Fixing what’s broken
For nine years, Kyle floated in the shelter system. A mere $800 or so a month from Social Security just didn’t cut it in the local housing market, where rent on even an efficiency can reach as high as $1,176.
By 2012, homeless service providers could almost predict his pattern. Family would hang on to him in three- to six-month increments, but his severe depression and drinking habits eventually wore out his welcome. The separation from a family home usually resulted in a lengthy hospital stay and a discharge to an area shelter. He’d stay as long as he was allowed, occasionally leaving to various housing arrangements with people he met along the way. But it never took very long for the cycle to start all over.
Homelessness had swallowed years from his life. In only his late 50s, his health was failing. Seizures and random dizzy spells were keeping him hospitalized more frequently than ever. He was spending nights in hotels, when he had the money, and on the street when he didn’t.
Under traditional rules, Kyle didn’t “deserve” housing. He never followed through on what his case managers told him to do. He wouldn’t make productive decisions. He almost always relapsed when something good was about to happen. And by golly, a service system can only try but so many times to “fix someone” before it starts to believe the individual is choosing homelessness over a stable living situation.
In the almost seven years that I have been in this work, I can still count on one hand the number of people I could argue a solid case for “choosing” a life of literal homelessness. Even in those limited cases, there is almost always a mental limitation that prevents the individuals from rationally considering their choices–unless, of course, fear of walls and thinking that the government will track them down if they stay in one place also counts as logic and reason.
For others who experience homelessness, their “failure to follow through” often has more to do with a clash between the client’s inability to think beyond the most immediate need and the service provider’s need to fix what’s broken before handing over the keys to an apartment. As service providers, failure seems inevitable for the chronically unemployed, the raging alcoholic or an unmedicated mental health patient, when tossed into independent living.
But from the homeless guy’s perspective, how does he get and keep a job when he can’t show up clean and may have to sleep over on the boss’s property? What’s the point in taking his mental health medication when there’s nothing better to look forward to? And why stop drinking when that’s the only thing that soothes his sorrows?
This is where the innovative new idea of “housing first” defies the traditional rule. Under housing first, participants are usually more willing than those in traditional models to take steps necessary to address their barriers because they are working to keep what they have been given, not trying to obtain something they can’t yet imagine.
In Kyle’s case, Micah had a choice. We could follow the evidence and years of history, which pointed at nothing but non-compliance and failed stabilization efforts. Or we could acknowledge the significance a housing intervention, or lack thereof, could have on his ability to live or die.
After a long stint in the hospital, Kyle had landed again in Micah’s respite program, a shelter for homeless people in need of temporary or terminal care. As discharge approached, we began to discuss what might be different when he left the program. We could easily have sent him on his way and waited for him to circle back. As sick as he was, it was generally more likely that our next contact would have been a call from the police in search of next of kin.
But the housing first concept, including the funding to support it, had just been launched in Virginia. There was particular talk of using available resources to house the most vulnerable in an effort to keep them from dying on the street and we were eager for the challenge.
Kyle moved into housing, paired with a roommate, start-up assistance and case management. As the program is designed, our support gradually faded away until he was on his own in three months. From an arms length, we watched and waited only to find that a miraculous thing happened–Kyle got better.
He paid his rent on time.
He kept his apartment clean.
He attended his doctors appointments, stayed on his medication and applied for a mobility scooter to help him get around.
Indeed, Kyle was broken for almost a decade. But no amount of “fixing” his symptoms – the alcoholism, the mental health issue, the physical impairment – was ever going to treat his diagnosis: being without a home. It was in gaining that home that he could finally feel worthy. He could finally have something to be proud of. He could heal. And almost exactly one year after his move-in date, he could die with dignity.