1. Craig Willse
Center for Ideas & Society
UC Riverside
cwillse@gmail.com
From Housing First to Chronic Homelessness
The Neoliberal Governance of Surplus Life

2. From Housing First
to Chronic Homelessness
I. Historical Background
II. Housing First
III. Chronic Homelessness
IV. Conclusions: Investing in Death

3. From Housing First
to Chronic Homelessness
I. Historical Background
II. Housing First
III. Chronic Homelessness
IV. Conclusions: Investing in Death

4. Historical Development
of Mass Homelessness
• Post-war: Emergence of Skid Row districts
• 1960s to present:“Urban renewal” and the
destruction of Skid Row housing
• Neoliberal economic restructuring
• Shift of industrial production out of U.S.
• Development of domestic knowledge and
service industries
• Rollback of public assistance programs
• Late 1970s: Mass homelessness emerges as a
“surplus population”
• 1987: McKinney-Vento Homeless Assistance Act

5. ✓ More than three hospitalizations or
emergency room visits in a year
✓ More than three emergency room visits
in the previous three months
✓ Aged 60 or older
✓ Cirrhosis of the liver
✓ End-stage renal disease
✓ History of frostbite, immersion foot,
or hypothermia
✓ HIV+/AIDS
✓ Tri-morbidity: co-occurring psychiatric,
substance abuse, and chronic medical
condition
Project 50: Vulnerability Index
Developed by Boston Health Care for the Homeless Program

6. From Housing First
to Chronic Homelessness
I. Historical Background
II. Housing First
III. Chronic Homelessness
IV. Investing in Death

7. From Housing First
to Chronic Homelessness
I. Historical Background
II. Housing First
III. Chronic Homelessness
IV. Investing in Death

8. I think there’s just this really old-fashioned
treatment approach to things, where you have
to earn your way to housing. I can’t really say
that I’ve ever seen any kind of formal funding
requirement of sobriety or anything like that.
You basically worked your way up the
Continuum. People thought that they needed to
have folks that were clean and sober. It was sort
of just a requirement that was handed down but
never really written anywhere.
“
”

9. So we focused on going out to the folks on
the street.They started to ask people,“Will
you work with us toward permanent
housing?” They didn’t talk to them about, like,
you need to get clean, you need to go into
[emergency] shelter, you need to get mental
health services.The first question was,“Will
you work with us towards permanent
housing?Your own apartment—your own
place with a door that locks. And if you’re
willing to work with us, we will stick with you
until it happens.” And that’s how they were
able to reduce [street] homelessness.
“
”

10. If this person goes back on the streets then
you the housing provider need to realize that
you failed the individual. It’s not the individual
that has failed himself, but we have failed to
figure out how to work with him. And you
need to be confident that you have exhausted
the possibilities. I think too much still we just
give up on people and say,“Well, they didn’t
jump through all the hoops we wanted them
to, so they clearly don’t want this housing.”
Well that’s nonsense, nobody wants to go to
sleep back on the street.
“
”

11. From Housing First
to Chronic Homelessness
I. Historical Background
II. Housing First
III. Chronic Homelessness
IV. Conclusions: Investing in Death

12. From Housing First
to Chronic Homelessness
I. Historical Background
II. Housing First
III. Chronic Homelessness
IV. Conclusions: Investing in Death

14. • Death rates twice as high
• 11x more likely to contract tuberculosis
• Rates of HIV twice as high
• 16x more likely to contract HIV
• 75 new HIV cases / 100,000 adults in NYC
• 1,241 new HIV cases / 100,00 adults in
shelter system

16. • 2,815 homeless deaths
• Average age of death 48.1 years old
(vs. 77.2 years old)
• Average life expectancy 36% shorter
• For Latina females, 49% shorter

17. “chronic homelessness”
“chronically homeless”

18. Dennis Culhane
Randall Kuhn
• “Applying Cluster Analysis to Test a Typology of Homelessness by
Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data”
• “Patterns and Determinants of Public Shelter Utilization Among
Homeless Adults in NewYork City and Philadelphia”

19. The ‘chronically homeless’ population could be
characterized as those persons most like the
stereotypical profile of the Skid Row homeless.
These are people who are likely to be entrenched
in the shelter system, and for whom shelters are
more like long-term housing than an emergency
arrangement.
Randall Kuhn and Dennis Culhane,“Applying Cluster Analysis to Test a
Typology of Homelessness by Pattern of Shelter Utilization: Results from the
Analysis of Administrative Data” (1998)

20. In general, being older, of black race, having a
substance abuse or mental health problem, or having a
physical disability, significantly reduces the likelihood of
exiting shelter.
Dennis Culhane and Randall Kuhn,“Patterns and Determinants of Public Shelter
Utilization Among Homeless Adults in NewYork City and Philadelphia” (1998)

21. Voice of America News
Broadcast July 30, 2008

22. The term ‘chronic homeless’ treats homelessness
with the same language, and in the same
fashion, as a medical condition or disease, rather
than an experience caused fundamentally by
poverty and lack of affordable housing.
National Coalition for the Homeless (2002)

23. Randall Kuhn and Dennis Culhane,“Applying Cluster Analysis to Test a Typology
of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data” (1998)

24. Randall Kuhn and Dennis Culhane,“Applying Cluster Analysis to Test a Typology
of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data” (1998)

25. Randall Kuhn and Dennis Culhane,“Applying Cluster Analysis to Test a Typology
of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data” (1998)

26. Malcolm Gladwell,“Million Dollar Murray”
The NewYorker, February 13, 2006
• 119 chronically homeless in Boston for 5 years
• 18,834 emergency room visits
• Minimum cost: $1,000 / visit
• 15 “chronically homeless inebriates” in San Diego for
18 months
• 417 emergency room visits
• Total average bill: $100,000 / person

31. From a conservative’s perspective, it saves
taxpayers money. Research has even shown it’s
cheaper in the long run to fund [housing]
programs because it reduces recidivism rates.
And it’s really expensive to go from shelter to
street to psych hospital to jail to community
courts, through all these revolving doors. So
that’s what I use sometimes when I’m talking to
a government type. I’ll talk about how it’s really
beneficial for people, but then if I’m really trying
to sell somebody on it who hates homeless
people, that’s what I’ll tell them about it.
“
”

32. From Housing First
to Chronic Homelessness
I. Historical Background
II. Housing First
III. Chronic Homelessness
IV. Conclusions: Investing in Death

33. From Housing First
to Chronic Homelessness
I. Historical Background
II. Housing First
III. Chronic Homelessness
IV. Conclusions: Investing in Death

34. I think we have the same interests.The business
community in downtown, some of the leaders
are a little bit ... hard to swallow. But we have
the same interests, right? I mean, I don’t think
they give a crap about homeless people, but
they wanna see no one sleep on the street and
we wanna see no one sleep on the street.
“
”