Housing *is* the Treatment
Content warning: trafficking, sexual exploitation
At one of the supporting housing sites I oversee, we recently conducted an assessment with residents. This assessment is designed to identify and quantify whether individuals who live there have ever experienced sexual exploitation or trafficking. The results of this assessment were a bit shocking and eye-opening—a great many of the youth who live at this site had in some way experienced these things, and not just the women.
Trafficking and exploitation may conjure a particular perception in your mind, probably influenced by sensationalized depictions in movies like Taken or Sound of Freedom. This global, under-ground ring version of trafficking is, of course, absolutely real and should be combatted. But trafficking happens on a much smaller scale too—all-too-commonly a young person enters into a relationship with someone offering something they need (food, shelter, security) and over time find themselves exploited within that relationship and, later on, trafficked by that partner to others.
A beautiful revelation from this hard-to-read assessment data was that these experiences of exploitation and trafficking were nearly always past experiences that stopped once they accessed supportive housing. It’s a stark reminder of why abusers target vulnerable people—it’s not only because they’re often isolated, but it’s also because they’re desperate. What would you be willing to put up with if it meant sleeping safe or eating for the first time in days? What might you fall for?
The intervention of stable housing for so many is enough to end that exploitation. When the survivor no longer needs the relationship to provide for their basic needs, all that’s left is the abuse. Leaving becomes attainable, and perhaps more importantly, imaginable.
There are so many important things this brings up, but for today I’m going to focus on one: that housing is an intervention that, even by itself, improves the holistic health of people who access it.
You likely know that I’m a proponent of the Housing First model, and a primary selling-point is that it provides a backbone stability upon which services can build. (I.e., it’s easier to find employment, access healthcare, store medication, comply with a treatment plan, etc., if you have a stable place to sleep and store your belongings every night.) But I think this reasoning alone can overlook the way that housing in and of itself improves all of these areas of people’s lives.
For example, drug use and addiction. For the 40-50% of unhoused people have chaotic relationships with alcohol and other chemicals, we can (and certainly do!) argue that moving toward recovery is much easier in housing than without it for a number of practical reasons. But the housing itself contributes to wellness more than just being a catalyst. People use alcohol and drugs primarily as coping mechanisms to regulate what is otherwise unmanageable and to meet immediate needs. I’ve known countless people who have used methamphetamines primarily as a way to stay awake and alert for safety. Many use opioids to manage pain both physical and emotional or to force their body to feel calm and safe when those experiences are impossible to them given their context of homelessness.
The same is true of mental health. While stable housing might provide you with a safe place to store medication or an increased ability to make and keep appointments with a therapist or psychologist, it also improves mental health intrinsically. The connection alone between good sleep and positive mental health can never be overstated. Additionally, the constant state of fight-or-flight that people experiencing homelessness must live in to survive exacerbates existent mental health issues and creates new ones, all while preventing any treatment or recovery. For those of you like myself who with anxiety, depression, or ADHD, imagine how much worse those symptoms would be if you were under constant stress and threat. Safe housing is an immediate treatment formental health, and enables so many more.
Dear reader, by this point I don’t think you need me to walk you through how this could impact physical health. You’re probably way ahead of me. I’ll spare you that, and instead tell you this: the connection between housing and physical health is so direct and clear that medical insurance companies are getting into the housing game!
Some of the biggest medical insurers in this country have been investing in and even developing housing because they recognize that their patients’ health depends on a stable place to live, and that in the long run they will spend less money on medical care if people have stable housing that keeps them from being sick and injured! On a government level, in several states (including Minnesota and California) housing supports are billable services for state Medicare! I’ve worked with agencies that bill housing search services, security deposits, and other services to unhoused peoples’ medical insurance.
It’s a total game-changer. The connections between housing and health are so self-evident that medical are prescribing housing as a treatment… and paying for it!
Consider this the last nail in the coffin for the old way of doing things—when we believed people had to get themselves “together” before they were “housing-ready.” All people are housing-ready, because housing is a necessity for human flourishing, not a reward for good behavior. It’s our housing that isn’t ready for people—with restrictive access, discriminatory practices, and misguided moralisms.
People don’t need treatment before housing.
Housing is the treatment, and the foundation for so much more.
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