Zeke Smith: Bridging the ideals of ‘Housing First’ and ‘Treatment First’ will put Spokane on a smarter path

By Zeke Smith

In Spokane, the debate over how to address homelessness has recently been framed as a choice between Housing First and Treatment First. Recently, this conversation has taken on a sharper edge – fueled by the current federal administration – that paints low-barrier or Housing First approaches as synonymous with “no rules.”

This framing may be politically convenient. It is not accurate. And, it risks steering our community away from the kind of integrated system we need.

Housing First does not mean the absence of expectations, structure, or support. Instead, it recognizes shelter as a necessary first step to stability. Successful Housing First models offer robust services – case management, behavioral health care, substance use treatment, and ongoing support – that help individuals maintain housing and move toward healthier lives.

There have been examples where implementation has fallen short – filling a warehouse with people is not a recipe for stability. When services are under-resourced or poorly coordinated it reinforces the perception that “low barrier” means low or no accountability. In our city, we’ve seen outcomes improve as smaller shelters with robust services create supportive communities that hold each other accountable and capable.

Now, local jurisdictions are being pushed to support a Treatment Memorandum of Understanding that leans heavily toward a Treatment First framework, in part to distinguish our region from Washington state. This approach risks committing Spokane to one side of a complex issue before we have built the infrastructure to support it.

In particular, this model relies on the threat of incarceration to compel treatment. Without sufficient access to care, this risks cycling people through systems not equipped to address any of the immediate issues or the underlying needs.

Our current system is not a one-size-fits-all Housing First solution. Spokane offers a spectrum of responses. The challenge is not choosing one approach over another – it is ensuring we have enough capacity, coordination and access to meet the need.

We do not need to import a national narrative aligning ourselves with the latest political trend. We need to build a system grounded in Spokane’s reality – one that uses real-time data, reflects the diversity of needs in our community, and invests in a full continuum of care.

We need a holistic system that includes the following:

• Low-barrier housing with strong, accessible services.

• Supportive housing with embedded behavioral health care.

• Recovery-focused and substance-free living environments.

• Timely access to treatment for substance use and mental health.

• Coordinated and adaptable pathways that allow movement between levels of support.

This isn’t about lowering expectations, but aligning them with what we know works. Sustainable change rarely happens through coercion alone, but when people have stability, support and access to the resources, relationships and care that make change possible.

We must address a core structural challenge: Housing and treatment funding have been siloed for too long. Federal housing dollars flow through HUD and Continuum of Care programs, which emphasize Housing First, while treatment funding comes through Medicaid, SAMHSA, and other health systems. The result is a system where housing and treatment are funded and delivered separately – even though people need both at the same time.

Spokane needs more affordable housing for people to return to after treatment. We also need timely access to treatment. We cannot fund one without the other and expect to make progress.

When we invest in housing stability, behavioral health care, and coordinated supports, we reduce the long-term drivers of homelessness, substance use disorder, and public safety concerns.

A system that addresses crises where possible and responds effectively when they occur – creates a Spokane that is safer, healthier, and more stable for everyone. For people experiencing homelessness, it means pathways to recovery and housing. For neighborhoods and businesses, it means safer spaces. For first responders, it means better tools to divert people out of our jails. For our community, it means a stronger foundation for shared well-being.

Instead of asking elected leaders to choose sides, we should be asking them to do something harder – and far more important – to work together, consistently and collaboratively, to build the integrated system our region requires. This is our moment to move beyond rhetoric and toward results. Let’s invest in housing, treatment and the connections between them. Let’s create multiple entry points that meet people where they are and support self-determination while ensuring access to effective care.

Let’s build the kind of Spokane we all want – one where every neighbor has the opportunity for stability, recovery and a healthy life, and where our entire community benefits from a safer, stronger place to live and work. Zeke Smith is president of Waters Meet Foundation (formerly Empire Health Foundation), a community-rooted organization created from the sale of Deaconess and Valley Hospitals. Waters Meet partners with leaders, organizations, and communities across the Inland Northwest to invest resources in solutions that dismantle health inequities and advance collective well-being; grounded in the belief that the communities we serve already hold the vision for their future.