This week, President Donald Trump announced that his administration will remove homeless encampments from Washington, DC. It came at a press conference in which he declared a public safety emergency in the nation’s capital, despite violent crime numbers hitting a 30-year low. But the announcement also illustrated something else: The way the country approaches homelessness is rapidly changing.
In July, Trump issued an executive order that not only makes it easier for cities and states to eliminate homeless encampments, but also directs authorities to involuntarily commit unhoused people struggling with mental health issues or substance abuse. The policies represent a dramatic shift away from an approach the federal government has used for years called Housing First, an evidence-based program that prioritizes housing over treatment. Sam Tsemberis first developed the Housing First approach in the 1990s. Tsemberis was working as a clinical psychologist in New York City, where he brought people who lived on the streets into hospitals for treatment, often against their will. He soon realized that many of those people ended up back on the streets, seemingly no better off.
Housing First proved more successful than treatment-first models. It soon became the way cities, states, and the federal government approached homelessness, including the Department of Veterans Affairs, which used Housing First to cut veterans’ homelessness in half over the last 15 years.
But the Trump administration is now abandoning the approach, and Tsemberis says that decision could lead to disastrous consequences for the hundreds of thousands of people who are homeless in America. “People will get discharged from the hospital. They will get released from the jail. And they’ll be back out on the street and the thing will be going in a circle again,” Tsemberis says. “The only way to end homelessness is to provide housing.”
On this week’s More To The Story, Tsemberis sits down with host Al Letson to examine the potential effects of Trump’s executive order, how he developed the Housing First approach decades ago, and whether the US has the necessary values to truly tackle poverty and homelessness.
Credits
Producer: Josh Sanburn | Editor: Kara McGuirk-Allison | Theme music: Fernando Arruda and Jim Briggs | Digital producer: Nikki Frick | Deputy executive producer: Taki Telonidis | Executive producer: Brett Myers | Executive editor: James West | Host: Al Letson
Dig Deeper
Listen: The Churn (Reveal)
Read: Trump’s Plan to Eliminate Homelessness Is Just Cruel. Here’s Another Option. (Mother Jones)
Learn more: Pathways Housing First Institute
Transcript
This following interview was edited for length and clarity. More To The Story transcripts are produced by a third-party transcription service and may contain errors.
| Sam Tsemberis: | People will get discharged from the hospital, they will get released from the jail, and they’ll be back out on the street and the thing will be going in a circle again. The only way to end homelessness is to provide housing. |
| Al Letson: | On this week’s More To The Story, I talk with Sam Tsemberis, a clinical psychologist who created a new way to approach homelessness in America and it worked. Now, that approach is under attack by the Trump administration. Stay with us. |
| This is More To The Story. I’m Al Letson. Back in the early 1990s, Sam Tsemberis was a clinical psychologist in New York City tasked with getting people who lived on the streets into hospitals for treatment, but he quickly noticed something, those same people ended up back on the streets sometimes just weeks later. That’s when a lightbulb went off. The way the country approached homelessness was completely backwards. Sam soon developed a new concept called Housing First, housing before treatment, and founded a nonprofit using that model. It proved so successful where it was tried that it became the way the federal government addressed homelessness around the country. The program helped reduce homelessness by almost a third during the George W. Bush administration, but now, the Trump administration is abandoning Housing First and adopting a more aggressive approach. Earlier this week, president Trump announced that his administration was eliminating homeless camps around Washington, D.C, telling people who live on the streets there to “move out immediately”. The overall shift in policy could have far-reaching consequences for the hundreds of thousands of Americans who still live on the streets every night. Sam, how are you today? | |
| Sam Tsemberis: | Hi, Al. Good to be with you. |
| Al Letson: | Let’s talk a little bit about how you came up with the idea for the Housing First Program. Exactly what is that and when did it originate? |
