Housing First is really ‘people first’

Sam Tsemberis was not any kind of expert on housing in 1992 when he came up with Housing First, an idea that has revolutionized how many projects and policies aimed at ending homelessness approach their work. But now he is, and that idea has inspired a great deal of research and innovation.

Born in Greece and raised in Montreal, he trained as a clinical psychologist in New York City in the early 1980s. And as he walked to work in the morning, he realized that he was seeing many people living on the street who had been treated at the hospital the previous month. This group of people began to attract labels – treatment resistant was one. In other words, somehow being homeless was their fault.

“Most local authorities in the US and the UK operate what is known as the staircase model,” says Positive News. “Unlike Housing First, staircase expects people to be sober, engaging with support services, seeking employment, and have completed courses on managing a tenancy. Only then can one be considered housing ready.”

Instead of requiring the chronically homeless to change their way of life so they could get housing, Tsemberis turned that idea upside down. His idea was simple, cost effective, and socially progressive – Give people housing first. But actually, his focus was on the person, more than the housing, he explained in an interview in Amsterdam in 2013. And for clinicians, this meant changing how they thought about the mentally ill.


The Washington Post explained how it worked:

“First, prioritize the chronically homeless, defined as those with mental or physical disabilities who are homeless for longer than a year or have experienced four episodes within three years. They’re the most difficult homeless to reabsorb into society and rack up the most significant public costs in hospital stays, jail sentences and shelter visits. Then give them a home, no questions asked. Immediately afterward, provide counseling, a step research shows is the most vital. Give them final say in everything — where they live, what they own, how often they’re counseled.”

While many people thought this was a crazy idea, many cities, and people working with the homeless, were keen to try out his approach. Because it worked, and while some folks might have thought of it as impractically progressive, Housing First saved money. A lot of money. And for the people delivering it, it created the same kind of learning that had prompted Tsemberis to suggest it in the first time. Watch Lloyd Pendleton, who led the Housing First pilot in Salt Lake City, Utah.

Tsemberis’ research “has inspired policies across the nation, as well as in the District,” the Washington Post reported in 2015. “The results have been staggering. Late last month, Utah, the latest laboratory for Tsemberis’s’s models, reported it has nearly eradicated chronic homelessness. Phoenix, an earlier test case, eliminated chronic homelessness among veterans. Then New Orleans housed every homeless veteran.”

Tsemberis currently serves as CEO of Pathways Housing First Institute and is a clinical associate professor with the UCLA Department of Psychiatry. He consults with programs addressing homelessness, mental illness, and addiction across the US and Canada, the EU, Australia, New Zealand, and South America, and has published numerous articles, book chapters, and two books on these topics. His work has been recognized by National Alliance to End Homelessness, American Psychiatric Association, and the American Psychological Association.

The COVID pandemic greatly accelerated the uptake of the Housing First idea. In the UK,  says Positive News, “Boris Johnson’s government effectively – and unwittingly – rolled out a nationwide trial of Housing First. In March 2020, when the nation was legally put into lockdown and people were instructed to stay at home to try to halt the spread of Covid-19, the government adopted its Everyone In policy: an emergency scheme to accommodate rough sleepers.”

Nathan Dumlao/Unsplash

“Local authorities and an army of volunteers from various homeless charities mobilized. They helped 37,430 people find temporary accommodation in budget hotels, delivering hot meals and support from a secure and settled base. The results were breathtaking. In January 2021, less than a year later, the government reported that the scheme had helped 26,167 people sleeping on the streets find permanent housing. For a time, Everyone In – essentially Housing First by another name – came the closest we’ve ever been to eradicating street homelessness in the UK.” There are, however, questions about what happens now to make it ‘everyone in’ for good.

Finland is the only country in Europe where the number of homeless people is declining, as the state, municipalities and NGOs have been working hard to reduce homelessness since the 1980s. Less than 4,500 people are homeless in Finland now, down from around 20 000 in the 1980’s, as a result of national programs based on the Housing First model which work with the most vulnerable long-term homeless people. The Y-Foundation, created in 1985, set out to acquire existing apartments and offer them as rental housing to homeless people living alone. Today, it has over 18,000 apartments in 57 cities or municipalities.

In June 2021, all EU Member States committed to work together towards the ending of homelessness by 2030 and launched the European Platform on Combatting Homelessness to bring together Member States, EU Institutions and civil society organisations to fight homelessness, by implementing integrated, housing-led approaches.


Meet the outsider who accidentally solved chronic homelessness. Washington Post, May 6, 2015

The surprisingly simple solution to homelessness that’s changing lives. Positive News, Nov. 4, 2022

Housing First in Finland

TED Talk with Dr. Sam Tsemberis, founder of the Housing First model.Wellhouse, 2012

Featured image: Etienne Girardet on Unsplash