The blog of the Urban Institute
March 9, 2020

Housing First Is Working in Denver. The City Needs More of It.

Coastal cities are not the only places struggling to address increasing unsheltered homeless populations. Walking around downtown Denver, Colorado, the evidence of homelessness and the housing crisis is striking. Tents crowd city sidewalks alongside shopping carts that hold a life’s worth of possessions. Yet, despite the visibility of the problem, our collective inaction renders people experiencing homelessness invisible.

On any given night in metro Denver (PDF, link added 03/12/20), 1,158 people experience chronic homelessness—332 of whom are sleeping outside, many have mental health or substance use disorders, and some cycle in and out of jail. All this may lead some to conclude that homelessness is unsolvable, that people choose to be on the street, or that solutions are ineffective

But a supportive housing program in Denver, launched by Mayor Michael Hancock in 2016, is challenging those conclusions. 

For the past few years, the Colorado Coalition for the Homeless and the Mental Health Center of Denver have been working with local police and mental health co-responders to house people who have experienced homelessness and cycled in and out of jail, hospitals, and detox centers. So far, they have engaged and housed more than 400 people in permanent supportive housing. 

Early results show 92 percent of the people offered housing accepted it and 71 percent moved in, busting the myth that people choose to experience homelessness. Almost 80 percent remained in housing two years later, according to the Urban Institute’s ongoing evaluation.

Denver is achieving these results by adopting a philosophy called Housing First, which helps people find a home, then addresses other challenges, such as substance use or employment, that can be impossible to fix while experiencing homelessness.

Housing First is not housing only. Once participants are in a home, they are offered physical and mental health services, harm reduction and substance use treatment, income supports, and employment. These trauma-informed supportive services—offered by teams that include housing specialists, social workers, behavioral health clinicians, nurses, psychiatrists, and peer coaches—are voluntary and based on evidence-based models. 

In Denver, the program is a public-private partnership (PDF) between the city and private investors, managed by CSH and Enterprise. Denver leveraged over $15 million in state and federal housing resources and Medicaid reimbursements. Private investors funded $8.7 million in supportive services. Denver will pay back investors if the project achieves predetermined outcomes that improve people’s lives and save taxpayer dollars. After seeing early results, Denver committed local resources to expand the program.

Evidence from other cities (PDF) shows that supportive housing can reduce jail stays and visits to the emergency room and detox centers, saving money and resources. Denver reported it spent an average of $7.3 million per year (PDF) on people experiencing chronic homelessness and cycling in and out of jail. The evaluation will show if the program’s success in housing stability can decrease these costs.

On the streets in Denver, it’s harder to see the results. If Housing First is working, why are so many people still experiencing homelessness? City leaders could replicate and scale the results of this promising program to meet the needs of the more than 1,000 people experiencing chronic homelessness. That would require more housing subsidies and more funding for services, a cost of about $23 million a year.

Denver can’t reach this scale alone—it needs help from the federal government. But federal investments in housing, which programs like Housing First rely on, have fallen over the past two decades. And a month ago, President Trump proposed reducing the US Department of Housing and Urban Development’s budget by 15 percent. Medicaid and the Affordable Care Act, important programs for providing supportive services, face combined cuts of $1 trillion over 10 years.

The next time you see tents or people’s possessions on the streets, remember homelessness is not an unsolvable problem. Housing First ends homelessness, and scaling this model more broadly in Denver and other cities will keep more people in housing.

Lisa Bryant, a clinical case manager with Mental Health Center of Denver, visits a supportive housing program participant in his apartment to help with paperwork on Wednesday, Dec. 5, 2018 in Denver, CO. Photo by Maura Friedman/Urban Institute.

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