| Sam Tsemberis: | The Housing First Program is a program that helps people who are homeless and have mental health, and addiction problems, and often health problems as well. The program originated in response to this era of homelessness. We’ve had homelessness in America at an increasing level for the last 40 years, so this has been around, for some of the people that are listening, I imagine, their entire lives. A whole generation has grown up thinking homelessness is part of the landscape, but homelessness really started in the early ’80s, right after the Reagan administration took office and introduced policies that were supply side economics, they were called. They had this idea about trickle-down theory, give tax breaks to the wealthy and to corporations and they will create jobs for the rest of the population and let’s cut government spending because there isn’t a lot of tax revenue because corporations and very wealthy people aren’t paying taxes so you have to reduce the size of government. |
| One of the things that they did was they were cut out, essentially cut out the public housing program which was housing for people who needed a rent subsidy. That, very soon, right after that, we began to see people on the streets of every major city in America. That was homelessness, that was disaster. Many of the people looked like they had disabilities, mental health issues, the shelters were filled, and there was a struggle in getting people into housing at that time, because in order to get housed, if you had a mental health or addiction problem, you needed to take care of the mental health issue and the addiction issue before you would get housing. Some people were successful in that, but many tried and couldn’t. Mental illness and addiction are relapsing conditions. You can do okay for a while and then you relapse and it’s back to the start, so there was a growing group that wasn’t managing in the existing system of care in the treatment then housing system. | |
| That’s a lot of background to say that we needed a different approach, we needed to do something else, and that’s where Housing First came in. | |
| Al Letson: | The Trump administration signed an executive order that will make it easier to remove homeless people from the streets and called for ending support for Housing First policies that don’t promote treatment, recovery, and self-sufficiency. What’s the clash between what they’re doing and what you do? |
| Sam Tsemberis: | What they’re doing is they are insisting that people go to treatment or else they get arrested and go to jail. It sounds like they’re doing something. Actually, other than the immediate removal of someone from the street to go to a hospital or to a jail, this is a very expensive and completely ineffective approach to homelessness, because people will get discharged from the hospital, they will get released from the jail, and they’ll be back out on the street and the thing will be in a circle again. This is what it was like in the ’80s when Reagan started all of this, and we had that same cycling. The only way to end homelessness is to provide housing. Unless you provide housing, you’re going to have people going in and out of jail, hospital, shelter, jail, hospital, shelter. They’re saying that they believe in treatment, recovery, and self-sufficiency. It absolutely flies in the face of what then they are proposing for their policy. There is no recovery in jail. There is no recovery in a hospital. You’ll take care of an immediate illness, but recovery is a long-term process that requires support in the community. |
| Al Letson: | It feels like their idea of recovery and homelessness is not based on reality, is based on the things that they would like to see. All of us would like to see people who are unhoused and who are having mental challenges get the help that they need and become self-sufficient, but that’s not an easy path. The reality of it is that it takes a while for these things to happen and sometimes you may never get the outcome that you want, but if that’s the case, do you just throw people away because they can’t get to that goal that you have set? That is an unrealistic goal. |
| Sam Tsemberis: | What I find amazing about the language in the executive order is that they have taken the very language of Housing First and twisted it into making it sound like this is what they want. Housing First is about treatment, and recovery, and self-sufficiency. That’s what living in an apartment by yourself with supports is all about. They have done the same thing with DEI. They’ve taken diversity and inclusion and made it into discrimination. I mean, there’s a sinister quality to this, like the language choice and calling up-down and left-right, and just confusing people with it. There’s a sort of a sinister quality to it. The thing that is to be determined, I would say, is the extent to which this executive order will actually translate into actual policy. This is an executive order. It’s not the budget for Housing and Urban Development, or Health and Human Services, or the Veterans Administration. |
