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Pathways to housing the homeless

(Page 3 of 3)

When one of Lee's clients asked for money for a manicure and pedicure, Lee agreed – with a flash of surprise. "This was a normal adult, taking care of herself," Lee says. "Working in the field, we still have these ideas – so I can imagine how people on the outside make all kinds of judgments about what [the formerly homeless] deserve."

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Consistent with its focus on independence, Pathways doesn't control clients' funds, but takes a "harm reduction" approach to finance. One-third of each client's Social Security disability checks, or other income, goes to rent. For the rest, they get their money in monthly lump sums – or, if they prefer, weekly allowances, so that spending sprees don't waste everything.

Those who have drug or alcohol habits that devour cash go food shopping with Pathways workers, who make sure they buy necessities first.

Harm reduction, in this sense, is a safety net to "minimize the extent of the damage, so the person will not end up homeless again," says Tsemberis.

Though critics decry such leniency as "enabling" addiction, supporters of Pathways and similar programs say that what clients do behind closed doors is up to them: The important thing is that they have doors to close.

Debating the standards

Critiquing programs that demand "housing readiness," Tsemberis shakes his head. "People with [mental illness and addiction who are] on the street ... see acutely the need for housing, for a place to feel safe and secure, before they're even ready to consider treatment. Recovery starts when you have something you care about, a place where you can go."

Still, most homeless advocates say that sobriety mandates have their place. Sue Watlov Phillips, president of the National Coalition for the Homeless, and executive director of Minneapolis-based Elim Transitional Housing, insists that both approaches are crucial.

Like Pathways, Elim operates on housing-first and harm-reduction models, on the philosophy that "If you can handle chemicals and handle life responsibilities, then it's not an issue for us," she says.

But for those seeking a stricter lifestyle, Elim offers two chemical-free sites. The "dry" environment, says Ms. Phillips, is crucial for those with life-threatening addictions, or those who must be sober to regain custody of children.

The Goose Hollow Family Shelter in Portland, Ore., likewise forbids substance use. But that, explains executive director Chuck Currie, is because the shelter serves families.

"I totally agree with what Pathways is doing," Mr. Currie says, lamenting the lack of similar local organizations. "Programs in Portland are pretty hard-core in saying: 'If you use alcohol or drugs, then we're not going to help you.' If you have severe mental health problems [here], you're more likely to end up living on the streets than in a shelter."

Costs for housing the homeless aren't cheap, but Dennis Culhane, professor of social welfare policy at the University of Pennsylvania, found that such programs as Pathways actually save money.

He determined that the cost to society for the average mentally ill person on the street was $40,500 per person annually in social and health services. Pathways' apartments and services, according to Tsemberis, cost only $22,000 per person each year.

But beyond the potential cost savings, the key to the success of Pathways and similar programs is that social services are offered – but not mandated.

"To attach services to housing is certainly a good idea," says Brad Paul, a housing-policy analyst at the Washington-based National Coalition for the Homeless, "but everyone should have the right to a place to live – regardless of whatever else they're dealing with."

For most Pathways clients, home is more than a right; it's a marvel.

After almost a decade, the wonder of his East Harlem studio apartment has not diminished for Hughes Smith: "It's like a dream, having your own place, being able to function like a human being," he says.