A Primer on Homelessness

Hard as it might be to believe, homelessness has not always been with us.  Until the 1950s and 60s, most people with severe mental illness were warehoused in mental hospitals.  Until 1980s, many low-income people received some form of government assistance to maintain their housing, although the major federal housing subsidy has always been for the middle class and the wealthy in the form of the mortgage interest tax deduction.  Personally, I don’t recall seeing homeless people on the streets until the late 1980s when pictures of them sleeping on the grates in downtown Washington began appearing in the Washington Post.  Now, of course, you can’t walk very far in an urban area without finding people with no or inadequate housing.

We’re all used to it now.  Homelessness has become normalized.

This is a brief history of the beginning.

Deinstitutionalization

The deinstitutionalization of the mentally ill from American mental hospitals took place primarily in the late 1950s and 1960s.  Publicity about conditions inside the hospitals —overcrowding, understaffing and a primitive understanding of the needs of mentally ill patients — along with the overuse of antipsychotic medications such as Thorazine — had aroused the public to the need for change.  The high public expense of institutional care added to the perfect storm of political pressure to empty the hospitals.  

Many who participated in the process later expressed regret about their role.  Scattered programs across the country, however, had demonstrated that comprehensive outpatient care could allow persons with mental illness to be adequately cared for in the community.  The wholesale deinstitutionalization of the mentally ill seems to have been a sincere attempt to provide better care.  The problem was its implementation.

Discharge of patients from the mental hospitals happened quickly over those two decades; building a system of adequate outpatient care did not.  Needed funding for out-patient institutional infrastructure never materialized.  State and local governments did not provide adequate housing with proper medical and social supervision.  When out-patients had set-backs, there were no community structures for temporary in-patient care.  There weren’t enough social workers to smooth the integration into normal society.  Those who’d been institutionalized were on their own in an often-hostile society.

As a result, between the mid-1950s and late 1960s, approximately 90 percent of persons in long-term state psychiatric institutions, that is, hundreds of thousands of patients, were discharged into the community.  Where did they end up?  On the streets and in the jails.  As a result, there are currently three times as many seriously mentally ill patients in jails and prisons as in hospitals.

Defunding federal support for low-income housing

Although up to 30% of currently homeless people may suffer from serious mental illness, the majority do not.  The second major wave of homelessness began in the 1980s as the Ronald Reagan Administration drastically cut funding support for low-income housing:  

[T]he federal commitment to new units of low-income housing went from 347,600 in 1979 to 2,630 in 1983.  These cuts followed big [housing] losses in the private market, as developers replaced inexpensive single-room occupancy housing with luxury and commercial properties.  Nationally, a million units were destroyed in the 1970s alone.  [from The Hill] 

Since the federal government stopped building new public housing, the Housing Choice Voucher program (“Section 8” housing) has become the nation's largest rental assistance program, helping 2.2 million low-income households, including about 1 million families with children, rent modest units of their choice in the private market.  Renters usually pay about one third of their income while the program pays the rest.  Finding landlords of acceptable housing who are willing to accept the poor into their units (even with government payment guaranteed), however, is not always easy or even possible.  Long waiting lists (of up to ten years for larger families) are common … if the lists are even open for more names.

Although homelessness today is ascribed to many complicated, often insoluble causes, the underlying problem is simple: housing for low-income people is just not available.  

Housing Undersupply in High-Cost Markets

The US is in the midst of a long-standing housing shortage.  There are about five million too few housing units compared with households that would like to buy homes.  Especially in high-cost cities, like Washington, DC, the population has continued to grow while the complexity and cost of constructing new housing means housing supply hasn’t kept pace.  As a result, housing prices have climbed significantly faster than people’s income.  In some markets, even modest or low-quality housing is snapped up by middle-class wage earners, leaving people with very low incomes little to no housing they could afford.  

Further, even so-called “affordable housing” is not really meant for poor people.  In DC, for instance, a family of four earning less than $64,000 per year is too poor to be able to afford housing built through the most common federal affordable housing program, the Low-Income Housing Tax Credit.  

It's not complicated.  Low-income people simply cannot afford adequate housing.  As the wealth gap widens, only government action – including providing subsidies and encouraging more housing supply - can meet the problem.  Without significant government assistance, the only choices poor people have are overcrowding, substandard housing or homelessness.