entering such programs.^[13] 

While the majority of people experiencing homelessness who use substances or have mental illnesses can thrive in permanent supportive housing, some people with higher health needs are not well served by traditional supportive housing. Such individuals can be assisted through a continuum of alternative housing settings — including group homes or other community-based settings that provide support for their daily needs — or permanent supportive housing that offers more intensive case management and skilled nursing care.^[14] Often, these models of care embed community practices and peer socialization in their housing programs as a means of supporting treatment for people with severe behavioral health conditions. At the local level, coordination among systems such as health, housing, emergency shelter, social services, and criminal justice can also help improve outcomes for people with the highest behavioral health needs experiencing homelessness.^[15] 

An emergency response system is also needed. Not everyone can be diverted into staying in or obtaining housing immediately, requiring cities to maintain an emergency shelter system. Many cities are now also managing the emergence of homelessness encampments, or groups of people living in tents or other temporary structures in public spaces. These encampments form predominantly in urban areas in response to both a shortage of vacant affordable rental housing and  specific conditions in homeless shelters. Shelter challenges include bed shortages, regulations that are incompatible with people’s needs — such as curfew times — or separation from a partner or pet.  Encampments can also provide an alternative to shelter, offering residents greater autonomy, privacy, and community.^[16]

There is considerable public concern about homeless encampments, and there are legitimate public health and safety issues associated with them in urban areas. Cities often adopt a “clearance, closure, and support” approach to addressing encampments by removing structures and belongings (also known as a sweep or abatement), asking residents to leave, and providing services.^[17] In adopting this approach, cities should be wary of deprioritizing its supportive aspect in favor of a purely punitive response. For example, some cities have adopted ordinances that criminalize encampments, meaning that residents can be arrested if they do not leave. Yet there is no evidence to suggest that criminalizing encampments without providing housing supports and services is effective in reducing overall homelessness in an urban area.^[18] Instead, it can perpetuate the homelessness-jail cycle: formerly incarcerated people are 10 times more likely to experience unsheltered homelessness (such as residing in encampments) than the general public, meaning that criminalizing encampments and other offences increases the likelihood that these formerly incarcerated people will be incarcerated again.^[19] Emerging qualitative and quantitative research suggests that encampment sweeps can also worsen health outcomes for residents by dispossessing them of the belongings they need to survive and key documents that help them access housing, and by pushing them into more distant areas less accessible to service providers.[20] Punitive encampment sweeps increase the distrust that residents feel towards authorities, including law enforcement personnel who are often responsible for enforcing orders to vacate.^[20]

Ultimately, the size and expense of the city’s emergency shelter system or encampment response can be reduced by effective policies that channel funds that might otherwise go to shelter or enforcement activity into longer-term housing solutions. Emerging research suggests that providing encampment residents access to housing and supportive services can significantly limit the health hazards caused by encampment sweeps and support their stability.^[21] Notably, cities such as Houston, TX, have found success in responding to encampments by facilitating coordination across law enforcement, city departments, and the homeless response system. Though the city works to close down encampments when public health and safety concerns arise, the goal of the collaborative effort is to move as many encampment residents as possible into permanent housing, with homeless outreach teams and non-profit partners leading the housing assessment, referral, and move-in process.^[22] By keeping access to stable housing as the ultimate goal of their encampment response strategies, cities such as Houston can both humanely address encampment health and safety issues and reduce the likelihood of encampments recurring elsewhere.^[23]

End and prevent homelessness with the housing policy toolkit

The exhibit below describes how a wide range of housing policies can be used to prevent and end homelessness. All four policy categories in the Housing Policy Library have some role. The most obvious policy categories are the first, focusing on creating and preserving dedicated affordable housing units that may be used to expand the inventory of housing for people leaving homelessness (including permanent supportive housing for those who need service-linked housing), and the third, which focuses on helping renters access and afford units.

It is likely that people who experience homelessness are overwhelmingly renters. Renters face greater financial uncertainty and struggle more to meet basic needs such as food and healthcare than homeowners.^[24] There is a positive relationship between area-wide rental market characteristics such as median rent, share of households in rental housing and eviction filings, and rates of homelessness.^[25] And when people find permanent housing after a homeless episode, that housing is generally rented rather than owned.

