Ending homelessness is ultimately a human endeavor. It involves relationships, meeting people where they are at, and seeking to find solutions that are a point of common understanding. My years working front-line as a nurse made it abundantly clear that providing advice or ‘solutions’ is of no value if you are not perfectly in sync with your clients. In a lot of ways, I became skeptical of the narratives around health education and health promotion as I found that in most cases my patients knew what they needed to do to be healthy, but lacked the determinants of health required to support this knowledge. And, often, my patients were simply wiser than me. Telling people what they need to do doesn’t often create much impact.
This same consideration needs to be central in how we support sustained exits from homelessness. Solutions need to meet the realities of peoples’ lives, the motivation needs to come from the individual themselves, and as service providers we are encouragers and providers of resources.
This is seen clearly in the principles of Housing First, in particular:
CONSUMER CHOICE AND SELF-DETERMINATION
Housing First is not about shifting people from one unwanted shelter environment to another unwanted housing environment, it’s about providing access to housing of choice. Housing will not be sustained if the participant is not on-board with the journey.
There is an ethical consideration here as well. Health and social services have a tendency to erode the control of individuals. There is a form of institutionalization when systems are inflexible, supports are impersonal, and choice is absent. This runs counter to what we learn as social workers, mental health care providers, nurses, etc. We are taught to value EMPOWERMENT, to make spaces for people to empower themselves, to share decision-making, to follow the lead of those we serve. This is the opposite of institutionalization, this is creating a system that is truly healing.
During the COVID-19 pandemic there have been challenges to this idea of autonomy and choice. The urgency to create safer housing environments is a new degree of pressure in terms of achieving independent housing outcomes. High density, full occupancy shelters are high risk, so are urban encampments. Therefore, there is rational evidence supporting the necessity of shifting people quickly into hotels/motels or independent rental or supported units. Indeed, this has been much of the success story, of how quickly and what scale we are able to create exits from homelessness when new resources are dumped into the system. But there is a flip-side to this. While we as ‘experts’ might perceive a move from a campsite to a hotel or housing is better for safety, this transaction can quickly become coercive. Several municipal interactions around urban campsites during COVID-19 have involved the offer of housing with the threat that the campsite would be removed the next day (or even next hour). Obviously housing is ideal, but the delivery becomes “housing or else…”
Oudshoorn (yes, I’m self-referencing this time), Dej, Parson, and Gaetz recenlty proposed an update to the Framework for Homelessness Prevention. To the 5 domains of (a) Structural prevention; (b) Systems prevention; (c) Early intervention; (d) Eviction prevention; and (e) Housing stability we have added the concept of empowerment. There is little value of rehousing people if we dehumanize them along the way. There will always be urgency in the system, while it’s a pandemic right now, at other times it’s funding cycles, evaluation metrics, or our own sense of needing to help. However, we can’t abandon the underpinning values of consumer choice and self-determination in the process of helping.