TEDMED 2016
Lloyd Pendleton: The Housing First approach to homelessness
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What do you think would happen if you invited an individual with mental health issues who had been homeless for many years to move directly from the street into housing? Loyd Pendleton shares how he went from skeptic to believer in the Housing First approach to homelessness -- providing the displaced with short-term assistance to find permanent housing quickly and without conditions -- and how it led to a 91 percent reduction in chronic homelessness over a ten-year period in Utah.
Lloyd Pendleton - Homeless advocate
Lloyd Pendleton wants to eliminate chronic homelessness. Full bio
Lloyd Pendleton wants to eliminate chronic homelessness. Full bio
Double-click the English transcript below to play the video.
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What do you think would happen
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if you invited an individual
who had been living on the street
who had been living on the street
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for many years,
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had mental health issues
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and was an alcoholic
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to move directly from the street
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into housing?
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We had heard this was being done
in New York City,
in New York City,
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and it was called the Housing First model.
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We wondered if it would work in Utah.
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So to make that determination,
we decided to create a pilot,
we decided to create a pilot,
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and Keta was one of the 17
chronically homeless individuals
chronically homeless individuals
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we included in this pilot.
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She had been on the street
for 20-plus years,
for 20-plus years,
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had mental health issues
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and was a severe alcoholic.
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The first night in her apartment,
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she put her belongings on the bed
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and slept on the floor.
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The next three nights,
she slept out by the dumpster
she slept out by the dumpster
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near the apartment building.
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With the aid of her case manager,
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she moved back into her apartment
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but continued to sleep on the floor
for several nights.
for several nights.
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It took over two weeks for her
to develop enough trust and confidence
to develop enough trust and confidence
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that this apartment was hers
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and would not be taken away from her
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before she would start
sleeping in the bed.
sleeping in the bed.
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Homelessness is a continuing
challenge for many cities
challenge for many cities
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throughout our country.
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Our homeless population falls
into three major categories:
into three major categories:
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those that are temporarily homeless,
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about 75 percent;
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those that are episodically homeless,
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about 10 percent;
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and those that are chronically homeless,
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about 15 percent.
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Chronic homelessness is defined
as an unaccompanied adult
as an unaccompanied adult
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who has been continuously
homeless for a year or more
homeless for a year or more
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or more than four times
homeless in three years
homeless in three years
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that totals 365 days.
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This small 15 percent
of the homeless population
of the homeless population
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can consume 50 to 60 percent
of the homeless resources
of the homeless resources
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available in a community.
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In addition, they can cost the community
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20,000 to 45,000 dollars a year per person
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in emergency services costs,
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such as EMT runs,
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emergency room visits,
as many of you will be aware,
as many of you will be aware,
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addictions, interactions with the police,
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jail time.
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Simply put, this small
population costs a lot.
population costs a lot.
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Based on this reality, the US government
began an initiative in 2003
began an initiative in 2003
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inviting states and cities and counties
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to develop a plan to end
chronic homelessness
chronic homelessness
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in a 10-year period.
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The state of Utah accepted
this invitation,
this invitation,
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and I was asked to lead this effort.
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In 2005, we approved a 10-year plan,
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and 10 years later, in 2015,
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we reported a reduction
in our chronic homeless population
in our chronic homeless population
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of 91 percent statewide.
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(Applause)
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That's amazing.
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When I began this process,
and we began this process,
and we began this process,
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I realized that I had a limited
understanding of homelessness
understanding of homelessness
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and the factors that impacted it,
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and that I needed a fairly major change
in my belief, in my thinking,
in my belief, in my thinking,
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because I had been raised
with the theory of rugged individualism
with the theory of rugged individualism
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and "pull yourself up by the bootstraps."
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That philosophy came from being raised
on our family's cattle ranch
on our family's cattle ranch
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in a small town
in the western desert of Utah.
in the western desert of Utah.
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On the ranch, you learned
that nothing takes priority
that nothing takes priority
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over caring for the cattle,
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something always needs fixing
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and most importantly,
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hard work makes the world right.
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It was through that lens
that I would see homeless people.
that I would see homeless people.
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When I was a teenager, our family
would go into Salt Lake City,
would go into Salt Lake City,
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and I would see these homeless people --
"hobos" we called them then --
"hobos" we called them then --
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sitting around on the street,
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and I would think,
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"You lazy bums, get a job.
Pull yourself up by the bootstraps."
Pull yourself up by the bootstraps."
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After high school, I left the ranch,
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graduated from college,
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went to work for Ford Motor Company
for several years,
for several years,
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then got a job at the Church
of Jesus Christ of Latter Day Saints
of Jesus Christ of Latter Day Saints
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and moved back to Salt Lake City.
