Housing First failed America’s homeless

OPINION:

When a policy intended to help vulnerable people actually harms them, the ethical response is immediate: Stop, reassess and tell the truth.

That was why, in January 1996, a team of doctors at the Seattle-based Fred Hutch Cancer Center dramatically halted the active phase of a study assessing the benefits of beta-carotene and vitamin A supplements for people at high risk of developing lung cancer.

Leading up to the study, Hutch News reported, “public enthusiasm for the purported health benefits of beta-carotene was so high, ’people thought it would be unethical to assign participants to the placebo group.’”

It turns out the placebo takers were the lucky ones. Among the 18,314 participants, those receiving supplements “had a 28 percent greater incidence of lung cancer and 17 percent more deaths.”

What was meant to help people was hurting them.

“It was just devastating when we learned the results,” a lead researcher recalled. “Everybody was so hopeful. After all, we’re here to prevent cancer.”

One staffer described being called in overnight to make thousands of phone calls warning participants to stop the supplements immediately.

No researcher or health organization ever wants to be in that position, yet those involved never hesitated to inform participants and the public of the failure of their hypothesis.

If only the same do-no-harm ethic governed the architects of our nation’s predominant homelessness policy. Housing First has not just failed in its promise to end homelessness; it has also been like gasoline on a fire now raging across America.

Although it may have been hard to predict that vitamins could do harm, the naive hypothesis at the heart of Housing First is less excusable. It is built on the claim that we will end homelessness by putting homeless people — most of them suffering from deeply disruptive and life-destroying mental illness or addiction — inside permanently subsidized housing units as quickly as possible.

Faith in this myopic approach is so strong that even modest safeguards or delays are discouraged or prohibited outright. These include requiring treatment, carefully screening criminal backgrounds, enforcing public health and safety laws affecting homeless populations, and sharing funding with programs that prioritize personal recovery.

So incentivized are housing units that a whole pillar of Congress’ homelessness mandate has been neglected since Housing First was formally adopted by the federal government in 2013. One of the four stated purposes for federal Continuum of Care funds (totaling $4 billion in taxpayer dollars this year) is that recipient agencies and programs “optimize self-sufficiency among individuals and families experiencing homelessness.”

The active phase of the Housing First experiment is still being aggressively administered. According to the just-released federal 2025 Annual Homeless Assessment, annual taxpayer subsidies for homeless housing and beds have doubled (in some categories, almost tripled) under the policy.

Protecting the industry that has ballooned to capitalize on this money requires pretending away the obvious: Homelessness is a human crisis largely driven by addiction and mental illness.

The pretense is devastating. Since 2013, homelessness across all measured categories has increased 27%, while the number of people living on the streets is up 36% and chronic homelessness is up 81%.

With little incentive to invest in treatment and no meaningful governance of tenants, homeless housing developments are predictably hellish: filled with drug use, filth, violence and despair.

Some managers acknowledge that death, not recovery, is the expected outcome. “Not to sound morbid,” one public housing director testified, “but as soon as people move in, they’re with us until they pass away.”

Yet the harm done to the homeless is only part of the story. Journalist Sam Quinones recently coined the term “tent encampment stress disorder” to describe the effects of living in proximity to homeless encampments and housing projects.

Neighbors, he said, “described prolonged exposure to secondhand madness — the insanity of others relentlessly inflicted on those who live nearby until they, too, slowly develop psychological problems.”

When the Fred Hutch hypothesis failed years ago, the research team hired additional staff to handle the angry calls they expected, but there were few.

Study participants “said they were involved in the study for altruistic reasons, and we got an answer,” a doctor recalls. Finding the truth would help others.

By contrast, as President Trump’s administration recognizes the failure and devastation of Housing First and pivots to recovery-based homeless policies, defenders of the failed experiment are circling their burning wagons.

Many profit richly from massive taxpayer-subsidized real estate empires and have used their resources to attack reforms in the courts, delaying needed changes.

Sincere mistakes are part of progress, but there is no excuse for defending self-interest in a status quo that is killing people.

• Marsha Michaelis is a research fellow with Discovery Institute’s Fix Homelessness initiative.