Ending the Housing First Policy Could Lead to More Homeless, Despite Executive Order: Katherine Koh, MD, MSc

Katherine Koh, MD, MSc, a practicing psychiatrist at the Boston Health Care for the Homeless Program and Massachusetts General Hospital, spoke about how the ending of programs like Housing First, which aims to get homeless people housed before addressing their mental or behavioral health problems within the program, would spell more harm than good after the executive order, “Ending Crime and Disorder on America’s Streets,” was signed.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

What conflicting wording does the executive order possess?

The executive order seeks to ensure that federal programs like SAMHSA, the Substance Abuse and Mental Health Service Administration, fund evidence-based programs, and yet, ironically, at the exact same time, it encourages defunding of harm reduction. Harm reduction is a pillar of evidence-based treatment for substance use disorders. So it's doing the exact opposite of what it purports to in trying to fund evidence-based programs if it takes away funding for what we know is the most effective evidence-based program.

Combined with the executive order, how do you think ending Housing First will affect how we approach homelessness in the US?

There is robust evidence in support of Housing First. It's been one of the most significant advances in homelessness policy over the last 2 decades. Multiple randomized control trials show that Housing First leads to faster exits from homelessness and increased housing retention for people experiencing homelessness. And in fact, it emerged in the early 2000s as a bipartisan response to attempts to require treatment and sobriety for people prior to moving into housing. When these requirements were implemented, it was actually found that homeless individuals had more difficulty entering housing than if these requirements were not imposed. Housing First emerged as part of this bipartisan movement over 2 decades ago, and so to defund Housing First would reverse decades of significant progress we have made in housing vulnerable people on the street. I work as a street psychiatrist on the Boston Health Care for the Homeless Program street team, and we have seen hundreds of homeless people move into housing and be able to achieve housing successfully as a result of the Housing First policy. I fear greatly that taking away funding for this evidence-based policy will only lead to people languishing and dying more on the street.