Housing First at scale
Permanent housing offered with no preconditions like sobriety or being in treatment, with supports attached to the person rather than the building; the question at scale is whether a whole system can be reorganized around it.
THE EVIDENCE, THE COSTS, WHO DECIDES▾
- Finland, the reference case since 2008, converted shelters into apartments; the OECD's review points to public savings of €9,600–€15,000 a year for each person no longer homeless. OECD ↗
- Canada ran the world's largest Housing First randomized trial (At Home/Chez Soi, 950 adults with serious mental illness). Stable housing was gained at Can$41.73 per day; 69% of costs were offset by savings elsewhere, for a net cost of about Can$6,311 per person per year. peer-reviewed (PubMed) ↗
- Houston merged roughly 100 agencies into one coordinated system after 2012 and cut regional homelessness by roughly two-thirds since 2011. Governing ↗
- The evidence is strong for keeping people housed and weak-to-mixed for everything else: a peer-reviewed review finds effects on mental health, substance use, and quality of life inconsistent or absent. Housing First ends homelessness; it does not, by itself, treat addiction or illness. peer-reviewed review ↗
- Medicine Hat reached "functional zero" chronic homelessness in 2021 — and the status lasted roughly five months. Functional zero is a condition you keep paying to maintain, not a finish line. CBC ↗
- Houston needs at least US$50 million a year beyond federal funding just to hold the line as pandemic-era money expires. Housing First at scale lasts only as long as its funding does. Kinder Institute ↗
- Canadian trial (high-needs group): a net of about Can$6,311 per person per year after offsets. The gross cost before offsets is much higher, and the savings land mostly in provincial systems, not with the city fronting the money. peer-reviewed (PubMed) ↗
44.28% of people assessed scored high acuity: 44.28% × 1,595 on the by-name list ≈ 706 people. At the trial's net cost, 706 × $6,311 ≈ $4.5M a year net — but that "net" assumes the mostly-provincial savings actually show up and get reinvested, and no current mechanism guarantees that. The gross cost would be several times higher and can't be worked out from the verified source. Apply the same scrutiny to any candidate's Housing First price tag. city snapshot (PDF) ↗