This week's Inland Journal episode is all about Housing First. Housing First is an approach to getting people off the streets by prioritizing getting them housed before anything else.
SPR hosted Jonathan Mallahan, Phil Altmeyer, and Simon Moorby to discuss the possible merits and shortcomings of the approach.
Mallahan is the executive director of Catholic Housing Ventures, the housing affiliate for Catholic Charities. Altmeyer is the CEO of Union Gospel Mission, which, among other things, provides high barrier homeless shelters. Moorby is the bar manager at Hogwash Whiskey Den. He has personal experience with both homelessness and addiction.
There's a lot going on in this conversation, but it's helpful to keep two big questions in mind.
First, both Mallahan and Altmeyer come at their work from Christian convictions. They both feel deep personal calls to love their neighbor, and you'll hear both of them repeatedly ask, what does it look like to love the vulnerable? Anyone who has tried to love someone who's suffering knows that that's a really tricky question.
Another question is, is housing a right or a reward? This seems to be at the heart of a lot of Spokane's housing conversations, so see if you can tease out how that question provides a backdrop for this conversation.
But we start off with Jonathan Mallahan giving us a more in-depth definition of what exactly housing first is.
JONATHAN MALLAHAN: At its root, housing first is a principle that there shouldn't be barriers between people and housing.
So if you're experiencing homelessness, housing first would say it is our job to find ways to say yes to you, to get you into housing, and then to work with you to overcome the challenges that might have contributed to your experience of homelessness.
ELIZA BILLINGHAM: Phil, would you add anything to that?
PHIL ALTMEYER: Well, it's interesting when you look at, it started in the early 2000s, and the goal was, 'Hey, if we help chronic homeless people, we'll save our city money because they won't be going to the hospital, we won't have the police showing up.'
And as Jonathan said, if you just get them in a house, then we can help them with the services. And so it's philosophy at the beginning, I really believe, showed some positive trends. I think the question is, is that happening today?
EB: Simon, you have experience being homeless...
SIMON MOORBY: Correct. Off and on through many years. I suffered about 15 years of active alcoholism. And through those years, off and on, I spent a lot of time on the streets.
EB: Was housing first something that was on your mind during that time or something that you heard about?
SM: It was something sort of on the horizon. I mean, ultimately, when I did find sobriety, it was, I think, paramount that I had that sort of structure in my life.
But ultimately, I found a room to rent through Craigslist, was the route that I found. And I certainly don't recommend it for most people.
EB: And did you find sobriety before or after you found your apartment?
SM: I was sober for about three months, I believe.
EB: Jonathan, would you start us off by talking about, is [Housing First] a successful model for getting people off the streets?
JM: I think it all comes down to what are we defining as success, as Phil was calling out.
Housing First's success is not the panacea to homelessness. There are many unique paths into homelessness. As many people as there are are homeless, there's a unique path into their experience. And so, there are unique paths out.
And so, we need lots of exits and opportunities for people to exit from homelessness. Housing First is one really important exit for people who have experienced chronic homelessness, who may also have a disability and have been homeless for a long period of time, and so what we see, and why I would say yes, I think Housing First is a great success, is that we see that people coming into our buildings have an average day of homelessness of over 10 years and that they have a disability.
We provide them with great wraparound support. We have an average of eight FTEs in our buildings to support people as they move through their journey as they heal. That includes care coordinators, health care navigators, peer supports, property management maintenance staff, as well as well as security.
What we see in those individuals' lives is really remarkable. We see that they reduce their vulnerability, the level of need in their first year by over 30%. We see that they rely on emergency services on average 40% less than when they were homeless.
We know that people who are homeless, and chronically homeless, die at a rate three times of what they do. Their mortality rate is three times as high as if they're housed. So, we know that housing first is helping people lead healthier lives.
It's helping people achieve their goals, and it's helping people rebuild their lives. But success does not look like homelessness in Spokane is eradicated and we've licked that problem and we can move on and do something else. There's a lot of work that still needs to happen.
EB: Phil, do you have things that you would like to...
PA: Well, I would come back to Jonathan and ask on the percents that you're sharing. Do you have statistics for the single housing first that we're talking about in the second and division area? That's different. I think, as I read, you have 771 people that moved on out of Housing First.
You guys do a wonderful work here in Spokane. You have so many programs. But when you give those statistics that you did, what's it look like for the people that are placed in the... They have a special term just for the Housing First downtown. I'm forgetting what it is.
JM: Permanent supportive housing?
PA: Yeah, but not permanent. Tell the listeners too, Jonathan, if I'm homeless, what is the requirement that allows me to move into housing first? Because people that go through a drug rehab program, people that get themselves sober, they're disqualified.
So you got to understand the chronic homeless, they know what it takes to get in there. And it's not making steps in the right direction. It's the people that have utterly made the worst of choices.
