Housing First.....it's all about context

So over the last few days I have ventured outside the streets of Downtown LA and done a bit of exploring. Probably due to everyone continually telling me, ‘Oh, you’ve got to have a car in LA’, I have been determinedly stomping around as much as I can, often surrounded by vast, concrete spaghetti junctions of freeways and accompanied by the soothing tones of car horns. These walks have helped me to somewhat understand the sheer scale of LA County (it is divided up into 85 separate cities), and the huge disparity between those that have and those that don’t. Walking back through the encampments, noise and rubbish on Skid Row, I reflected on my time at one of Downtown’s permanent supported housing units, and some of the discussions I had had with staff and clients there. 

Permanent supported housing (PSH), or Housing First, is a big thing in LA, as one practitioner mentioned in a meeting I attended a couple of days ago, “I wish we’d been doing this when I started 25 years ago”. Just as in the UK, those eligible for PSH must be ‘chronically’ homeless; in the US the definition of this is a person that has been homeless longer than one year and/or four or more times in a three-year period. Downtown’s 2016 needs assessment survey found that 58% of the women they surveyed had experienced chronic homelessness, this is over half of the female homeless population on Skid Row. Due to the chronic nature of their homelessness these women are much more likely to have poor and untreated physical and mental health and experienced violence or sexual assault. It comes as no surprise then that Downtown’s 119 on site, permanent supported housing units are in high demand!

I turned up at one of Downtown’s two onsite PSH, to meet case manager Zayda, who had kindly agreed to let me sit in on a case management session with one of the residents there. The building has 48 units, 40 of which are currently occupied, and residents share kitchens and bathrooms. The building has a lobby that is staffed 24 hours by a resident manager, but Zayda is the only case manager for the 40 women that live there (sometimes struggling to case manage my 6 clients, my jaw dropped when she told me this!). I sat in on a case management meeting with resident, Claire, aged 72, who happily announced that it was her 1 year anniversary of moving into her flat, and asked why no-one had thrown her a party! Claire told me that she suffers from depression, COPD and a number of other chronic physical ailments. She spent many years in temporary shelters and described how women and men were often put in the same dormitory, divided by a rope, which she tactfully described as ‘not good’. 

Zayda estimated that about 40% of the women that she supports are over the age of 65; this has made me aware of another stark difference between the US and UK context, where the local authority has a duty to house pensioners. Also, many of the women in the residence are domestic violence survivors, but due to the rules banning any boys over the age of 14 from the site, domestic violence is generally not an ongoing issue, as I have found it to be among our female clients in scattered site accommodation in the UK (although they have had some incidences of same sex domestic violence). A completely different way of ‘doing’ housing first then! Next week I will be visiting Housing First clients that live out in the community, in scattered site accommodation – cannot wait to compare and learn more!