Pathways' Housing First approach has been phenomenally successful. More than 80 percent of those who went into the program have maintained their places for at least three years, compared to fewer than 40 percent in other programs. By way of explanation, Tsemberis invokes Abraham Maslow's "hierarchy of human needs," noting that the basics come before things like treatment.
"If you live on the street, safety — where you will sleep — occupies a person's entire psyche," Tsemberis says. "If you're hungry and exhausted, you can't sit still in a 12-step meeting. Once that calms down, once you house people, then they become interested in treatment. It's human nature."
Culhane's study, published in 2001, compared the cost of an individual in supportive housing — that is, housing plus oversight and social services — with the cost of someone on the streets. He found that the chronically homeless used an average of $40,000 per year when they lived on the streets. Supportive housing cost about $18,000 a year, and those who had it used about $16,000 less in social services. Thus the net cost of providing the chronically homeless with supportive housing was about $2,000 a year.
Since then, dozens of cost-benefit studies have been done all over the country. They put social costs of life on the streets in a range of $35,000 to $150,000 per year. Supportive housing costs from $13,000 to $25,000 and substantially reduces social service expenses. The studies found that this strategy to address chronic homelessness doesn't just break even; it can produce a huge savings.