Guest Opinion: Palliate, don’t punish homelessness

Spokane is failing at homelessness, and it can’t be solved by punishment. The new ordinance to ticket or jail people for sleeping outdoors is like jumping off a cliff and calling it a new direction, trying to treat a public health crisis through the criminal justice system. We’ve done this with addiction since the war on drugs campaign and created mass incarceration instead of recovery. Why repeat the same mistakes?

It can’t be solved by “Treatment First” programs either, making people prove they deserve housing by sobriety. The deeper problem is misunderstanding who the homeless are and why they’re there. Most are not criminals or people who “choose” homelessness. Many are working poor, disabled, elderly or survivors of partner abuse, including children. Others live with mental illness or addiction, conditions that remove choice, not reflect it. Homelessness is a public-health condition that worsens without stabilization.

“Housing First” offers a proven model that recognizes humane and successful treatment is palliative. Comparative studies in the U.S. and Canada found Housing First programs cut homelessness by 88% and reduced ER visits and hospitalizations. By shifting from crisis management to permanent housing and on-site care, Spokane can save money, reduce emergency calls, and free law enforcement to focus on actual crime. The experience of Seattle, Denver and Houston shows that when people are stably housed, public costs drop and community safety improves. Denver’s 2021 evaluation of its supportive-housing initiative showed a 40% reduction in police arrests and a 30% drop in jail stays. In Houston, coordinated Housing First programs have reduced homelessness by nearly 60% since 2011. These programs succeed because they treat homelessness as a medical and social condition, not a moral failing.

Houston’s Alan Graham isn’t a physician but he diagnosed the problem and came up with a treatment that works:

“People think if you build a bunch of houses you’ve ‘solved’ homelessness,” he said. “I don’t buy into the word ‘solution.’ It’s less an issue of ‘curative’ than ‘palliative.’ By virtue of relieving their suffering, we hope to make a positive impact. These are God’s beautiful, broken children.”

Graham’s Community First Village is a tiny-home community with on-site elective health care and job support. Residents apply, pay modest rent, and rebuild stability. Austin saves overall, not just on police calls and hospital use. Spokane doesn’t need to reinvent the wheel but can embrace this proven strategy:

PLAN – Team up housing developers with experts in homelessness. Address upfront concerns from healthcare and emergency services, nearby residents and businesses. Use current data and expected needs to determine size and prospective locations in partnership with neighboring counties.

FUND – Offer tax incentives to companies that supply labor, materials, and maintenance. Reallocate overlapping program funds and use existing sources such as the Washington Housing Trust Fund, HUD Continuum of Care grants and Low-Income Housing Tax Credits. Begin resident applications early for fair, income-based leases and to identify support structures needed before move-in.

IMPLEMENT – Build permanent, sustainable communities with utilities, shared gardens and on-site space for child and senior programs, plus a clinic for behavioral, primary and urgent care. Each community should be large enough for measurable income and anticipated needs but small enough to maintain a cohesive community. Track housing, health, and employment outcomes and expand based on measurable results and projected demand.

Housing First is not charity. It’s effective public health, fiscal responsibility, and community investment. Why can’t we all be proud of where we live?

Dr. Suzan Marshall is a mother, surgeon and death investigator in Spokane who serves on the Washington State Board of Osteopathic Medicine. Her policy work focuses on public health legislation that is expert-informed, enforceable, and built on proven frameworks with existing resources to ensure proportional accountability.