Rent subsidies, especially when targeted to families and individuals with extremely low incomes, both prevent homelessness and can be used to place people otherwise on the street or in shelters into housing quickly and effectively. Tenant-based rental assistance is used just as effectively by families leaving homelessness as it is by other low-income families.^[26] For people who need service-linked permanent supportive housing, subsidies may take the form of dedicated affordable housing units or tenant-based housing vouchers that are linked to services.^[27] Some cities have found that getting the public housing agency to provide a set-aside of tenant-based housing choice vouchers is the only way to achieve the volume of permanent supportive housing needed for individuals with chronic patterns of homelessness. PHAs in cities with large numbers of people experiencing homelessness are often reluctant to create open-ended preferences that put people experiencing homelessness at the top of waiting lists, because of a concern that it will prevent other populations from accessing housing assistance. However, some PHAs have been willing to create set-asides of finite numbers of vouchers to serve this vulnerable population.^[28]

The other two policy categories also have an important role. Moderating housing costs can reduce pressures on individual and family budgets and make the families or friends of people in crisis more willing to provide a temporary place for them to stay, thereby expanding the overall supply of available housing. Measures that lower barriers to creating affordable housing can help with the location of supportive housing — for example, by permitting the development of small multifamily properties. Policies that advance housing stability are also important. Good cause eviction policies and legal assistance can help avert unnecessary evictions — a crisis that is often a pathway into homelessness. On the other hand, when cities adopt policies that improve housing quality through code enforcement, they should consider whether enforcement of rules designed to prevent overcrowding will discourage people from offering a family member or friend in crisis a place to stay temporarily.

Combining policies to end and prevent homelessness

The specific policies highlighted in the exhibit often can and should be used in combination, as illustrated in the following scenarios:

Scenario 1: A city, town, or county with a large or growing number of individuals with chronic patterns of homelessness identifies a need for an expanded supply of permanent supportive housing. The city, town, or county offers gap financing to a developer who commits to setting aside 20 percent of the units for permanent supportive housing in a development that is being recapitalized and preserved with LIHTC. Medical and case management services are provided through a partnership with the city’s mental health agency. Project-based Section 8 rent subsidies already attached to this preservation property are used to make the rents affordable for people whose only source of income is SSI.

Scenario 2: A city, town, or county is experiencing an increased inflow into its emergency shelters for families. As an alternative to building another shelter, the city, town, or county persuades the public housing agency to target a higher percentage of its housing choice vouchers to families with extremely low incomes. Through a further agreement with the PHA, the city uses the waiting list for Section 8 vouchers to reach out to families who may have a crisis leading to homelessness while they are waiting their turn for a rent subsidy. The city, town, or county also examines its enforcement of housing codes to determine whether rules against overcrowding are associated with increased demand for emergency shelter.

Partnerships and coordination

As the scenarios just described illustrate, policies to prevent and end homelessness require coordinated policies and partnerships. A city, town, or county that has identified ending and preventing homelessness as an important objective should examine how the strategic planning carried out by the local Continuum of Care (CoC) on behalf of that jurisdiction’s homeless services system can be linked to the city’s broader strategic planning for housing.

CoCs differ from city to city, county to county, and state to state in their governance and functions. Some are embedded in local government, while others are led by private non-profits. In some places, they have succeeded in making the public housing agency and the mental health and Medicaid agencies full partners in ending homelessness. If that is the case, the agency responsible for the city, town, or county’s housing plan can build on the relationships that the CoC has established as the foundation for a partnership. In other cases, the housing agency should make itself part of the CoC and help strengthen it.

Footnotes

[1] Aron, L., Burt, M., & Lee, E. (2001). Helping America’s homeless: Emergency shelter or affordable housing? Urban Institute Press; Shinn, M., Greer, A. L., Bainbridge, J., Kwon, J., & Zuiderveen, S. (2013, December). Efficient targeting of homelessness prevention services for families. American Journal of Public Health, 103(Suppl. 2), S324–S330; Rog, D. J., & Buckner, J. C. (2007). Homeless families and children. In Toward understanding homelessness: The 2007 National Symposium on Homelessness Research. U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, and U.S. Department of Housing and Urban Development, Office of Policy Development and Research; Shinn, M., & Cohen, R. (2019, January). Homelessness prevention: A review of the literature. Center for Evidence-based Solutions to Homelessness.

[2] Moschion, J., & van Ours, J. C. (2021). Do transitions in and out of homelessness relate to mental health episodes? A longitudinal analysis in an extremely disadvantaged population. Social Science & Medicine, 279; McVicar, D., Moschion, J., & van Ours, J. C. (2015). From substance use to homelessness or vice versa? Social Science & Medicine, 136–137, 89–98.