| I think where the rubber hits the road on these policies will be determined about where the money is allocated. I mean, are they really going to stop funding housing and rent subsidies? What about the thousands, probably hundreds of thousands of people now, that are housed and the government is paying rent for them? Are they going to pull those rents? I doubt that that is going to be welcomed even by this party. Taking such a strong stance specifically against Housing First Program reverses the policy that’s been in place for at least the last 10 or 15 years. The question is, will the funding follow the policy? If it does, it would be quite disastrous. | |
| Al Letson: | As someone who was around when Ronald Reagan put these policies in place that helped create the homelessness problem we’re seeing today, the ideas of trickle-down economics, are you now feeling a sense of déjà vu watching what the Trump administration is doing on this issue? |
| Sam Tsemberis: | Absolutely, a parallel in policy, although I would say that the first version, there was still a veneer of politeness about the things somehow. This is the gloves off and we got to get these people off our street, they’re a hazard to us. Any trace of compassion about people suffering is really gone from this administration’s policy. There’s a punitive tone to getting people out of the citizens’ ways, get people out of parks, get people off the streets, reclaim the cities, which is understandable from the point of view of we’ve had homelessness for a long time and why haven’t we solved it, because I think there is a solution. I have that same frustration. But from that frustration, this administration is going to punitive measures like arresting people or demanding involuntary treatment for people, basically to move them from the streets into jail or hospital as opposed to something more compassionate like help them get housed. It’s cruel. |
| Al Letson: | Do you think that through the eyes of the administration just going off of their policy stances, that they look at poor people, unhoused people, people with mental disabilities as like it’s a moral failing? I.e. like you did something wrong and so now you have to pay the consequences and it’s not on us to fix it. |
| Sam Tsemberis: | Yes, that was the policy. I don’t know if you recall, Reagan used to talk about welfare queens and people taking advantage of the system, and then about homelessness, he’s quoted saying that, “Well, some people are just out there by choice,” and always pointing to individual failings, because if you don’t point to individual failings, you have to acknowledge that we have an out-of-control real estate system, that the rents have been increased, and minimum wage has barely increased at all. You have people falling into homelessness all the time not because they’re not working hard. You have people in shelters that are working one or two jobs and can’t get that first month’s rent and first month’s security together. |
| Everyone is doing the best they can, but the system is stacked up against you if you are not making enough money, if you are a member of a minority group. In every single state that we count homeless people, in every single state, minorities, Blacks, Latinos, or indigenous people are always overrepresented, so these are structural issues that preclude people getting the good jobs, getting into housing, and then you see the representation on the street and you’re blaming the individual for a game that’s stacked against them. | |
| Al Letson: | Yeah. Can you give me a sense of how many people are homeless in the U.S. at any given night? |
| Sam Tsemberis: | On the last count for 2025, we had about 775,000 people that were homeless on that one night, but it’s a very narrow window. They count in January so all of the northern states are quite cold. I mean, that’s the minimum number, and these are people who are both in shelters and on the streets. |
| Al Letson: | With this new executive order from President Trump, what do you expect to happen to that number? |
| Sam Tsemberis: | I think if you remove the funding from housing and put money into going into hospitals or jails, it’s going to be much more expensive and there are going to be many more people homeless. |
| Al Letson: | Let’s talk about that a little bit as in the expense of it, because on the surface, it would seem that they are creating this new path as a way to save on the budget. It’s in the spirit of Doge and trimming the government down, but you think it’s going to actually cost the government more in the long run. |
| Sam Tsemberis: | Well, it costs, on the low side, about 1,500 to $2,000 a day for a hospital bed. If you put someone in a hospital for a month, you have basically spent… Let’s say a $2,000 day, you’ve spent $60,000 for a month of hospitalization, and then at the end of that month, the person is discharged back out into homelessness. For $60,000, you could pay someone’s rent for three or four years depending on where they’re living. This is not saving anyone any money. It’s costing a fortune for these very expensive acute care services and doing nothing about ending the homelessness. Whereas that investment just skip hospitalizing people, skip arresting people, put them right into housing, you would save a lot more money and you would house and end homelessness for a lot more people. |
