Homelessness is an entrenched problem for thousands of people in the Las Vegas Valley each year. A recent op-ed by Dave Marlon made the important point that many individuals experiencing homelessness also contend with substance use and mental health challenges.
Indeed, the evidence shows that the stress of experiencing homelessness itself exacerbates these challenges and makes treatment less effective. Decades of research tell us that an accumulation of traumatic experiences, including homelessness, increases frequency and severity of mental health disorder.
Unfortunately, many of the subsequent claims in Marlon’s piece are incorrect. In calling for mental health and substance use treatment to precede any housing assistance (a “treatment-first” approach), he disregards the large body of evidence showing that a housing-first approach to addressing homelessness is more effective than withholding services from unhoused individuals until they demonstrate sobriety.
Housing first is a philosophy that prioritizes rapid return to housing for individuals who have lost their homes. Housing-first approaches do not and have never implied that additional services are unnecessary — simply that human beings should not have to prove themselves “housing ready” before being offered a safe, stable, permanent place to sleep at night.
The U.S. Department of Housing and Urban Development (HUD), the Substance Abuse and Mental Health Administration (SAMHSA), and the U.S. Interagency Council on Homelessness (USICH), among others, endorse a housing-first approach to address homelessness among people with substance use and mental health needs. Without stable housing, it is extremely difficult to achieve and maintain mental stability, sobriety, or employment.
Homelessness is a complex problem with both individual and structural causes, and people experiencing homelessness are not a monolithic group. HUD distinguishes between many subgroups of people experiencing homelessness, including veterans, individual adults, families with children, unaccompanied youth, and people with disabilities.
These groups have different needs, including temporary shelter, rapid rehousing, transitional housing, permanent supportive housing, or short-term financial support to stay in existing housing. By implementing HUD’s Coordinated Entry system in our community, countless homelessness service providers grapple with this complexity every day.
Many people simply need wages to keep pace with housing costs. This has not happened in Nevada, where median wages have increased 31 percent since 2012 while median home prices are up more than 150 percent.
Researchers at the Urban Institute and the National Coalition for the Homeless estimate that about 25 percent of individuals experiencing homelessness are employed, with another 40-60 percent moving in and out of employment. The evidence shows that most people who experience homelessness did not become homeless because of a mental health or substance use disorder but because they could not afford housing.
Making housing contingent on mental health and substance use services addresses none of these issues and leaves children without a safe place to sleep. Policies that protect women and children, emphasize adequate wages, provide accessible, high-quality health care and affordable child care are all crucial components of a comprehensive plan to end homelessness for good.
While this is an opinion column, the question of how best to solve homelessness isn’t a matter of opinion – it is a matter of evaluating the evidence. Meta analyses of randomized controlled trials, the gold standard of scientific evidence, show that a housing-first approach keeps people in stable housing for longer and reduces their use of emergency services compared to alternative approaches.
And even though housing first directly targets homelessness, not addiction, the evidence shows that a housing-first approach is just as effective as a treatment-first approach for reducing substance use.
In addition to this research evidence, logic tells us that even if every person experiencing homelessness with a mental health or substance use disorder in Las Vegas got sober tomorrow, we would still have a homelessness crisis because we have an affordable housing crisis. The Nevada Housing Coalition estimates the state has a deficit of over 100,000 affordable housing units. For those who earn 30 percent or less than the area median income, there is a deficit of more than 80,000 units.
Solving this problem will require that we pull together as a community – to build more affordable housing, preserve existing housing, raise wages so that people can afford that housing, and extend comprehensive supportive services to those who require a higher level of care, including mental health and substance use treatment, while they recover in housing.
Anything else will waste time, money and lives.
Nicholas Barr is an Assistant Professor of Social Work at the University of Nevada, Las Vegas. His research investigates risk and protective factors for populations with an elevated likelihood of traumatic experiences, like military-connected populations and young adults experiencing homelessness. Before joining the faculty at UNLV, Nicholas was a Cohen Veterans Network funded postdoctoral research fellow and a psychiatric social worker for the Los Angeles County Department of Mental Health.
Katherine Marçal is an Assistant Professor of Social Work at the University of Nevada, Las Vegas and a member of the Southern Nevada Continuum of Care Board. Her research examines impacts of and solutions to homelessness. Her research has been funded by the U.S. Department of Housing and Urban Development, the National Institutes of Health, and the Doris Duke Charitable Foundation.
Nathaniel Waugh is the Interim Executive Director of the Nevada Homeless Alliance. He holds a Master of Arts in Urban Leadership from the University of Nevada, Las Vegas.