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During that employment,
I had the opportunity to be loaned out
I had the opportunity to be loaned out
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to the state's largest homeless shelter
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to assist them in developing and improving
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their financial
and management capabilities.
and management capabilities.
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While there, I became aware
of a new approach
of a new approach
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to dealing with homeless individuals
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and drug addicts.
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It was called the harm reduction model,
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and it consisted of passing out
clean needles and condoms.
clean needles and condoms.
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And I thought, "Now that
is one stupid idea."
is one stupid idea."
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(Laughter)
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"That's just going to encourage them
to continue that behavior.
to continue that behavior.
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Just tell them to stop."
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Several years later, I read
some of the early 10-year plans
some of the early 10-year plans
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to end chronic homelessness
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promoted by the federal government.
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As I read through those plans,
and I thought,
and I thought,
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"Pfft! This is unrealistic.
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You can't end homelessness.
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There's too many personal choices
and factors beyond our control."
and factors beyond our control."
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My perspective changed, however,
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when I attended a conference in 2003,
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where I learned the reason
behind the 10-year plan.
behind the 10-year plan.
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First was this small population
of the homeless group
of the homeless group
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that was 15 percent
and were very expensive.
and were very expensive.
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That made sense
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for a conservative state like Utah.
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The second insight was learning
about this Housing First,
about this Housing First,
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or low-barrier housing.
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There had been an agency in New York City
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that had been inviting
mentally ill homeless individuals
mentally ill homeless individuals
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to move directly
from the street into housing.
from the street into housing.
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And they were also allowed to continue
to use drugs and to drink,
to use drugs and to drink,
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just like we can in our homes.
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They were, in addition, offered
services -- not required to use them --
services -- not required to use them --
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by on-site case managers
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to assist them to adjust
to their new living arrangements
to their new living arrangements
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and to stabilize their lives.
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They were using the harm reduction model.
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And despite my initial low expectations
about hearing about this model,
about hearing about this model,
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they were having
an astonishing success rate:
an astonishing success rate:
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85 percent were still housed
after 12 months.
after 12 months.
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The third insight
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was the importance of developing
a trusting relationship.
a trusting relationship.
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Because of the abuse
these individuals have had
these individuals have had
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throughout most of their lives,
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they hardly trust anybody,
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and the clean needles and condoms
and low-barrier housing
and low-barrier housing
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was a means to begin to develop
a relationship of trust.
a relationship of trust.
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Vital.
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So as I flew home from this conference,
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sitting in the plane
looking out the window,
looking out the window,
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I realized that my understanding
and perspective about homelessness
and perspective about homelessness
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was shifting.
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And as I stared out that window,
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this very strong feeling
and thought came to me
and thought came to me
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that if there's any state in the union
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that could end chronic homelessness,
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it was the state of Utah,
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because there's an underlying feeling
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and desire and willingness
to collaborate to serve our neighbors,
to collaborate to serve our neighbors,
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including those who are homeless.
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A new vision was becoming clear to me
how this could be done.
how this could be done.
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Now, those of us that attended
the conference said,
the conference said,
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"Yeah, these models will work in Utah."
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But when we got back home,
there were many who said,
there were many who said,
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"Nah, those aren't going to work.
They won't succeed here."
They won't succeed here."
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But there was, however,
an affordable housing organization
an affordable housing organization
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who was willing to build
our first 100 units.
our first 100 units.
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But they had concerns about having
100 chronically homeless people
100 chronically homeless people
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in one location.
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To address that concern,
we decided to create a pilot
we decided to create a pilot
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to test that idea while we built
the first 100 units.
the first 100 units.
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We would use existing units
scattered throughout Salt Lake City.
scattered throughout Salt Lake City.
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Then we debated:
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Should we select fairly
high-functioning homeless persons
high-functioning homeless persons
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or the most challenging
ones we could find?
ones we could find?
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And this is where my background
on the ranch came into play.
on the ranch came into play.
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Back then, my mother cooked our meals
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and heated the water for our weekly bath
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on a wood-burning and coal-burning stove.
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And after chopping wood
for that stove all those years,
for that stove all those years,
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I'd learned to chop
the big end of the log first,
the big end of the log first,
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when I had the most energy.
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We decided to use the "big end
of the log first" approach
of the log first" approach
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and selected 17 of the most challenging,
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difficult, chronically homeless
people we could find,
people we could find,
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because we knew we would learn
the most from them.
the most from them.
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Twenty-two months later,
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all 17 were still housed,
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including Keta,
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who today, 11 years later,
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is sleeping in her own bed
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and is sober.
