Dr. Marybeth Shinn: Homelessness in America

[0:00:37]

MARYBETH SHINN: Well, widespread homelessness in good economic times is a relatively recent phenomenon. Back in 1970, there was a small surplus of housing units that poor people could afford, and there was very little homelessness. One book at the time was called “Old Men Drunk And Sober” because homelessness was largely confined to older white men on skid rows. Many social scientists thought that when that generation passed, homelessness would end. But it didn’t end. Housing costs rose, wages failed to keep up and that surplus of housing units became a bigger and bigger deficit. We began to see new groups of people on the street – young men, minorities, women and even families. So housing at – homelessness at base comes about because people can’t afford housing. Rates of homelessness are highest in cities where rents are highest, and rental subsidies both prevent and end it by making housing affordable.

[0:01:44]

MARYBETH SHINN: In the long run, yes. But homelessness is not typically the immediate result of an eviction. People move in with family and friends. They do everything they can to avoid homelessness. Most people who are homeless at any given time did not come from places that they owned or rented. They came from doubling up with other people. And so over the long term, we may well see more homelessness. Homelessness is sometimes called a lagging indicator. But I think the more immediate consequence will be more people doubling up with others because they can’t afford a place of their own.

[0:02:31]

MARYBETH SHINN: Well, obviously, being exposed to the elements is not good for people’s health. And on the streets, one often does not have access to sanitation, to healthful foods. It’s hard to keep medicines. It’s hard to – you don’t have refrigeration. And so there are lots of ways that living outside can affect people’s health. People who have been living on the streets for a while have health problems like people who live in indoors who are 20 years older than they are. So they have all the chronic health problems of house people, but they get them two decades earlier.

[0:03:26]

MARYBETH SHINN: Well, that was happening even before COVID-19 struck, and COVID-19 has exacerbated that because shelters have not been very helpful places. They have frequently been COVID hot spots. When people are in congregate shelters, they’re cheek by jowl with other people, and that can lead to transmission of viruses. So even before COVID-19, we were seeing the trend of more people living out of doors, but that certainly accelerated.

[0:04:05]

MARYBETH SHINN: Mostly they simply get displaced. If they’re in encampments, they have already decided that shelters are not suitable places for them, so they’re likely to simply move to some other street corner unless they’re offered housing. So the way to close encampments is to give people access to housing that they can afford. And most people don’t want to live outdoors. They live outdoors because nothing better is on offer.

[0:04:43]

MARYBETH SHINN: We do have to think about different groups. For families, affordable housing ends homelessness. We did a large study of over 2,200 families that we recruited in homeless shelters at 12 sites around the country. And we used a lottery to offer them different programs to end homelessness. Then we followed them for three years to see what happened. What we learned is that offering families a rental subsidy that holds their housing costs to 30% of their incomes not only ended homelessness and other forms of residential instability, it also had radiating benefits for other aspects of family life. Rental subsidies reduced food insecurity and domestic violence. They reduced psychological distress and substance use. So problems that can sometimes cause homelessness were reduced when families had access to affordable housing. Rental subsidies reduced separation of parents from children and reduced kids’ school absenteeism, improved their behaviors. So affordable housing provided a platform for families to solve whatever other kinds of problems they might have had on their own.

Folks with serious mental illnesses and substance use disorders probably need something more. And there, a program called supportive housing, particularly following a Housing First model, has been proven to work and work well. The idea there is that people get affordable housing paired with social services that are voluntary and people get these apartments directly from the street without prerequisites for sobriety or participation in treatment. Programs offer wraparound services – psychiatric, medical, substance services, vocational and recreational services – but only those that people choose because services work a lot better when people choose them than when they’re foisted on folks. And a number of studies in the United States and Canada and France have shown that this kind of Housing First program succeeds in housing people with serious mental illnesses and substance use disorders.

[0:06:59]

MARYBETH SHINN: We can think about preventing people who are at high risk of homelessness, and then we can think about generating less homelessness. For people who are at high risk, there are a number of prevention programs that have had effects. They’re not as large as the effects that we get for ending homelessness with housing choice vouchers. But the same rental subsidies, the same housing choice vouchers that end homelessness for people who experience it also prevent homelessness for poor families. We’ve had some success with eviction prevention programs, though most people who become evicted don’t become homeless. So in one study in Chicago, people who called up an eviction hotline when there was no help available became homeless at a rate of 2% over the next six months. People who called up when money was available to help them with their rent became homeless at a rate of only half a percent – so a big reduction, but from a small base.

There’s also a prevention program in New York called Homebase, which is good old-fashioned social services for folks who are at high risk. And the trick there is to identify the people who are at highest risk and who can benefit most. We also need to stop generating more homelessness. And because housing affordability depends on housing costs and on incomes, anything that raises incomes for people at the lowest rungs of the economic ladder or reduces their housing costs will help. And because African Americans and Native Americans are at special risk due to racism, we need to combat racism in housing, employment, incarceration and the accumulation of assets. And all of those things will reduce the number of people who become homeless.

[0:09:01]

MARYBETH SHINN: One thing that’s important for people to know is that many more people pass through homelessness than are homeless on any given night. So if you think of homelessness as kind of a separate species of individual, it’s very hard to think about how to change it. The tiger doesn’t change its stripes. But if you realize that many people pass through homelessness, that gives us a lot of points of intervention. We can stop people from becoming homeless. We can shorten their stays in homelessness. We can prevent them from returning. And so it’s important to understand that.