How one state almost solved America’s homelessness problem

A mural painted by BiltsLouisArt at The Road Home's Pamela Atkinson Resource Center in Salt Lake City, Utah. (Photo via @TheRoadHomeUT / Twitter (X))

The United States is facing one of the most severe housing crises in its history. According to the National Low Income Housing Coalition, not a single state has an adequate supply of affordable homes for renters in the lowest income bracket. Nationwide, an estimated 7.3 million more affordable homes are needed. The shortfall has resulted in epidemic levels of homelessness across the United States. Between 2020 and 2022, homelessness in Phoenix, Arizona, rose by 22%; in Austin, Texas, by 26%; and in Sacramento, California, by a staggering 68%. On any given night, almost 600,000 Americans are living unhoused.

This problem has grown exponentially since the 1980s, when cuts in federal funding for the construction of public housing led to a steep reduction in the quantity of affordable homes across the country. During the pandemic, the Biden Administration approved $47 billion in emergency rental assistance for struggling homeowners. This measure, in conjunction with moratoriums on evictions, temporarily mitigated the problem. But as concern over the pandemic faded, so did federal relief. As help and protections have been withdrawn, and as housing prices have risen, more and more Americans have found themselves on the street.

As all these details show, the United States desperately needs a comprehensive solution to its housing crisis. The good news is that such a solution exists and has been battle-tested. Indeed, a few places – most notably, Utah – have already implemented it. But doing so required them to reframe their understanding of the homelessness problem. While some leaders and voters remain reluctant to do so, it’s high time for legislators elsewhere to focus on what actually works – and to make it happen.

A chronic crisis

Chronically homeless individuals are classified as people with a disability who have lived in shelters or places not meant for human habitation for at least 12 months total over the course of three years. Although the chronically homeless represent only 22% of the unhoused population in the United States, they use emergency services significantly more than the situationally and episodically homeless and therefore consume a disproportionate share of taxpayer dollars. But reducing that expenditure is but one reason for governments to prioritize helping this smaller segment of the homeless population; others include basic human values and the need to reduce the burden on shelters and emergency services.

A train passes by homeless people at a homeless tent city on March 23, 2009 in Sacramento, California. (Photo by Justin Sullivan/Getty Images)

In the early 2000s, a handful of state governments attempted to do so by using a new method known as Housing First, a model that grew out of clinical work conducted by the psychologist Sam Tsemberis. While working at Bellevue Hospital in New York City during the 1980s, Tsemberis would often find that his patients lived on the streets. The frequency of this overlap between mental health problems and homelessness had a profound effect on Tsemberis’ understanding of the issues. As he recounted to me, his patients would frequently ask him, “Can’t you tell I need a place to live?” Such conversations taught Tsemberis that helping these struggling individuals requires more than clinical solutions. What they needed most of all was housing.

At the time, most programs focused on resolving homelessness required potential clients to establish that they were already in treatment or sober; as a consequence, these programs had largely failed. So Tsemberis began to wonder, what if the government simply gave homes to those in need and worried about services afterward? Once at-risk individuals were stably housed, they would be provided wraparound support services like treatment for mental illness and substance abuse, as well as vocational training. These services would both address the needs of the chronic homeless and help them reintegrate into their communities. To that end, in 1992, Tsemberis developed the Consumer Preference Independent Living Model, a housing program for unhoused people with disabilities that also provided clinical support. The program was revolutionary at the time, and the results of its early trials were astonishing: Participants enjoyed higher housing retention, improved health, and reduced substance abuse. It wasn’t long before Tsemberis’ model became the standard for approaching this problem. In 2004, the George W. Bush Administration adopted the program, now known as Housing First, as part of its national policy to end homelessness.

Coalitions of the willing

Although the initial calls to address chronic homelessness in the early 2000s came from the White House, in Utah, the cause was first championed by a rather unlikely private citizen. Lloyd Pendleton was raised on a desert ranch with the values he’s described as “rugged individualism and pull yourself up by the bootstraps.” He worked as an automotive executive before becoming a bishop in The Church of Jesus Christ of Latter-day Saints. In both jobs, he was well known for his management skills, which led the church to loan him to Utah’s state government to help reform the shelter system. In 2003, Pendleton attended a conference in Las Vegas, Nevada, on the subject of homelessness, where he met Tsemberis and learned about the Housing First approach. At first, Pendleton was skeptical. His conservative beliefs made him suspicious of what sounded like a handout, but it was hard to argue with Tsemberis’ data. Pendleton soon embraced the model. After a couple years working closely with shelters, in 2006, he was tapped by then-Gov. Jon Huntsman Jr. to become the Director of Utah’s Homeless Task Force. Shortly thereafter, Pendleton formed the Salt Lake Valley Coalition to End Homelessness.

Pendleton pushed the Housing First method hard during his tenure as Utah’s homelessness czar, and the methodology soon earned strong support in Utah’s state legislature, as well, thanks in no small part to Pendleton’s senior position in the church. Indeed, the approach became one of the few policies at the time that garnered backing across the political spectrum. The cost-effectiveness of the Housing First approach attracted conservatives, while the moral value of providing homes for the unhoused resonated with liberals. This bipartisan approval proved key to the program’s success. Elected leaders came to see Housing First as a humane and cost-effective solution backed by data, and not a partisan issue.

