Braços Abertos in Sao Paulo, what can we learn from the Housing First model?

The “Braços Abertos” (Open Arms) program is an interesting new intent to reduce the significant health, social and security problems in Cracôlandia, a huge open crack scene in Sao Paulo, Brazil. “Braços Abertos”, launched by Sao Paulo Mayor Fernando Haddad in December 2013, is targeting approximately 400 drug users who were previously living on the streets of Cracolândia. The project offers the residents to leave the houses they were squatting in the “favela” (slum) in order to get housed in one of the five motels contracted by the government for that purpose. There, they have access to health care, they have the opportunity to work four hours per day (cleaning parks and other public places) for 4£ per day, and they receive 3 meals a day. Even if there’s a strong police presence in that area, the police usually don’t arrest people for using or selling crack there, as long as it is confined in the area. Information is provided to the users about existing treatment programs and other services, but there’s no obligation to use them.

The fact that there is no requirement for crack users to give up their drug use has led to strong criticism from some Sao Paulo’s officials and social workers. Their argument was that the project would delay dependent people’s rehabilitation, and that it would make it easier for people to keep using drugs. It has been claimed that the program had been implemented with little empirical basis.

What they tend to forget is that housing programs for people dependent on drugs with no obligation to engage in a treatment or to give up drug use have existed at least since the early 1990’s, when Sam Tsemberis launched is Pathways to Housing program in New York, the first ever housing first program. Since then, this model has been implemented in many cities around the world.

Housing First programs were created in order to help homeless people suffering from drug dependence and mental illness to get housed and minimize their health and social harms. A range of social services are usually offered within the programs, but people don’t have any obligation to use them. The vision of these program is that if you provide homeless people with a place to live, they will be given a chance to stabilize and maybe start a recovering process which would be far more difficult to do while living in the street.

Since the 1990’s, numerous Housing First programs have been implemented around the world: in more than 50 US cities; Montréal, Toronto, Winnipeg and Vancouver in Canada; Lisbon, in Portugal; Brussels, Anvers, Charleroi, Ghent and Liège in Belgium; Toulouse, Lille, Marseille and Paris in France; as well as in Glasgow (Scotland), Amsterdam (the Netherlands) and Helsinki (Finland). In Denmark there are plans to develop Housing First programs, and low-threshold housing programs without a requirement of abstinence already exist.

Housing First programs have been systematically evaluated across the world. Globally, these programs have showed much better results than the “Treatment First” programs. The main results of the Housing First programs evaluation are: a reduction in drug use and dependence; a diminution of emergency service and hospital admissions; a better perceived choice concerning the services provided; lower participation in criminal activities; and higher housing retention rates than the higher threshold housing programs.

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