And so you're taking drug addicts, people that are using, and the philosophy is I put them in a house and all of a sudden they stop using. And they're going to be able to think clearly now, make good decisions.
Do our listeners understand even who gets to go to the front of the line to be chosen to go in? I know of nothing in our society that rewards bad behavior and then works.
So why don't we change who we allow and move forward in housing? You [Simon] just shared you were three months sober before you went into your first housing.
SM: Well, there were plenty of barriers set up between me and any sort of like outreach program that was willing to help me. Mostly it was the fact that I could find a couch to sleep on most any general night. So I wasn't statistically I was not considered one of the most at risk.
But on the flip side of that, I do find sobriety to be something that is it shouldn't be the barrier between the outreach available and the individual. Having been through that experience through much of my life now, I'm well aware that only 10% of those who suffer ever do find sobriety or recovery. And that leaves 90% of those who are suffering needlessly, who would be left without any sort of outreach help. That's a large number.
JM: I think if I could just add some context, people don't get selected to go into housing in Spokane because they're addicted. They are assessed—it's called the SALA now that's used in that assessment—to gauge someone's vulnerability.
Chronic homelessness will mean that they'll have a disability and they might they would have a prolonged stay in homelessness. So individuals with a disability, behavioral illness, those sorts of things, and higher stays in homelessness are the most likely to get housed first in these voucher units in our housing.
But we also have veterans. We have veteran vouchers for individuals who have served our country and are in need of assistance that live there.
The statistics I'm giving predominantly from our singles individual downtown projects.
And what I would say is, Phil, I hear you that do people choose to stay in their addiction? And what I see is if they don't become housed, they don't have the opportunity for that choice because the most likely outcome for them is death. So when we house them, people stay alive and we work with them to give them opportunities to change their life.
We know that 86% of the people in our buildings downtown choose to engage with services. They're saying, 'I do want to change my life. I want to work towards that.'
And, you know, Simon, your story is amazing. With Phil, I just stand in admiration of what you've accomplished. And what we see with folks is a lot of just personal perseverance. But that path to recovery is not a linear one. It is one full of successes and valleys. And that's what we see with the residents in our housing downtown.
EB: I think maybe an oversimplified definition of housing first is you put someone in a house and then they choose sobriety. That kind of linear pattern. And Jonathan, you just said that path to sobriety isn't linear.
I wonder if one of the deepest questions that we're asking is how do you convince someone to choose sobriety? And I understand that addiction and homelessness are not the same circles, although I think they overlap.
And so that's why I'm asking about this. But I wonder, can you force someone to choose sobriety? Can you force someone to fight their addiction? Because I wonder if that will get at where housing fits into this picture.
Simon, can I start with you?
SM: Absolutely. Through my personal struggles and in plenty of court cases due to my personal behaviors and bad decisions, I have had plenty of judges try to force sobriety on me. I've been through even family interventions explaining the issues and the behaviors and how these things require change on my part. To look back on it now, it seems so simple to correct those things that I was doing wrong.
But at the time, in the moment, those are so many boundaries. And with blinders on my perspective back then, I didn't see a way out. In my mind, it wasn't a decision. It wasn't a choice I was making. It was just where I was at in the moment. And I didn't really see a way out.
So I relate a lot to individuals who are in that position now. And thank you for the compliments. I do appreciate the community support and outpouring of love that I've received.
But at the same time, through my recovery, it wasn't necessarily a personal choice that, okay, I'm done. I'm going to change those behaviors now.
After 15 years, it was really a radical acceptance of how I was going to proceed from here on knowing that if I continued down that path, that I was going to die.
And that, you know, ultimately, I accept the fact that I will perish at some point, but I will control very much those terms and my actions of when that day comes.
And so, yeah, it gives me a perspective now of knowing that the best thing that I can do for those who still suffer is to help, to give them support. You know, a lot of these people out there who struggle not just with homelessness, but with active addiction are simply trying to survive the best way they know how.
And from another perspective, it doesn't, you know, we don't see that. You know, someone who is not in that headspace in that moment will never understand what those people are going through. You've really got to, you know, sit down and really experience what it is that they need.
And I think these gentlemen can offer a lot more perspective than I can as far as how the outreach is working.
EB: Jonathan, can I ask this idea that people are going into, name a building, and they're doing drugs in there instead of on the street and now we've just kind of concentrated the problem in a certain building. Do you think that's an accurate critique of housing first or is there a different way to think about it?
JM: People don't apply the same standards to us as they would a hospital. There's a lot of sick people that end up in a hospital and they're there because they're very sick. And the same is true of the buildings and the supportive housing environments that we provide in downtown.
I know that forced treatment results in twice as many overdose deaths as choice-driven treatment. That's what we're offering. We're trying to create an environment where people have the opportunity to be alive and to change their lives.
