Why Does the Ten-Year Plan Focus on the Chronic Homeless?

Despite the belief by some that Knoxville is unique in tackling chronic homelessness, the idea for the Ten-Year Plan didn't originate here in the foothills of the Smoky Mountains or even in Tennessee. Its ideological grounding comes from early '90s New York City, and from various plans, including those in Seattle, Portland, Denver, and Philadelphia. Today, there are more than 350 Ten-Year Plans at various levels of implementation across the country, with roughly a third dealing specifically with the chronically homeless and the rest aimed at the homeless population as a whole.

That national movement is approaching 10 years old. Back in early 2002, President George W. Bush appointed Philip Mangano to head up the Interagency Council on Homelessness, the federal body charged with overseeing this domain of policy. Mangano (pronounced with a hard ‘g') was seen as something of a dynamo in his field, and drew on research from Dennis Culhane at the University of Pennsylvania. Culhane argued for working to move the chronically homeless—defined as people who are disabled and homeless for more than a year, or four times within a three-year period, and who constitute just 10 to 15 percent of the total homeless population—into housing as quickly as possible. His research showed that despite being a small percentage of the group, the chronically homeless consume a disproportionately large amount of resources—somewhere around 50 percent; since many in this population are mentally ill and/or substance and alcohol abusers, society incurs untold costs for jail cells, emergency room visits, ambulance rides, etc.

Mangano argued for placing the chronically homeless in housing, whether they were clean and sober or not. The theory goes that once there, with a door between them and the world, people would become more stabilized and could better focus on how to address the problems that initially landed them on the streets in the first place. The benefits of this strategy, known as Housing First, would be twofold: 1.) It's the right thing to do from a humanitarian standpoint, and 2.) it will ultimately save money.

In 2008, Dr. Roger Nooe, who taught at the University of Tennessee's College of Social Work for 30 years, and who served as first director of Knoxville's Ten-Year Plan, used a sample of 25 chronically homeless individuals to estimate a per-person cost of annual services of roughly $37,000. Meanwhile, the cost of an individual in permanent supportive housing, according to the Office of the Ten-Year Plan, is somewhere around $17,000. That means the public would get somewhere around $20,000 in savings while achieving better results.

However, Ron Peabody, spokesman for TYP Choice, and others question those projections. Peabody thinks the sample size is too small, and his homeowners association produced its own estimates that arrived at a cost of $37,000 per client in permanent supportive housing (or "patient" as Peabody's analysis refers to the individuals). Mike Dunthorn in the Office of the Ten-Year Plan calls Peabody's calculations "dubious," and says many of the assumptions underlying his calculations are wrong. For example, Peabody projects a cost of nearly $6,000 in therapeutic addiction counseling per person per year, but not every chronically homeless person has an addiction and/or will require the same level of care. Likewise, Peabody projects $2,925 per client per year for mental health counseling, but not every client will require the same level of treatment.

Actual costs are difficult to come by, given this population, but Nan Roman of the National Alliance to End Homelessness says the evidence shows either cost savings in permanent supportive housing or roughly equal costs with better results. Still, the lack of projections locally presents a problem for many, so the Office of the TYP is now working on a study that will track individual costs before and after housing. To do so, it's drawing on the experiences of 300 or so individuals who have already been placed in housing through the Ten-Year Plan. Those numbers are due out this fall.

What we do know is that, according to the Homeless Management Information System's annual report, in 2009 the chronically homeless in Knoxville were only 23 percent of the clients who received services, but they received 41 percent of those services. The actual number of chronically homeless has grown from around 600 at the end of 2009 to around 1,000 at the beginning of August.