Can Homelessness Be Prevented?
The policy emphasis on chronic homelessness is an important, albeit incomplete, solution in the quest to end homelessness among people with mental disabilities. There is ample evidence that permanent supportive housing has improved many lives. By prioritizing high-need, high-cost individuals who have extensive histories of street and shelter living for access to this highly specialized resource, people with mental disabilities who may be at risk of homelessness but do not meet the stringent criteria for chronic homelessness are left out. The lack of prevention and early intervention services can result in a constant influx of newly homeless people with severe mental illness whose homelessness may eventually become long-term and chronic. Ending homelessness requires opening the “back door” of the homeless services system to housing opportunities for people already homeless, but also closing the “front door” with effective interventions to prevent people from experiencing a first homeless episode (National Alliance to End Homelessness, 2009). The federal response to homelessness following the recession of 2008, the Homeless Prevention and Rapid Rehousing Program, gave new currency to a prevention paradigm whose effect is still being assessed (Culhane et al., 2011).
A prevention approach that considers a distinction between high-risk prevention and population-level prevention (Rose, 1992) is applicable to people who are extremely vulnerable to homelessness. It has the advantage of drawing attention to the need to address prevention, not only by intervening directly with those at high risk, but also by modifying the overall social and economic context in which homelessness can occur. The knowledge that people with severe mental illness constitute a group at high risk for homelessness obviates to some degree the problem of accurate targeting of prevention interventions when the risk for homelessness cannot easily be specified, an issue widely discussed in the literature (Burt et al., 2007; Culhane et al., 2011; Shinn et al., 2001). At present, there are no evidence-based homelessness prevention approaches, but ongoing work in the area is promising.