After working on various programs with limited success, Tsemberis began to realize that the homeless were not the problem; homelessness was. He stopped assuming he knew what was best for people and started listening. What he heard was not revolutionary or surprising, but it has changed the way homelessness is approached.
In 1992, Tsemberis founded Pathways to Housing on the principle that the chronically homeless need housing first. With a place of their own, Tsemberis felt, the homeless would be in a position to turn the rest of their lives around; with a safe place to sleep and live, other problems such as drug abuse, alcoholism and mental illnesses could be dealt with. With a dedicated team of psychiatrists, nurses and staff, Pathways is delivering the figures to confirm the promise of their approach.
Sam Tsemberis recently spoke with MotherJones.com from his home in New York City.
MotherJones.com: Talk about some of the programs you were involved with before starting Pathways to Housing. What was their purpose?
Sam Tsemberis: They were called “outreach programs,” and their purpose was to engage people who were mentally ill and not living anywhere. One of the reasons the program was started was that there were so many people out there who appeared not to be able to take care of themselves because of their mental illness. There was a concern that they were a risk both to themselves and to others; we have people here who have psychotic symptoms and they’re in public places; it’s a precarious situation.
One of the programs consisted of a team that was made up of a social worker, a psychologist, a nurse and a psychiatrist. We would drive around the city, essentially conducting these sidewalk house calls to people who appeared to be in a very precarious state, whose survival was really in question. One of the events that launched the program was the woman who froze to death in New York. She wasn’t the only one who was homeless, mentally ill and died, but she was a case that came to a lot of people’s attention. The program was designed to prevent that sort of thing from ever happening again. No one should ever have to die on the streets.
Now, there were actually very few dramatic cases like that. But there were hundreds and hundreds of people we saw who were mentally ill and were living on the streets; we wanted to be able to do something for them. That’s where we really began this frustrating process of figuring out where we could refer people. We were trying to get them into housing programs, but there was a huge wall because the housing providers wanted people to be clean and sober for a period of time. They wanted them to be taking medication. The homeless people were somehow supposed to be stabilized before programs would even consider them to be eligible tenants. And these are program that were designed to house the mentally ill! But with so many homeless and mentally ill people and so few program slots, the housing providers have fallen into the habit of picking from among the applicants the ones who were the best tenants. And we couldn’t persuade, beg, or in other ways entice the providers to accept these referrals. Ultimately it was that frustration that pushed me, with my colleagues, to start a housing program that would accept people on their own terms, because we understood what people were asking for.
MJ.com: They wanted housing first.
ST: Yeah, they wanted housing first. And it seemed like a reasonable request, especially after working with them for so long and seeing how well they were managing on the street. The whole thing with the housing providers was well, “How can this person manage?” Well, if you look at a person who is on the street and the way they have to take their things from one place to another; figure out what soup kitchens are open on what days; finding out where the mailbox is. They are managing an entire life out there, in addition to taking care of themselves in terms of choosing a safe warm spot that they can sleep in and finding other people that they can trust on the street who won't take advantage of them. There’s a whole set of skills that they are using and if you noticed that, you would appreciate that moving into an apartment of their own was not a big complicated thing for these people.
MJ.com: What do you think the role of federal government should be in preventing and housing homeless?
ST: Well, the federal government is really the way that a large part of this started. It was during the Reagan years, the very first year or two, when they basically pulled out of the business of building affordable housing in this country. Maybe people don’t realize, but this particular homelessness epidemic has only been around since the early eighties. We had one like this during the Depression, but this one has lasted way longer. One of the key reasons is that the federal government’s commitment to building affordable housing is basically gone. It was gone those very early Reagan years and then through Bush and Clinton and now Bush again and there is still no commitment to building affordable housing in the country. None of the administrations since Reagan have done anything close to what is needed.
MJ.com: What needs to be done?
ST: All you need to solve homelessness in the country is about $10 billion; you would solve homelessness permanently in the country.
MJ.com: Where would the money go?
ST: About 80 percent of it would go to housing and then 20 percent for the services and support that some people would need.
MJ.com: Why are so many people homeless now?
ST: Because the economy is so terrible. Someone has likened the tight housing market to a game of musical chairs: when the music stops and people have to sit down, those who are the most disabled are less likely to find units. The people who were on fixed incomes, like the people who are mentally ill and are on SSI [Supplemental Security Income] are still at the five-, six-hundred dollar income a month level. The market has passed them by. They are not able to compete successfully for the little affordable housing that is around. And once they are on the street, whatever conditions had existed previously are exacerbated because of struggles and traumas of street life.
But there is also this extra component of people with disabilities and people who are poor. I think it is a deeply engrained, cultural belief that if you are somehow poor that you have squandered what was given to you. Or somehow you don’t deserve anything. You had a chance and somehow blew it. This is especially true if there is drug use involved. People don’t see addiction as an illness, but rather as a voluntary kind of recreational drug use gone awry. So there is a very punitive and moralistic societal value we have about people who are homeless and in desperate need.
MJ.com: There is a program here in San Francisco called Care Not Cash. Part of the funding for the program goes to supportive housing and part gives homeless people money. Do you think just giving money to homeless people is a good way of dealing with homelessness?
ST: It’s a wonderful thing to do. It gives them a little control over their lives. Who are we to know what they want and what their priorities are? I found out for sure that the whole clinical, mental health and substance abuse treatment system didn’t have a clue about how to prioritize people’s needs. The only reason our program is successful is because we let people choose what they want. It wasn’t our idea to give them housing first; it was their idea. We just said, “Tell us what you want and we will give it to you.” And suddenly when you do that, you realize all of these people who say, “Oh, these people can’t be engaged, they're too psychotic,” is not at all true. People who are homeless are listening up and are very eager to vote with their feet. They go right into those apartments. So, I say, give people control of their lives. How can you keep people so completely dependent they can’t even make a decision about how to spend 500 bucks, and then, at the same time, expect that they are going to be independent, fully functioning citizens in society? Where are they going to learn those skills, if you have them completely handcuffed?
MJ.com: Who are your clients? Where do they come from?
TS: Over the years, the program has changed really from working with people on the street to working with a lot of people who were homeless and were arrested. There was whole big effort to improve the quality of life on the streets of New York and a lot of other cities too. A lot of people ended up in jail. And so now, instead of going to jail for jumping the turnstile of the subway, you can come into the program if you are mentally ill and homeless. So, some of the places where we are getting our referrals have changed, but essentially the people are the same. They’ve just been shifted around to different locations as a result of whatever social policy that is flying at the time. The usual way it goes is people immediately want the apartment and a very short time after that they are looking for something to do. Not treatment, really, but a little work, making a little extra money. They want to fix up their place; they want to hold onto it. Having a home is a great motivator.
MJ.com: There was an article in the Los Angeles Times in November 2004 that talked about how the city was completely unprepared to deal of the rising number of homeless, including a rising number of families with young kids. Would you say that most cities are unprepared?
TS: Oh, completely overwhelmed. The numbers are overwhelming.
MJ.com: Why so many families?
TS: It’s poverty! You can’t really pay the rent with a minimum-wage job. Minimum wage has not kept up at all with the cost of living. People are making six and seven dollars an hour where just to be able to afford a place you have to be making 12 or 15. So a lot of the people who are working at the minimum-wage jobs, even with two jobs, have a hard time paying the rent, especially if there are kids involved –- they need a bigger place. It’s all about poverty, in a way. Once you lose your house you can’t hear back from an interview; it’s a downward slide very quickly.