| Al Letson: | When we come back, Sam talks about what inspired him to approach homelessness in a completely new way. |
| Sam Tsemberis: | We went to the people themselves that were on the street, was very much a ground-up kind of a program developed, and we said, “How can we help you?” They said, “Isn’t it obvious?” |
| Al Letson: | Before we get to that, somehow summer is almost over. I know, I’m shedding tears as I’m saying this. Maybe you’re planning one more cookout, one last vacation, one more pool party that you should totally invite me to, I would come. Can I put one more thing on your summer to-do list? Tell your friends about Reveal. Come on, give us a rating or review before the leaves start falling and help others discover Reveal’s award-winning reporting. Let’s make it official. Tell people about us. You know you want to. Okay. Don’t go anywhere, more with Sam Tsemberis in just a moment. This is More To The Story. I’m Al Letson and I’m back with clinical psychologist and CEO of Pathways Housing First Institute, Sam Tsemberis. Talk to me about how you got into this work. |
| Sam Tsemberis: | Well, I got into this work out of complete frustration and failure in trying to bring people to the hospital, ironically enough, because I thought that was the right thing to do. I was trained as a psychologist, I saw people on the street that had mental illness, and I would try and persuade them that it’s for their own good to go to Bellevue and get some treatment and things will be better, I naively thought. Some people did go, and other people, we actually had to bring involuntarily to the hospital. I was one of those people that worked in one of these involuntary treatment programs that are being proposed now. What I saw both as an experience, but we were also keeping data on it, is that the majority of people ended up returning to the street and actually being more wary of engaging in treatment because it didn’t go well for them that first time. That’s ultimately what got me to thinking, “Hey, we got to do something else, because what we’re doing is not only not effective but it’s actually alienating people.” |
| We went to the people themselves that were on the street, was very much a ground up kind of a program developed, and we said, “How can we help you?” They said, “Isn’t it obvious? Isn’t it obvious? We need a place to live?” We began to bring people literally from the streets into apartments, and then we had a team of case managers, social workers, psychiatrists, people with lived experience that would make house calls after the person was housed. We thought, “Okay, we had now at least another alternative for those who couldn’t get clean and sober to get into housing.” People got into housing and then they got well, they got better. 80% of the people assigned to Housing First would be housed and stay housed, and about 40% of the people that needed treatment first and then housed would get housed, so we were onto something, I thought, very, very effective. | |
| We published it and then people began to say, “Maybe there’s something to this. We think it’ll work over here, why don’t we try it over here? Would you be willing to come and show us how to do it?” I think the gradual implementation of the programs with the success that it delivered, it began to be more widely accepted. | |
| Al Letson: | Here’s what I’m trying to wrap my head around. A decade ago, this approach was widely celebrated and received bipartisan support. The George W. Bush administration was even the first to make it a centerpiece of their federal approach. When did things start to change? What happened? |
| Sam Tsemberis: | It was during the first Trump administration. They appointed somebody in what used to be the United States Interagency Council on Homelessness that the Doge people have actually now eliminated as an agency, but that was sort of the federal agency in charge of setting federal policy. The first Trump administration appointed someone that was anti-Housing first. They were saying, “Housing fourth. First is treatment, sobriety, and then employment, and then housing maybe,” but they weren’t in power long enough to actually do anything about it. Project 2025 did a lot of work in between those two terms, and when they hit the ground running this time, it wasn’t housing fourth, it was housing last, and now we have the executive order that says, “Actually, don’t do Housing First at all.” |
| Al Letson: | Housing First definitely has its critics. Homelessness in the U.S. has been rising, some say that Housing First doesn’t adequately address the underlying mental health and addiction issues that often contribute to homelessness. What do you tell people who say this approach doesn’t work? |
