In November, the Department of Housing and Urban Development announced deep cuts to permanent housing programs for people experiencing homelessness. The feds wanted to shift the money to transitional housing programs with work or service requirements.
It was an attack on so-called “housing-first” programs that put people experiencing homelessness in housing, without requiring them to find a job or get treatment for substance abuse first. HUD called it a failed ideology and pulled the funding.
That was met with a barrage of lawsuits — including from Arizona Attorney General Kris Mayes and other state attorneys general who sued over the cuts.
Now HUD is temporarily pausing the plan. But they say they still intend to do it in the future.
The funding overhaul would have had major implications here in Arizona. Leaders warned it would put 1,400 housing units for the formerly homeless at risk in Maricopa County. According to Nathan Smith, the CEO of Central Arizona Shelter Services, it left them scrambling to figure out how many people in HUD-funded housing would lose it.
Smith spoke to The Show about the impending changes before the administration put them on hold. And, he said, he was willing to see if it worked.
Full conversation
NATHAN SMITH: One of the things that I think the administration is doing is it’s focusing very heavily on a particular and very visible group of people who are experiencing homelessness: the ones that are at the intersections, they’re folks who are panhandling. Every time you get off the freeway, at every freeway exit, you’re gonna see someone panhandling, it feels like.
Those folks often have higher rates of substance use disorder, mental illness, even serious mental illness than many others, say families or older adults in the homeless population. So what I think we’re doing is focusing on a very specific subset of people experiencing homelessness. That said, I think there is some merit to saying if you’re receiving these services and we’re experiencing returns to homelessness from these housing projects at rates that are disappointing to us, then we’re going to switch some things up. So the administration is saying, you’re going to switch some things up.
On the other end, I think it’s a gamble because oftentimes requiring people to participate in treatment services isn’t the best way to get them to do it. You want people to self-select to go into these services, and now we’re going to force them.
The incarceration system does that all the time. "Hey, you’re on probation. You gotta participate in these services in order to get off probation." So those probationary requirements do exist for people. Some of those people have experienced homelessness. But it’s not known to be the best way to get people to participate.
So I think I’m willing to say, "Let’s see if this works. Let’s see if our returns to homelessness go down. Let’s see if meaningful participation in behavioral health and substance use services goes up."
But I think there’s rightly some skepticism as to whether it’ll be effective.
LAUREN GILGER: What do those return to homelessness rates look like?
SMITH: So I think for us in Maricopa County — and this would need a refresher — but we’re roughly in the maybe 30% range. And yeah, I think we would want to see those numbers go down. That’s something that we’ve been wanting as a community for a long time. The administration is saying, "Here’s how that’s going to happen."
And again, there are questions as to whether that’s going to work, but either way we’re have to give it a try and see what happens.
GILGER: Right. I mean, the underlying assumption here is that the root cause of homelessness is substance abuse or addiction or mental health issues. Like almost this idea that if people wanted to get out of homelessness, they could. We’re just not making them do it.
SMITH: Yeah. Now that’s where I think the biggest issue comes in. And that’s where I think this approach has some weakness and potential to fail.
The root cause of homelessness — if you’re looking for a single thing — the root cause of homelessness is economic in nature. It’s the problem of rising costs of living, pushed heavily by rising costs of housing and not being matched by rise in wages at a quick enough pace.
So that’s what’s causing homelessness more than anything else. It’s certainly not the only set of factors, but it’s a huge one.
So here’s my take on it. If we were to heal all the mental illness problems, heal all the substance use disorder problems, you would have a bunch of sober and mentally well people experiencing homelessness still.
GILGER: It wouldn’t go away.
SMITH: It wouldn’t go away. You’d still be on the streets, and they would just be better on the streets. Versus if you put all of our resources and energy and attention — or heavier percentage of it — into addressing the economic problems that we continue to face all across the country, especially in big cities, including in Phoenix, then you would have a bunch of people who may not be fully well from a substance use standpoint and maybe have some untreated mental illness, but they would be housed, and they would be in position to then take advantage of those services.
GILGER: OK, so what are the ways in which this could work? How do you have to do it to do it right, to try to keep people in housing with these requirements involved?
SMITH: That is an incredibly important question. So one of the things that will happen naturally is our caseload sizes will increase. As it is today, an organization that provides permanent housing programs to people only has the people on their caseloads who want to be on those caseloads. Now it’s going to be everybody has to be on that caseload.
So what we’ve done is we’ve made it more expensive to offer that intervention. Again, that may or may not be the best approach, but it is certainly going to be more expensive.
GILGER: So you just have to have a lot more people working with people experiencing homelessness because they have to meet these requirements. That takes work and manpower. What about the way the care is offered or the way the treatment’s offered, like the way that you approach the whole thing?
SMITH: So one of the things that you’ll have to do as a provider offering these sorts of services is you’re gonna have to really focus heavily on treatment compliance, meaning people are actually using the service. And so this is speculative, but I imagine agencies will be wrestling with a shorter leash for people who are not complying with the stipulations of their case plan.
And it’s potentially going to be the case that you’re facing having to exit people from a program because of their lack of participation in these services. And that’s what’s really unfortunate because now you’ve got — for any number of reasons, and honestly some of them very valid — people not taking advantage of a service that’s offered to them.
But as a result of that, they’re going to be potentially facing homelessness again.
GILGER: That just repeats the cycle. I’ve done interviews on The Show before about trauma-informed care when it comes to people experiencing homelessness. Especially because that so often is a part of why people are experiencing homelessness, that they’ve experienced significant trauma in their lives.
Can you do trauma-informed care when it’s something that they are going to be mandated to do, to take these offered treatments?
SMITH: You absolutely can. You can do trauma-informed care in almost any setting, no matter how disadvantageous it is to a trauma-informed approach. And it can be as simple as the way that we create an assessment or an assessment process doesn’t ask the same question about how your life impacted your substance use disorder over and over and over and over again.
Asking somebody to revisit that history in an assessment process over and over again is retraumatizing.
GILGER: Yeah.
SMITH: So you can still say we’re going to implement a process by which we’ll gather information as to people’s history and how it’s impacting their mental illness and their substance use disorder. But you can do that in a trauma-informed way. The person sitting on the other side of the individual receiving services can do their level best to create a nonthreatening and nonjudgmental environment for this conversation. That is a trauma-informed approach.
So we won’t take the foot off the gas on trauma-informed approaches. We just overall some of the things have been impacted. I think a truly trauma-informed approach doesn’t require people to participate in services that they don’t want to participate in.
GILGER: Right. Because anybody who has ever had a family member or a friend or somebody go through a substance abuse issue knows that you can’t force them to do it, to fix it. You kind of have to wait for them to be ready. Is that trauma-informed, to force them?
SMITH: That component by itself, I think many would argue is not trauma-informed. And I would lean in that direction with them. So that component is taken off the table, and now we’ve gotta be trauma-informed within that new context.
GILGER: Sure. And you think you can do that?
SMITH: I think we can do it. On the whole, I think we can implement trauma-informed practices like I was mentioning before. But I don’t think that it will be as trauma-informed as it would have been otherwise. On the other side, we’re going to see if it reduces waste. Are we spending less money on people who are ultimately going to return to homelessness anyway?
Are we spending less money on programs that may not be working in terms of helping people get off the streets and stay off the streets? You know, jury’s out. It’s a social experiment in some ways. But to answer your question, again, purely: Yeah, we have a less trauma-informed context to work in, but we can still be trauma informed.