And the data shows that it's more effective than forced treatment, that people die at three times higher rate when they're not housed, that people have higher rates of overdose addiction when they're forced into treatment, when people have self-determination when they're empowered to move forward in their lives, when they have peer supports that are staffed in our buildings, sharing their own personal stories of coming through that trauma and through that experience and succeeding on the other end.
We build a community that people feel connected to and that they're more likely to move forward in their lives and overcome their addiction. I am not here to say that it works every single time that it's a panacea and I am so thankful for organizations like UGM and others that are doing so much good work.
The number one thing I want people to know is there are many paths in to homelessness. There need to be many paths out. Catholic Charities is not the only solution.
We're not claiming to be the right solution for everyone. We're saying we're here to help some really vulnerable people unconditionally, just like Jesus did. That's why we do it and we know that the successes that we see in the people's lives that we serve.
EB: Phil, can you talk about what UGM does and how you approach housing people and why you approach it that way?
PA: Well, I would say your question a minute ago was profound. Can you force someone? I love Jesus' example. It was always an invitation.
And there's this amazing thing. There's four of us in the room and I can't change any of you. I can only change myself. And to help an addict is to help him understand that. You know, there's only one person. And all you can do is offer hope and a path out. That's all you can do.
And peer support is critical. The thing that I wrestle with in the process of helping, what does it look like to help? And I believe the most important thing we can do is have a safe place for people to be healed. You don't put people in environments where other people are using and expect them to walk out of it. It's the worst place for that person.
So we really believe in a safe place. And we believe that it's heart change and it's invitation.
I can't force someone into recovery. But like I said, as a culture, we have accepted this as simply a sickness we're allowing people to kill themselves. And we call it compassion with no accountability.
I'm saying you aren't helping the person. We need to go deeper and understand what addiction is. And it's interesting when people become uncomfortable, they start moving toward wanting help.
It's fascinating to me, Jonathan, when I started this journey, we didn't have people living on our streets. It was unheard of. You had a few Vietnam vets that would camp out in the woods.
Today, culturally, what we've allowed in our culture, a subway of life. And we've added to this fentanyl, which has changed everything. Meth changed everything. One time and all of a sudden you're addicted.
And you ask people have a choice. Here's what's the hardest thing for me to grab ahold of. And I say it's a miracle when someone wants to change. And here's why.
Drugs alter a person's thinking. How can someone want out of something that their mind has been totally changed? You and I go, why are you sleeping out in the middle of the winter on a sidewalk? It's a no-brainer. We can't understand it. But when the mind is altered through drugs and addiction, they don't have the ability to see that that's not healthy.
So you say forced treatment? No, you can't force that person to change. But what's it look like to help him? That's the question I ask. What does it look like to help an addict? And I don't think keeping them on their drugs with that going on changes.
I can tell you now story after story of people where their life was changed, where the wake up call came. And I don't know if it's part of your journey and story. But for many, it's sitting in a prison cell where they finally got sober and started thinking differently, and brought them in off the street. It gave them what they need, food, shelter, and it gave them a chance to maybe rethink differently.
But I'm going to guarantee you while they're in prison, they didn't feed them drugs. They didn't allow drugs to be a part of their life that kept them in the wrong thinking.
So again, I think as a society, we have shifted so much about, yeah, people have a choice. Let's let them do what they want to do. Even though we know in our hearts, it's destructive. 'But I can't change that.' But I think there's things we can do as a culture and a society that do change that.
We allow this in our city. We've allowed it—lawlessness, crime. I mean, six thousand arrests on second division, six thousand.
We're saving money? Our hospital, did you know how much our hospital, they spent 157.8 million in poverty write-offs. All these things we were going to save money for by doing this, I'm not sure we're saving. Are we saving?
JM: Absolutely. We see that the residents in our housing have 40% less interactions with emergency service systems. We see that they visit the emergency room less frequently.
We see that they are taking care of chronic health conditions in a way that doesn't drive massive expenses and tragic deaths. So we see it very impactful for those individuals' lives.
And we shouldn't conflate the increase in homelessness in our community with whether or not Housing First as a model is successful or not.
Because Phil, you've been at this way longer than I have in this community. But the community has changed in many ways, not just in our policies about how we respond to people who are experiencing addiction. But I've just called out, this is really important for people to understand: housing and homelessness are integrally related.
In Spokane, in 2019, you could rent a one-bedroom apartment for $885. In 2025, that same apartment is going to cost you $1,444. That's a 66% increase.
In 2019, the number of people experiencing homelessness was 994. In 2015, that number is 1,435. That's a 50% increase. That's not an accidental correlation.
PA: Can I challenge that?
