While homelessness is a year-round crisis in the U.S., it becomes especially visible during the cold winter months. This holiday giving season, we look at the state of homelessness in America.

On any given night in America, more than half a million people are experiencing homelessness. Some, about a third, are families with children. Most, 67 percent, are individuals struggling with substance abuse, mental illness, job loss, high housing costs, or some combination of difficult circumstances.

Many metropolitan areas are struggling to balance the needs of people experiencing homelessness with quality of life issues in their communities. Throughout Seattle and the San Francisco Bay Area, unauthorized tent cities sit beneath overpasses and in public parks. Earlier this year, Los Angeles saw an outbreak of typhus among its homeless population, while New Mexico, Ohio, and Kentucky have seen bouts of hepatitis A. In New York, residents are frustrated by the city’s practice of using neighborhood hotels as emergency homeless shelters.

People experiencing homelessness come from many backgrounds and lose reliable shelter for many reasons. For policymakers, this means there are no easy answers, no single approach that will fully solve the problem. One model, however, has gained support around the country and has shown some promising outcomes: Housing First.

The Housing First Model
Advocates say that most people who experience homelessness do so for only a few weeks or months. Others, around 15 percent, are chronically homeless, meaning they are individuals who have been homeless long-term or repeatedly, and who have a disabling condition like a serious mental illness, drug or alcohol addiction, or a physical disability or illness. It’s this population that inspired cities to pilot the Housing First model, which offers people housing without traditional strings attached.

The idea behind Housing First is that giving people safe, dependable housing creates a stable enough environment to tackle other issues, like employment or substance abuse treatment. People can access housing without prerequisites like getting sober or finding a job. Once in housing, residents have access to services like job training, health care, and substance abuse treatment, which they can use if they wish. Tenants usually pay some form of rent.

Housing First has produced some extraordinary results. When Utah took a Housing First approach, it reduced homelessness in the state by 91 percent. Columbus, Ohio created a board that coordinates funding and services across the region and, using a Housing First approach, eventually moved 70 percent of its homeless residents into stable housing with leases close to market rate.

Many experts say that before Housing First became popular, the typical response to homelessness was backward. Chronically homeless people usually needed to complete drug rehab or mental health treatment to be deemed ready for housing. But evidence showed that few people made it past the necessary hurdles to obtain housing. “You actually need housing to achieve sobriety and stability, not the other way around,” says Sam Tsemberis, a psychologist who pioneered the Housing First model.

Bipartisan – But Not Universal – Support
Over the past 25 years, Housing First has gained broad, though not universal, support. President George W. Bush embraced the approach, contributing to a 30 percent reduction in homelessness between 2005 and 2007. The Obama administration also adopted it, and from 2010 to 2016, homelessness dropped 23 percent among families – 27 percent among chronically homeless individuals, and 47 percent among veterans.

Not everyone supports Housing First, including the new head of the U.S. Interagency Council on Homelessness, which coordinates policy on homelessness among 19 federal agencies. “Having a home is not the problem for the homeless. It’s maintaining a financial stability that allows you to maintain your homestead,” Director Robert Marbut said in a 2015 interview.

Other observers have begun warning that Housing First is being applied too broadly and that some formerly homeless people moving into shelters do not have adequate support for independent living. The Washington Post chronicled a rental building in D.C.’s stylish Cleveland Park neighborhood where about half the residents receive subsidized housing vouchers, and many are struggling with serious behavioral issues. Since 2016, police visits to the building have increased four-fold, other residents have complained about safety and quality of life, and the city hired social workers to manage problems.

The cost of chronic homelessness is not only human but monetary. Because chronically homeless people cycle in and out of shelters, hospitals, and jails, each one costs taxpayers an average of $35,578 per year. One Los Angeles study found that supportive housing for homeless people paid for itself in a year and even lowered costs by 20 percent.

When managed well, Housing First programs have shown strong results in reducing chronic homelessness. But persistent homelessness, especially in high-cost cities, is putting this model to the test as policymakers decide what to do next.

Learn More

Complex Cases: Housing First pioneer Sam Tsemberis explains the history of homelessness in the U.S. and how he thinks policymakers should respond – via TedX

Children in Crisis: This moving five-part series follows an 11-year-old homeless girl living with her parents and seven siblings in a New York City shelter – via The New York Times

Parking Lot Living: Some West Coast cities are turning parking lots into safe havens for people living in their cars via – Vox

Held Hostage: A writer critical of city policies says that San Francisco has allowed social norms on its streets to degrade so severely that the city is now unlivable – via City Journal

A Degree in Homelessness: In a survey, 12 percent of community college and nine percent of university students reported being homeless. Colleges and universities are stepping up their response – via Hechinger Report