On January 27 I wrote about three lessons imbedded in Russell Schutt’s fine book, Homelessness, Housing, and Mental Illness (Harvard University Press, 2010). Schutt’s team founds that executive function improves in group homes and gets worse in individual apartments. Addictions (unsurprisingly) lower rational thinking. “Empowerment’ of tenants works in theory, not practice.
Here’s his fourth conclusion: “Consumer preferences in themselves are not meaningful predictors of readiness for independent living.” That’s important in a current debate about whether mentally ill persons sleeping outside can be moved under roofs regardless of their preferences. Where that isn’t allowed, they have to be lured inside by promises of a separate apartment, even if that’s not the best place for them.
Shouldn’t we ask homeless people what they want, and then try to satisfy them? Not the mentally ill. Schutt: “Prevailing policy orthodoxy… presumes that independent housing will maximize housing retention because that is what most homeless persons with mental illness want. [But the evidence] calls into question the rationality of housing preferences — if by ‘rationality’ we mean a correspondence between what type of housing our participants wanted and what type they needed in order to maximize housing retention and functioning.”
Schutt’s research shows that giving an apartment — literally, housing apart from others — to a mentally ill person is a problem, not a solution. It can leave a person with nightmarish fantasies without a suitemate who can apply a dose of reality. Sure, “sleeping rough” is bad for physical health, but mental health is just as important, and roofs are insufficient when roots are lacking.
What about apartments for addicts or alcoholics? That’s also usually a big mistake. Schutt: “Brains that have been rewired by prolonged substance abuse to prioritize supporting the addictive habit above all other behaviors do not permit rational evaluations of the long-term costs and benefits of repeated substance abuse. When abstinence is not supported and maintained, the urge to ‘take up’ and continue using soon overwhelms the feeble defenses that reasoned calculation creates.”
Besides, drugging or excessive drinking in party situations is a problem, but drinking alone is no solution. I’ve seen in some cities — Houston most recently — how a certain campground camaraderie develops: Stashing one person in an available apartment and a friend somewhere else manufactures loneliness. That’s reality, not theory: Schutt found that homeless people who strongly preferred to live independently, and then received an apartment, were more, rather than less, likely to re-experience homelessness.
What about the minority of homeless individuals who are sane and healthy, but who have just been priced out of the housing market? Maybe, but the real solution is to build more housing, and that often requires changes in zoning and a reduction of red tape. The California solution of taxing people more to nab at least half a million dollars per apartment sends high earners fleeing to Texas or other states, and leaves low earners dependent on winning the equivalent of a lottery.
Overall, Schutt’s team randomly assigned some participants to group living and others to independent apartments. Group home residents had a higher rate of residential stability and gained in “executive functioning,” the ability to plan ahead and meet goals. The opposite happened to those in separate apartments: their executive functioning dramatically declined. This shouldn’t be a surprise: As coaches say, we play like we practice, and when we have less daily practice in interacting with others, we can readily become hermit crabs.
So what should we conclude about elevating homeless consumer preferences? Maybe that’s necessary when judicial interpretations force governments to pay steep prices to move people off the street. But those who absorb biblical wisdom know “the heart is deceitful above all things” (Jeremiah 17:9) and “Whoever trusts in his own mind is a fool” (Proverbs 28:26). We should be skeptical about our own self-assessments or predictions about what we need to be happy. That’s particularly true for people with below-average cognitive functioning because of alcoholism, drug addiction, or mental illness.
The larger beneficiaries of a “Housing First” program — hand a person an apartment — are (a) people offended viscerally by the sight and smell of homeless people, (b) people offended intellectually by the reality that in a rich country some are radically poor, (c) people who benefit financially by filling up old hotels with government-paid customers, and (d) officials who benefit financially by administering homelessness programs.