The Dilemma of Housing First in Social Work: Client Choice and Anti-Carcerality

Background

Since the early 2000s, the “Housing First” approach has been the ideal evidence-based practice in homelessness intervention. While initially advanced by Sam Tsemberis as a more effective treatment model in a consumer choice and harm reduction framework, it proliferated for reasons of economic spending efficiency under the Bush administration. Compared to a Linear Residential Treatment model, which requires adherence to specific behaviors like sobriety to advance to housing, Housing First is viewed today as the ethical approach, somewhat distorting its proliferation out of economic necessity. This paper will investigate the degree to which Housing First can be considered anti-carceral by assessing treatment challenges and theory about client choice. It will also introduce a social work lens to practice situations where Housing First can reproduce inequality.

Methods

Assembling a literature review from political science, law, criminal justice, and rhetorical studies, this paper will use intersecting theories to evaluate the ethics of Housing First practices. First, we will reintroduce the historical conditions that led to the proliferation of the Housing First approach in the United States. Second, we will analyze how Housing First theoretically contrasts with the carceral logics of power, coercion, and control. Then, we will assess whether "consumer choice" can actually disrupt carceral logics under neoliberal economic systems, evaluating positive and negative freedoms and how structural inequality affects the ability to freely choose. Finally, we will consider modern case studies of rough sleeping and other forms of public homelessness that remain unaddressed by the Housing First model and provide practice recommendations for social workers and their clients that remain outside of these mainstream treatment models.

Results

Theory and evidence from failures of encampment resolution efforts suggest Housing First is not a direct solution to resolving homelessness. Part of this may be due to how inequality effects consumer choice. When an offer of housing feels inferior or meaningless devoid of other resources in severe material deprivation, or a client is incapable of choosing in the best interests of their health, Housing First highlights a key tension in social work’s code of ethics. Within the ethical principle, “Dignity and Worth of the Person,” offers of housing on their own may fail to promote client’s “socially responsible self-determination.” Advocating for more resources can address shortcomings of the model while also retaining the anti-carceral logics of the Housing First model.

Implications

This paper has practice implications for multiple levels of the homeless services and public mental health systems. Practitioners can use the theoretical insights from the literature to understand that consumer choice rhetoric is not inherently anti-carceral under structures that proliferation broader economic inequities and material deprivation. As author Neil Gong writes, “Is choice better understood as a person's stated desire to be left alone, or the cultivated ability to control impulses and pursue more elaborate life projects?” Social work can be better informed by class analysis and the resources required within Housing First to produce positive freedoms and rights to pursue elaborate life projects. Only then does choice truly become anti-carceral.