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At the end of this pilot,
one of the young case managers said,
one of the young case managers said,
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"We used to debate
up at our university classes
up at our university classes
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which theory of case management
was the most effective.
was the most effective.
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Now our theory of case management is:
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anything necessary to keep them housed."
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We became believers,
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and built hundreds of units
over those next 10 years,
over those next 10 years,
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leading to the reduction of our statewide
chronic homeless population
chronic homeless population
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of 91 percent.
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Now, who are homeless people?
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Many people just want them
to go away, to disappear,
to go away, to disappear,
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not disrupt our lives.
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Through this 10-year, 11-year process,
I gained many insights
I gained many insights
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of why people become homeless.
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One of those insights
came to me a few years ago
came to me a few years ago
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when I was visiting
with our medical outreach team.
with our medical outreach team.
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These are our frontline workers
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that go out and visit
the street homeless and the prostitutes
the street homeless and the prostitutes
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to check on their medical health.
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One of the team members mentioned
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that eight of the prostitutes
had given birth to 31 children
had given birth to 31 children
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that had become wards of the state.
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They also shared that some of the pimps
were their husbands,
were their husbands,
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and worse yet,
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their parents.
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These prostitutes,
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in their late teens, 20s, early 30s,
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were expected to earn
enough money a day to support
enough money a day to support
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a hundred-dollar-a-day heroin addiction,
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their living expenses
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and their pimp.
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And with unprotected sex,
they were paid more,
they were paid more,
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and predictably,
this would lead to a pregnancy.
this would lead to a pregnancy.
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Children born under these circumstances
many times end up becoming homeless.
many times end up becoming homeless.
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And it's not helpful to look at
those born under those circumstances,
those born under those circumstances,
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or a parent that makes their child
a drug addict at age seven,
a drug addict at age seven,
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or a generation of babies
born through drug addiction,
born through drug addiction,
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and not feel some despair.
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For me, I believe
every person is of value,
every person is of value,
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no matter who you are.
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And it's not helpful to look
at somebody with this start in life
at somebody with this start in life
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and blame them for where they are.
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(Applause)
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No one grows up saying,
"My goal in life is to become homeless."
"My goal in life is to become homeless."
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And that's the beauty of the harm
reduction and Housing First model.
reduction and Housing First model.
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It recognizes the complexities
of the different factors
of the different factors
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that can shape a human life.
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These models meet people where they are,
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not where we are
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or where we think they should be.
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The pilot we did with our 17
taught us many lessons.
taught us many lessons.
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When people have been living
on the street for many years,
on the street for many years,
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moving back into housing
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requires lots of things to learn.
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And Donald
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taught us some
of these transition lessons.
of these transition lessons.
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His case manager asked him
why he had not turned up the heat
why he had not turned up the heat
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in his cold apartment.
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Donald said, "How do you do that?"
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He was shown how to use a thermostat.
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The case manager also observed
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that he was heating the beans
in the can on the stove,
in the can on the stove,
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like he had done over
the campfires for many years.
the campfires for many years.
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He was shown how to use pots and pans.
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We also learned that he had a sister
that he had not seen in 25 years,
that he had not seen in 25 years,
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who thought he was dead.
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She was happy to learn otherwise,
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and they were soon reconnected.
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Hundreds of people like Keta
and Donald are now housed
and Donald are now housed
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and reconnecting with their families.
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Also, many of our
communities are incurring
communities are incurring
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fewer emergency services costs.
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I have learned over and over again
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that when you listen to somebody's story
with an open heart,
with an open heart,
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walk in their shoes with them,
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you can't help but love and care for them
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and want to serve them.
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This is why I'm committed
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to continuing to bring hope and support
to our homeless citizens,
to our homeless citizens,
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who I consider to be
my brothers and sisters.
my brothers and sisters.
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
Lloyd Pendleton - Homeless advocateLloyd Pendleton wants to eliminate chronic homelessness.
Why you should listen
After retiring from high-ranking positions at Ford Motor Company and the Church of Jesus Christ of Latter-day Saints, Lloyd Pendleton began his second career as the Director of Utah's Homeless Task Force in 2006. His goal: to functionally eliminate the state's chronic homelessness problem within 10 years. Through Utah's Housing First program, Pendleton prioritized providing the homeless with short-term assistance to find permanent housing quickly, and without conditions. With access to permanent, stable housing, individuals were better equipped to sustainably improve their wellbeing. The Housing First approach succeeded in reducing the number of homeless from 1,932 to 168 by 2016. Pendleton retired from state employment in June 2015 and has since been consulting with other states about different approaches to eliminate chronic homelessness.
Lloyd Pendleton | Speaker | TED.com