[3] O’Flaherty, B. (2004). Wrong person and wrong place: For homelessness, the conjunction is what matters. Journal of Housing Economics, 13(1), 1–15.

[4] Quigley, J., Raphael, S., & Smolensky, E. (2001). Homeless in America, homeless in California. The Review of Economics and Statistics, 83(1), 37–51; Early, D., & Olsen, E. (2002). Subsidized housing, emergency shelters, and homelessness: An empirical investigation using data from the 1990 census. Journal of Economic Analysis and Policy, 2(1), 1–34; Hanratty, M. (2017). Do local economic conditions affect homelessness? Impact of area housing market factors, unemployment, and poverty on community homeless rates. Housing Policy Debate, 27(4), 640–655; Tamla Rai, V. (2024). Local rental market dynamics and homelessness rates among unaccompanied youths, single adults, and people in families. Journal of Urban Affairs, 47(9), 3173–3190.

[5] Padgett, D., Henwood, B., & Tsemberis, S. (2015). Housing first: Ending homelessness, transforming systems, and changing lives. Oxford University Press.

[6] Gubits, D., Shinn, M., Wood, M., Bell, S., Dastrup, S., Solari, C. D., Brown, S. R., McInnis, D., McCall, T., & Kattel, U. (2016). Family Options Study: 3-year impacts of housing and services interventions for homeless families. U.S. Department of Housing and Urban Development; Aubry, T., Nelson, G., & Tsemberis, S. (2015). Housing first for people with severe mental illness who are homeless: A review of the research and findings from the At Home–Chez soi demonstration project. The Canadian Journal of Psychiatry, 60(11), 467–474; Montgomery, A. E., Hill, L. L., Kane, V., & Culhane, D. P. (2013). Housing chronically homeless veterans: Evaluating the efficacy of a Housing First approach to HUD-VASH. Journal of Community Psychology, 41(4), 505–514.

[7] Gillespie, S., Hanson, D., Leopold, J., & Oneto, A. D. (2021, July). Analyzing the costs and offsets of Denver’s supportive housing program. Urban Institute; Bausch, J. C., Cook-Davis, A., & Springer, B. (2021, May). “Housing is health care”: The impact of supportive housing on the costs of chronic mental illness. Morrison Institute for Public Policy, Arizona State University.

[8] Gubits, D., Shinn, M., Wood, M., Bell, S., Dastrup, S., Solari, C. D., Brown, S. R., McInnis, D., McCall, T., & Kattel, U. (2016). Family options study: 3-year impacts of housing and services interventions for homeless families. U.S. Department of Housing and Urban Development; Aubry, T., Hwang, S., Palepu, A., Farrell, S., Nisenbaum, R., Hubley, A. M., Klodawsky, E., Gogosis, E., Hay, E., Pidlubny, S., Downing, R., & Cherner, R. (2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: A systematic review. The Lancet Public Health, 5(6), e342–e360.

[9] SchoolHouse Connection, Covenant House, & National Network for Youth. (n.d.). ‘To become the best version of myself’ youth-supportive transitional housing programs as an essential resource for addressing youth homelessness; Gubits, D., Shinn, M., Wood, M., Bell, S., Dastrup, S., Solari, C. D., Brown, S. R., McInnis, D., McCall, T., & Kattel, U. (2016). Family options study: 3-year impacts of housing and services interventions for homeless families. U.S. Department of Housing and Urban Development.

[10] Reid, C. (2023). Permanent supportive housing as a solution to homelessness: The critical role of long-term operating subsidies. Terner Center for Housing Innovation, University of California Berkeley.

[11] Kushel, M., & Moore, T. (2023, June). Toward a new understanding: The California statewide study of people experiencing homelessness. Benioff Homelessness and Housing Initiative, University of California San Francisco.

[12] Raven, M., Niedzwiecki, M., & Kushel, M. (2020). A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services. Health Services Research, 55(Suppl. 2), 797–806; Padgett, D., Gulcur, L., & Tsemberis, S. (2006). Housing First services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74–83.

[13] Padgett, D., Gulcur, L., & Tsemberis, S. (2006). Housing First services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74–83.

[14] Roman, C. G., McBride, E. C., & Osborne, J. (2006). Principles and practice in housing for persons with mental illness who have had contact with the justice system. Urban Institute.

[15] Kushel, M., & Moore, T. (2023). Toward a new understanding: The California statewide study of people experiencing homelessness. University of California San Francisco Benioff Homelessness and Housing Initiative; Coleman, A. (2013). Hospital discharge: Safe and effective models for people experiencing homelessness. Regional Municipality of Waterloo.