Pendleton also helped by developing a strong partnership between the public and private sectors, convening leaders from the church, governor’s office, state legislature, and the business, nonprofit, and philanthropic worlds. Michelle Flynn, Executive Director of The Road Home (TRH), the largest nonprofit in Salt Lake City focused on homelessness, described to me how this coalition collaborated to build the foundation for Housing First in the state. She explained that they “decided the Salt Lake City Housing Authority was going to develop the first [housing] project, the Salt Lake County Housing Authority was going to develop the second, and TRH was going to develop the third.” Those projects opened on schedule and added over 1,200 new housing units. Flynn, like Pendleton, emphasized that their approach was grounded in data. The key shelter provider, the health care providers, and the street outreach lead brought together their databases and cross-referenced lists to prioritize who was going to be housed first. The value of collaboration between the public and private sectors and various interest groups cannot be overstated. Janice Kimball, the CEO of the Housing Authority of the County of Salt Lake, told me that “the LDS church played an instrumental role … they provided beds, furnishings, tables, and chairs for the first two properties. In addition, they provided the volunteers to set it all up.”

As a direct result of these efforts, Utah saw a 72% reduction in chronic homelessness between 2005 and 2015; Kimball told me that Utah got “a couple hundred units away from functional zero” chronically homeless individuals by 2015, meaning that at that point, it almost had fewer homeless people than beds in shelters. In 2014, the state estimated that the community saved approximately $8,000 per chronically homeless person housed through the program. Together, those savings amounted to a 40% reduction in total money spent on the unhoused. The state’s success was heralded by news media around the world.

Tents in a camp of homeless people in Utah in 2022. After shifting funds away from Housing First in 2017, homelessness in Utah once again rose. (Photo by Jon G. Fuller/VWPics/Universal Images Group via Getty Images)

Things fall apart

Despite this overwhelming success, however, beginning in 2015, support for Housing First in Utah’s government began to unravel. Ignoring the data, certain business leaders and voters looked at anecdotal evidence – such as the persistence of some people camping on certain streets – and concluded that the homelessness problem was worse than ever. In 2017, newly elected leaders responded to their constituents’ complaints by shifting funds away from the Housing First programs. A new program called “Operation Rio Grande” was launched; it used law enforcement, which put an emphasis on arrests, to address the unhoused. The state closed its largest shelter, which was located in the downtown Rio Grande neighborhood, and replaced it with three smaller shelters on the outskirts of town. This shift, Kimball told me, “tripled costs and reduced capacity from 1,100 to 800 beds.” Kimball said the new shelters “do better in some regards, but don’t [permanently] get people off the street.” That makes sense; shelters are meant to be a temporary solution. As a consequence, in the years since the state abandoned Housing First, Utah’s chronically homeless population has grown consistently.

Operation Rio Grande had another major flaw: It asked developers to create public housing. The problem, as Wayne Niederhauser – Utah’s current Homeless Coordinator and a former real estate developer himself – explained to me, is that truly affordable housing simply does not “pencil out financially” for the private market. Housing the most economically disadvantaged people is never going to be a profitable endeavor and requires public subsidy.

The reality is that homelessness is a complicated problem. As rent prices climb and income growth is undone by inflation, the number of unhoused Americans will continue to rise. Thousands are forced out of housing every year as a result of misguided housing policy. The evidence shows that cities urgently need more investment in affordable housing. Housing First alone is not a definitive solution but rather a crucial first step. Housing the chronically homeless minority broadens capacity for the shelter system to meet the needs of the majority – the temporarily and episodically homeless. Given enough time and sustained investment, this program will create the ideal conditions for the unhoused to be reintegrated into society.

Critics of Housing First claim that the recent increase in chronic homelessness, rising costs, and a paucity of employed tenants are evidence of the program’s shortcomings. But such claims not only disregard the damage done by Utah’s shift to Operation Rio Grande in 2017, they also ignore the data. In 2020, a review of 26 studies confirmed that the Housing First approach decreases homelessness by 88%, increases housing stability by 41%, and improves quality of life for the unhoused relative to traditional approaches. The data also proves that the economic benefits of Housing First outweigh the costs: For every dollar invested in the program, Housing First saves $1.44.

Other cities in the United States have taken note of Utah’s success and implemented their own versions of Housing First. Houston, Texas, and Milwaukee, Wisconsin, are two prominent examples. By following the lead of Salt Lake City, Houston reduced homelessness by 63% between 2011 and 2021, and Milwaukee has reduced it by 92% since 2015.

The fact that Utah leaned on the church and its significant resources to help implement its Housing First program has led some skeptics to question whether other states that lack such an affluent and committed nongovernmental institution could follow Utah’s example. But the success of Houston and Milwaukee shows that states don’t need a financial behemoth behind them to successfully apply the program. There’s no single pathway to success; one community might lean heavily on government funding while another might rely more on civil society and philanthropy.

Sam Tsemberis (R) meets with Irish officials at the launch of a new initiative to tackle homelessness in 2018. (Photo by Brian Lawless/PA Images via Getty Images)

The three C’s

When Pendleton is asked to provide recommendations to other cities and states hoping to replicate Utah’s success, he frequently cites “the three C’s” he deems critical to success: champions, collaboration, and compassion. And Salt Lake City’s recent regression suggests a fourth: consistency.

In order to have a meaningful effect on homelessness, communities need people at the legislative, civil society, and philanthropic levels who are deeply committed to the cause: in other words, champions. Utah, Houston, and Milwaukee also succeeded because of collaborations: The coalitions they built behind Housing First were strong and held together over time. Pendleton’s final C, compassion, is also vital. Many elected leaders and commentators in the United States villainize the unhoused. Rather than see them as people who may have lost a job or suffered debilitating medical expenses, they view them as people who just need to pull themselves up by their bootstraps.

The best thing about Housing First, however, is that it’s compassionate and pragmatic. It is grounded in the recognition that housing is a basic human need, but it is also the most efficient and cost-effective approach to the problem. If anything can unite the country behind a comprehensive attempt to solve homelessness, it should be that combination.