Walking into my quiet, darkened apartment in Midtown after work, the noise and tumult of the day starts to fade; my breathing slows down; and I can feel my cortisol level, a stress hormone, dropping. Across the city, 50,000 other men, women and children living in a public shelter or on the street can’t experience what I just have: the luxury of opening the front door to a home of their own.
The Bowery Mission estimates that for every person sleeping on sidewalks or on subways, 20 more are sleeping in shelters. With Mayor de Blasio’s recently announced plan to move people experiencing homelessness out of hotels, where they were housed during the pandemic, and back into shelters, New York City’s homeless will be even further away from a safe and secure future.
As a family physician and the new CEO of The Jewish Board, one of New York State’s largest behavioral health and social services agencies, I believe that shelters are a triage, and they won’t solve the entrenched problem of homelessness. In fact, over the course of my career as a doctor, the most powerful medication I’ve ever seen is an apartment. After someone moves into an apartment off the streets, within a few weeks, their health conditions improve, they look better, voices they may be hearing in their head quiet down, addiction improves and recovery begins.
Chronic street homelessness is hard to solve because it’s not one problem but many issues compounding over time. Multi-generational trauma, domestic violence, poverty, unemployment and underemployment, addiction, mental health issues, learning disabilities and histories in the foster care system are just some of the underlying challenges that, often together, lead to people living on the street. Moreover, many people who are chronically homeless experienced physical and sexual abuse as children from which they have never recovered. Lying in an open shelter, on cots, without physical or psychological safety after a history of such abuse is damaging, cruel and potentially re-traumatizing.
The good news is that in the last 20 years we’ve learned a lot about how to “cure” homelessness, and the answer is simultaneously both simple and complex: an apartment with specialized supports provided by a team of behavioral care experts. In the older housing model, clients had to initially go through a shelter, often taking years to “earn” an apartment of their own. In the newer, low-barrier model, called Housing First, people move directly into an apartment with a trained team, supported by innovative treatment approaches that may include newer anti-psychotic medications, medication-assisted addiction treatment and patient-centered care planning. As this model has spread all over the country, we’ve seen how shelters are mostly unnecessary — if adequate supportive housing units are made available.
New York City is a catchment for people experiencing mental health, addiction and housing challenges from across the region, so it’s time to think of the solution in statewide and regional terms. My organization operates 1,200 units of supportive housing across New York City for many people who were formerly homeless and provides much-needed mental health counseling and job training to support them and move them toward independent living. Every day we watch our clients take steps towards recovery, wellness, employment and re-engagement with their families through the safety of an apartment and the quiet of being off the streets and out of the shelter system.
But with the cost of acquiring housing so expensive, it is likely not possible for city-based providers to house every single person experiencing homelessness here in the five boroughs; we need to view this as a statewide problem with a statewide solution to create new units of supportive housing for anyone who wants to relocate. New York State’s recently announced budget and legislative actions include significant resources for enacting a five-year housing plan, new units of supportive housing, and enhanced support for existing units of supportive housing. These investments could not be more timely or more needed.
Now is the time to encourage coordination and collaboration between the city and state, making it possible to maximize the use of federal Medicaid investments to pay for much of the wraparound care that would help people succeed in living independently and target families exiting domestic violence shelters. Many hotels across the state will likely remain empty; the state’s plan to spend $100 million to convert these units to affordable housing is a smart and timely investment.
As we emerge from COVID, we must think boldly about our social infrastructure. Instead of growing our institutional economy of prisons and hospitals, we need to create a caring economy of community-based services. New York City needs to be prepared with shovel-ready projects to eliminate homelessness through expansions in supportive housing.
Brenner is CEO of The Jewish Board of Family and Children’s Services.