[16] Dunton, L., Khadduri, J., Burnett, K., Fiore, N., & Yetvin, W. (2020). Exploring homelessness among people living in encampments and associated cost. U.S. Department of Housing and Urban Development; Tsai, J., Haley, G., & Kinney, R. (2024). Why some homeless individuals are unsheltered: A narrative review of self-reported reasons. Social Science & Medicine, 358.

[17] Dunton, L., Khadduri, J., Burnett, K., Fiore, N., & Yetvin, W. (2020). Exploring homelessness among people living in encampments and associated cost. U.S. Department of Housing and Urban Development.

[18] Dunton, L., Khadduri, J., Burnett, K., Fiore, N., & Yetvin, W. (2020). Exploring homelessness among people living in encampments and associated cost. U.S. Department of Housing and Urban Development; Lebovits, H., & Sullivan, A. (2025). Do criminalization policies impact local homelessness? Policy Studies Journal, 1–15.

[19] Couloute, L. (2018, August). Nowhere to go: Homelessness among formerly incarcerated people. Prison Policy Initiative.

[20] Chang, J. S., Riley, P. B., Aguirre, R. J., Lin, K., Corwin, M., Nelson, N., & Rodriguez, M. (2022). Harms of encampment abatements on the health of unhoused people. SSM – Qualitative Research in Health, 2; Meehan, A. A., Milazzo, K. E., Bien, M., Nall, S. K., Vickery, K. D., Mosites, E., & Barocas, J. A. (2024). Involuntary displacement and self-reported health in a cross-sectional survey of people experiencing homelessness in Denver, Colorado, 2018-2019. BMC public health, 24(1), 1159.

[21] Mayer, M., Mejia Urieta, Y., Martinez, L. S., Komaromy, M., Hughes, U., & Chatterjee, A. (2024). Encampment Clearings And Transitional Housing: A Qualitative Analysis Of Resident Perspectives. Health affairs (Project Hope), 43(2), 218–225. 

[22] White, M. (2021, August). City of Houston/Harris County homeless encampment response strategy. Coalition for the Homeless of Houston/Harris County.

[23] U.S. Department of Housing and Urban Development. (2023, November). Evidence for housing-based encampment strategies.

[24] Scally, C. P., & Gonzales, D. (2018, November). Homeowner and renter experiences of material hardship: Implications for the safety net. Urban Institute.

[25] Treglia, D., Byrne, T., & Rai, V. T. (2023). Quantifying the impact of evictions and eviction filings on homelessness rates in the United States. Housing Policy Debate, 33(2), 1–12; Collinson, R., Humphries, J. E., Mader, N., Reed, D., Tannenbaum, D., & van Dijk, W. (2024). Eviction and poverty in American cities. The Quarterly Journal of Economics, 139(1), 57–120; Hanratty, M. (2017). Do local economic conditions affect homelessness? Impact of area housing market factors, unemployment, and poverty on community homeless rates. Housing Policy Debate, 27(4), 640–655.

[26] Gubits, D., Spellman, B., Dunton, L., Brown, S., & Wood, M. (2013). Family Options Study: Interim report (Report No. HUD_503). Abt Associates Inc. for U.S. Department of Housing and Urban Development, Office of Policy Development and Research; Gubits, D., Shinn, M., Bell, S., Wood, M., Dastrup, S. R., Solari, C. D., Brown, S. R., Brown, S., Dunton, L., Lin, W., McInnis, D., Rodriguez, J., Savidge, G., & Spellman, B. E. (2015). Family Options Study: Short-term impacts of housing and services interventions for homeless families (Report No. HUD-PD&R-15-XX) [Report]. U.S. Department of Housing and Urban Development, Office of Policy Development and Research; Fiore, N., Khadduri, J., & Dastrup, S. (2024). Using tenant-based vouchers to help people leave homelessness: Lessons from Los Angeles. Cityscape, 26(2), 197–208.

[27] Abt Associates. (2015, December). Evaluation of the Conrad N. Hilton Foundation Chronic Homelessness Initiative: 2015 Report; Dunton, L., Henry, M., Kean, E., & Khadduri, J. (2013, September). Study of PHAs’ efforts to serve people experiencing homelessness. Abt Associates.

[28] Abt Associates. (2013, September). Study of PHAs’ efforts to serve people experiencing homelessness (L. Dunton, M. Henry, E. Kean, & J. Khadduri, Authors); U.S. Department of Housing and Urban Development. (2021, September). How PHAs can assist people experiencing homelessness.