Curbing rates of veteran homelessness begins with implementing permanent supportive housing models that prioritize access to health care and mental health services.

Veterans are at a disproportionately high risk of experiencing homelessness: while they represent only 7 percent of the general public, this group accounts for 10 percent of the total homeless population in the United States. In Los Angeles County alone, there are approximately 3,886 homeless veterans according to the 2018 Greater Los Angeles Homeless Count.

Today, new solutions for affordable housing paired with health care and mental health services are being deployed across the country to help mitigate this issue. To shed light on how permanent supportive housing (PSH) policy may be implemented to effectively address veteran homelessness, we spoke with Benjamin Henwood, associate professor at the USC Suzanne Dworak-Peck School of Social Work. Henwood helped launch the Philadelphia housing agency Pathways to Housing and has a rich background in serving homeless individuals struggling with mental illness, physical disease and addiction.

A “housing first” approach to permanent supportive housing

While PSH programs can take a number of forms based on a community’s specific needs, permanent supportive housing is defined by the National Health Care for the Homeless Council (NHCHC) as “a model that combines low-barrier affordable housing, health care and supportive services to help individuals and families lead more stable lives.”

Traditionally, the approach to reducing veteran homelessness has begun with transitional models in which individuals experiencing homelessness are required to complete short-term residential rehabilitation and treatment programs before they can move into permanent housing.

However, the U.S. Department of Veterans Affairs (VA) has led a movement in recent years toward a reimagined “housing first” model of permanent supportive housing, which prioritizes placing individuals in PSH without requiring that they pursue mental health treatment, financial advising or addiction care. “The housing first model has become more popular in recent years due to a large body of evidence that suggests it may be more effective in permanently reducing rates of homelessness,” Henwood said.

The three types of permanent supportive housing

When it comes to the actual PSH placement, individuals are generally housed in one of three options: single-site, mixed housing or scattered-site housing. With purpose-built or single-site housing, entire apartment complexes are designed to house previously homeless tenants or tenants with specific service needs. In the mixed housing model, property owners or managers hold a set number of units to lease to formerly homeless tenants. Meanwhile, scattered-site housing is a model in which formerly homeless people can lease units from private landlords with the help of rental subsidy vouchers.

“Past research supports that the scattered-site approach is the most desirable to many people transitioning out of homelessness, because it seems to afford tenants more privacy and freedom to choose where and how they live,” Henwood said. However, more research on veteran-specific housing preferences is needed to determine if some veterans may prefer communal living that is similar to the experience of military service.

The scattered-site approach is also particularly beneficial to homeless veterans, who can utilize the HUD-Veterans Affairs Supportive Housing (HUD-VASH) program to obtain subsidies on housing units of their choice. The HUD-VASH program combines Housing Choice Voucher (HCV) rental assistance for homeless veterans with access to case management and clinical services offered by the VA.

Benefits of permanent supportive housing for veterans

Many permanent supportive housing programs include what are known as wraparound services. Wraparound is an approach to care in which multiple service providers—including social workers, nurses, primary care physicians, occupational therapists and others—collaborate to provide more comprehensive physical, mental and behavioral health care to the tenant.

Henwood believes that veterans may particularly benefit from wraparound services. “Permanent supportive housing models and services were originally designed to support people with multiple physical, mental or behavioral health issues,” Henwood said. “Since veterans are at increased risk for traumatic brain injuries, addiction, PTSD and other health complications, wraparound services can greatly increase veterans’ access to critical care and enable them to enjoy a better quality of life.”

Because there are no standardized clinical guidelines for these services in most cities, the quality and scope of care with PSH can vary immensely. While one program may have a full range of professional services available for every formerly homeless tenant, other programs may employ a single case manager with no background in social services or trauma-informed care to manage a roster of 50 cases. To increase the quality of care available to clients transitioning out of homelessness, Henwood believes that clearer guidelines surrounding the scope and quality of PSH services should be established.

Creating momentum to end veteran homelessness

Henwood is optimistic about the success of housing first models currently being implemented across the country. He’s right to be hopeful: a recent study conducted by the Centre for Research on Inner City Health of St. Michael’s Hospital in Toronto found that, over a two-year period, mentally ill homeless individuals who were provided with both rental housing and comprehensive mental health care services within a new housing first model fared significantly better than those who did not receive the same services.

Henwood is currently conducting a three-year study in conjunction with behavioral scientist Sarah Hunter at RAND Corporation on the efficacy of different outreach models in reducing veteran homelessness. The hope is that, by working with the VA to better understand current approaches, they can begin to develop more effective, regulated models that can meet the housing and health care needs of homeless veterans in LA County and beyond.

“Field-based work is not the kind of work that you’re often trained to do, even as a social worker — but when it’s done right, by offering comprehensive, home-based support that meets individuals in their communities, the potential impact within the veteran population is enormous,” Henwood said.

A previous version of this article stated that veterans account for 23 percent of the total homeless population. This statistic was outdated and has been updated accordingly.