| Sam Tsemberis: | Homelessness is rising because of the structural factors that contribute to homelessness. The rents are too high and the salaries and the benefits are too low and there’s a racial discrimination. That’s what contributes to homelessness. We have more people falling into homelessness. Every year that we’ve been counting homelessness with a few rare exceptions, the numbers keep going up. Housing First is a program that works for people who are homeless and have mental health and addiction problems. Everywhere where the program is implemented properly, it solves homelessness for 80 or 90% of the people it’s working with. These programs serve a couple of hundred people. |
| We don’t have a National Housing First Program, but we have a national homeless count, so because the national homeless count is going up does not mean that the hundreds of Housing First Program serving people are not working. They are absolutely working, but we’ve never taken Housing First to a national scale. We’ve never tried to house 770,000 people. Not all of them would need Housing First anyway. Most of the people who are homeless just need a housing voucher, but we’ve never taken Housing First to scale, so to say that it hasn’t solved homelessness is accurate, but… | |
| Al Letson: | But it’s also disingenuous. |
| Sam Tsemberis: | Totally disingenuous, because it’s never been scaled up to try and solve homelessness. It only solves pockets of homelessness in the cities where it’s tried. |
| Al Letson: | Yeah. You’ve been working on this for a really long time. How does it feel seeing something you’ve developed get dismantled this way? |
| Sam Tsemberis: | I haven’t given up that it’s being dismantled actually. But the attack, the attack, I have to say, is completely new, and it’s just such a disservice to homelessness. The irony of it is that Housing First is probably the most successful program that has been used by the two federal agencies that have actually embraced it. HUD and the Veterans Administration have used Housing First over the last 10 years to house veterans that are homeless, and they have reduced veterans’ homelessness by 56%. |
| Al Letson: | Do you think this executive order is going to threaten those programs? |
| Sam Tsemberis: | It appears as a threat to all Housing First Programs, and I don’t know exactly how it’s going to be implemented. |
| Al Letson: | Yeah. What are you doing to try and keep your policies, Housing First, in place? Is there anything you can do? |
| Sam Tsemberis: | Well, the thing that I think we can do is sort of the same thing we’ve learned from people that were running DEI programs and other programs that have been pushed out by this administration. We are basically providing people with housing and supports. I think that maybe we get less pushback if we say we’re housing people and we’re providing support services for them. You don’t have to call it Housing First, you don’t have to call it anything. You can call it helping people who are homeless. |
| Al Letson: | Yeah. It’s like figuring out ways around the roadblock by not calling attention to it. |
| Sam Tsemberis: | Exactly, exactly. |
| Al Letson: | If the Democrats get back in power, what are the moves that you think that they should be taken? I guess the question is that Ronald Reagan was in office for a set amount of time, and when he got out, we never went back to fixing the policies that clearly weren’t working, so what is the work for the next administration that wants to get this right? |
| Sam Tsemberis: | I’m not sure that, as a country, we inhabit or embrace the kinds of values it would actually take to fix poverty in this country. If you recall after Reagan, Clinton came in and did away with welfare so that people who are poor have been beaten up on by both parties, because both parties are somewhere in the middle of the political spectrum between left and right. I mean, we’re way over on the right now. But even if the usual Democrats get back in, I don’t know that they are willing or able to go back to building public housing, guaranteeing healthcare for all, which are the kinds of things we would need to have to begin to deal with the damage that has been done since Reagan and what this administration will also contribute to significantly. We have to move way over to a much more… A society where we believe that every member of our society needs to be taken care of. |
| Al Letson: | Sam, thanks so much for coming on and talking to me today. |
| Sam Tsemberis: | No, great to talk with you, Al. Thanks for having me. |
| Al Letson: | That was Sam Tsemberis, CEO of Pathways Housing First Institute. If you like this episode, you should check out the Reveal episode The Churn. It’s about the rising numbers of people experiencing mental health crises on America’s streets and how it’s fed a political narrative that U.S. cities have fallen into chaos and decay. Lastly, just a reminder, we are listener-supported. That means listeners like you, you can help us thrive by making a gift today. Just go to revealnews.org/gift. Again, that’s revealnews.org/gift. Thank you. This episode was produced by Josh Sanburn and Kara McGuirk-Allison. Taki Telonidis edited today’s show. Theme music and engineering help by Fernando, my man, yo, Arruda and Jay Breezy, Mr. Jim Briggs. I’m Al Letson, and you know, let’s do this again next week. This is More To The Story. |