Housing First Contributes to Urban Livability

A few years ago my morning walk to work from Seattle’s Capitol Hill neighborhood often included the sight of people passed out in doorways surrounded by empty cans of high octane booze. And walking home often meant running a gauntlet of panhandlers looking for money to drink again. It’s an unfortunately familiar dimension to Northwest cities. Like a lot of people, I’ve felt frustrated about the human toll as well as the signs of neighborhood decay.

I’m not the only person who’s felt frustrated.

Some city dwellers have called for Alcohol Impact Areas (AIAs) as a way to deal with chronic public inebriates. (An AIA is a geographically defined area where products with high alcohol content cannot be sold.) Tacoma has tried AIAs. So has the State of Oregon. But generally speaking, AIAs have not been wildly successful—and they paper over serious health and housing problems.

Consider what’s happened in Seattle. The city petitioned the Washington State Liquor Control Board in 2006 to establish two AIAs to address the problem of chronic public inebriates, most of whom are homeless. Their success has been mixed. Two City of Seattle reportsshow that the suppliers of high-alcohol booze have simply been changing the name of their products to circumvent the ban!

Another serious problem with the AIA concept is that they tend to push the problem around. Even when the ban is effective in actually limiting the supply of high alcohol drinks in one area, the demand just travels to other neighborhoods.

Fortunately, there may be a better model: one that addresses chronic public drunkenness by going after the root of the problem. It’s called Housing First, an approach that Seattle’s Downtown Emergency Service Center recently tried: providing housing for homeless alcoholics rather than trying to dry up the supply of booze. The 1811 project provides 75 beds for previously homeless people. What makes 1811 different than most transitional housing is that there are no requirements to abstain from alcohol. In fact, residents are free to drink in their rooms.

Needless to say, the 1811 project raised a lot of eyebrows at its inception. There were some powerful opponents like the Benaroya Corporation who own property nearby and who nearly scuttled the project. People worried about increased crime, lowered property values, and scaring away customers from local businesses. Others worried that providing housing to chronic inebriates was somehow rewarding bad behavior. 

Fortunately, most of the worries were misplaced. As the P-I reports, a recent study of the 1811 project found that it was actually cheaper and more effective than doing nothing. Let’s look at the numbers. 

Some of these people wound up in the emergency room as many as 200 or 300 nights a year. While there are only a few hundred serious users of services like these, the cost to the tax payer staggering. The study found that the median monthly cost for the 95 participants in the program was $4066 per month. (These costs were determined based on admissions to Harborview Medical Center’s emergency room, Medicaid charges and responses from Emergency Medical Services.) During the study period, when 1811 was operational, the median costs for participants fell to only $1492 per month. In total, participant costs fell from $8 million per year in the old way of doing business to about $4 million per year during the study period. In other words, the program reduced taxpayer expenses by about half.

It’s true of course that Housing First costs money too. But it seems to address each component of the problem more affordably than current practices, including the AIAs.

Under current practice, we spend millions of dollars in public funds on a very small number of seriously ill people with little or no effect on their condition. Under business as usual, homeless inebriates play out their struggles on city streets, in public, and their serious addiction goes untreated. As a consequence, according to a Public Health Seattle King County study, the average age of death for these homeless people was 47 years old, a shameful figure in the prosperous Northwest. The 1811 project has demonstrated that housing can be the first step toward easing alcohol abuse, reducing the strain on publicly funded emergency rooms like Harborview, and maybe even  toward recovery. There’s real evidence that the program is improving the lives of those suffering from lifelong homelessness and alcoholism, like the resident featured in this story.

I can see the difference in my neighborhood. Since the 1811 project opened near where I live, the streets have gotten a bit cleaner. So not only is Housing First a cost-effective strategy for social service, but it’s also a big benefit for urban living. Feeling unsafe on city streets can be a disincentive for living in a dense neighborhood. (Justified or not, people sleeping and drinking in doorways and panhandling for change contribute to the “big dirty city” stereotype of density.)

Plus, the perception that dense neighborhoods are dangerous or dirty can discourage neighborhoods and suburbs from increasing density. So supporters of density should take a close look at Housing First. It just may be able to solve one of the seemingly intractable problems that discourages city living.