JM: Well, please, but if I could finish that, I'd love to hear your take. But people have been suffering with addiction for decades and decades in our community. That is not new. Whether it's behind doors or on our streets, definitely is new.
And fentanyl has absolutely changed the environment of the game. That is a problem our community needs to address. Catholic Charities believes that individuals who are involved in unsafe and criminal behaviors should be engaged by law enforcement. There should be support and help for them and accountability for the behaviors that detract from our community.
What I'm saying is Housing First is not the progenitor of those challenges. Housing First is an effective intervention to serve people with high needs and reduce their reliance on emergency services.
EB: Phil, I see you're wanting to say something, but can I ask a question really quick that I'm going to throw to Simon? Because I think part of what we're talking about is support versus enablement.
And I wonder, Simon, do you have ways that you parse those? Do you see them as the same thing? What I heard Phil saying was, 'we can't make it too comfortable for people who don't have homes because then they won't have the motivation to change their life.' Because I think you've talked about having this rock bottom experience or this experience of, like, 'I'm going to die. I have to change something.'
Do you think there's a difference between supporting someone through homelessness, maybe giving them a meal, giving them a place to stay, something like that, versus enabling someone to maintain an unhealthy lifestyle?
SM: Well, I think that the support, the community support in anything that we can do is sort of the catalyst to change. I think that's what inspires individuals, knowing they're not alone, knowing that someone cares, and knowing that their survival is not self-dependent, knowing that the help is there if they need it.
Now, I found the question interesting myself is sort of the paradox of whether this city is saving money by helping homeless people or not.
I think we lost our original question. It was like, are we here to help people, or are we here to save money?
There's a vast difference there. And I find that a lot of this struggle, not just in this city but nationwide, is because we're trying to solve an economic issue while trying to save money.
The wealth disparities in this country are at an all-time high. Wages will not pay for the rent in that apartment now. And what we're offering people as sort of the solution of becoming a functional member of society are these low-paying, menial jobs.
Where are the high-paying union jobs of old? Where is the meaning that these jobs used to hold, whereas now it's menial labor. And finding that as a solution for an individual who's been struggling through feelings of worthlessness is not the answer. I don't see it there.
EB: Phil, I cut you off, and we're coming up to time, so I'm going to let you close us out.
PA: Well, we talk about housing first as if there's not another alternative. Let's talk about the shelters that we've had for years, which is the first step to help providing housing, food, the resources necessary.
I get excited when I think of people going through that process, getting the support they need, not being on the streets. It's available. And then from there, when they make the choices and get the help they need, then putting them into housing.
Jonathan, I get this housing problem. Here's where I disagree strongly. When I look at the individuals that are on our street, the addicts and the homeless, they are incapable, even if you had housing, to live in it and take care of it.
It's their addiction or mental illness that has put them there. It's not a housing problem. Those individuals are not capable of living out there in a house.
They've been there. They've done drugs. They've gotten kicked out.
I mean, we're talking here to someone that couch surfed, then was able to even rent.
There's rentals out there, and I agree. The gap is getting wider. It is hard. But our crisis of homelessness is not because we don't have rentable housing for people. It's addiction.
They aren't even able to live in it and pay rent. They're the people that have been evicted. And so when we continue to say housing, housing, housing is a problem.
And the people that we're dealing with that are homeless can't even live, can't even work. I mean, let's be honest. That's not the problem. The problem is their addiction and where they're at.
So I agree that we need to build more housing, but that's not going to solve this problem we're talking about, nor is it to point the finger and say that's why they're on the street. That's not to me right.
It's not fair. It's not honest to what we're really seeing, because again, they've had the housing. They've been evicted, and it's usually almost all the time addiction related.
We've changed our philosophy on how we're helping people. And I say compassion is loving people, giving them the opportunity, and hold them accountable.
Because if the drugs hold them accountable, there's only one end, and it's death.
JM: If I could, and I know you're trying to wrap up here, Phil and I share our desire to help people and share our belief that we need to show the love of Christ. Catholic Charities is here to feed the hungry, heal the hurting, and welcome the stranger. And we help 70,000 people a year, and we move hundreds of people a year out of homelessness.
The challenges of street homelessness and people who are struggling with addiction are myriad. Housing First is not the panacea to solve all these challenges. It is a highly effective intervention for some people, and we need many other services to help solve this.
The face of homelessness in Spokane, though, is not the average person you see on our streets downtown. It's women and children. It's families.
And that's why we need to get upstream. We need to keep building more housing. That's what Catholic Charities does every day, helping people avoid those adverse experiences and that trauma that leads them to the experience of chronic homelessness and addiction later in their lives.
And when people find themselves there, just like Jesus didn't ask for conditions before he healed people, we're here to help. We're here to help you move forward in your life, and we are going to create that safe welcoming space.
PA: The great thing is, he healed them.
