This commentary is by Mike Block, CEO of All Roads.
I have an eerie feeling that we have been here before.
In the early 1960s, President Kennedy questioned the United States’ reliance on large mental health institutions to serve those suffering from extreme mental health issues. By the 1970s, that thought had become policy. And by the end of the 1980s, 500,000 institutional beds serving those with the gravest mental illnesses were lost.
The promise was that the savings from closing those institutions would be reinvested into community mental health centers, and care would be improved. Instead, of the approximately 565,000 mental health beds available in 1950, only 65,000 remain today — a per capita reduction of nearly 95%.
While the flaws in these institutions have been well documented (not least by the film “One Flew Over the Cuckoo’s Nest”), shutting down nearly the entire system and sending a half million severely impaired souls out of their beds amounted to throwing the baby out with the bathwater. Modern homelessness was born, and no significant adjustments have been made since then to provide a dignified response for many people whose mental health condition poses a threat to themselves or others or leaves them gravely impaired. Today, when someone is plainly unable to care for themselves, authorities often have no place to take them other than, at best, a few hours of observation before being released.
Unfortunately, I fear we are at the front door of another misguided policy shift. In the past few years, conservative think tanks have begun to target Permanent Supportive Housing (PSH), a model for ending homelessness that pairs long-term housing (often referred to as Housing First) with support services, especially access to treatment. These are proven, highly successful housing programs for homeless individuals with the most severe impairments. These individuals die at an average age of just 51 years. Yet far from seeing this as a health crisis and these programs as its best solution, the Heritage Foundation’s Project 2025 proclaims, “Housing First is a far-left idea.”
The stakes are enormous. PSH houses and provides support to 240,000 of the most desperate people in the country, including over 300 right here in Boulder County. Yet Congress is considering proposals to cut funding for these programs, instead supporting programs that focus on treatment. This is a false choice. Treating pathologies is critical for everyone, but so is housing. Forcing severely disabled individuals back into homelessness is cruel and short-sighted. Yet national and even some local voices support this plan, rallying behind a bill introduced last year by a Kentucky congressman that would do just that.
And who among us believes that the powers in D.C. leading this fight will actually follow through on the promised reinvestment in treatment? Or are we instead facing a repeat of the broken promises of the 1970s and 80s, when shutting down mental health institutions was more about cutting services than reinvesting and improving lives? If history teaches us anything, it’s that attacking Permanent Supportive Housing could push hundreds of thousands of our most unlucky, impaired and at-risk neighbors back onto the streets, armed only with the hollow promise that an unproven approach will yield better results. We don’t have to imagine what might go wrong — we’ve lived through this only a few short decades ago.
Not long ago, “John,” a client of All Roads, Boulder’s primary homeless shelter and Permanent Supportive Housing provider, visited Boulder Community Health’s emergency room a staggering 161 times over 24 months. Years of misfortune had left him living on our streets, in a near-constant battle with medical conditions that required ER visits nearly twice a week. After John was placed in our Permanent Supportive Housing program three years ago, his ER visits dropped to just 14 — a 94% reduction. This is exactly the kind of person who would end up back on the streets if we allow political leaders to dismantle these Permanent Supportive Housing programs.
Let’s not fall for the false choice that it must be either housing or treatment. We need both. If we allow this attack to succeed, we will likely end up with neither.
Excellent op-ed. We need more PSH, not less. Housing First is an obvious approach to homelessness that we as a community need to support.
We do need more PSH. But we also need more and better treatment and oversight within PSH, especially for the mentally ill and those suffering from addiction. This is the crux of the issue for many who are critical of PSH — the services are rarely adequate for those populations. Although it is a godsend for those with physical and medical disabilities, those other vulnerable populations require a much higher standard of care and oversight than typically provided through PSH. This will only get worse.