What Is Permanent Supportive Housing? A Complete Guide

Defining Permanent Supportive Housing

Permanent supportive housing combines two essential components:

• 1. Permanent housing: A stable, affordable place to live with no predetermined length of stay. Tenants have full tenant rights and pay rent (typically 30% of their income).
• 2. Supportive services: Voluntary services tailored to individual needs, which may include mental health treatment, substance use treatment, case management, life skills training, and employment support.

The key word is "permanent." Unlike transitional housing, which has time limits, PSH is intended to be a long-term home. Residents are not working toward moving out unless they want to and are ready. For many with chronic conditions, PSH becomes their permanent housing solution.

The other key word is "supportive." Housing alone, without services, often fails for people with complex needs. The combination of stable housing plus ongoing support is what makes PSH effective.

Who Is PSH For?

PSH is specifically designed for people experiencing chronic homelessness, which HUD defines as:

• • Homeless continuously for at least 12 months, OR
• • Homeless on at least four separate occasions in the last three years with a combined length of at least 12 months, AND
• • Has a disabling condition (mental illness, substance use disorder, physical disability, developmental disability, or HIV/AIDS)

This population represents about 20% of the total homeless population but consumes a disproportionate share of emergency resources. They are the people who have been homeless longest, who cycle through shelters, ERs, and jails, and who have not been successfully served by traditional programs.

According to the 2024 HUD data, there were approximately 152,585 chronically homeless individuals in the United States. The majority are single adult men, and most have co-occurring mental illness and substance use disorders.

How PSH Works in Practice

The Housing

PSH housing typically comes in two models:

• • Single-site: A building or complex where all or most units are PSH. Services are often provided on-site. This model allows for specialized facilities and concentrated services.
• • Scattered-site: Units are rented in regular apartment buildings throughout the community. Tenants receive rental assistance and services come to them. This model offers more integration and housing choice.

Both models provide standard housing with the same features as any apartment: private bathroom, kitchen, locks on the door, tenant rights. This is real housing, not a shelter or institution.

Rent is typically capped at 30% of income. For someone receiving only SSI (about $943/month in 2024), this might mean paying around $280/month. Rental subsidies cover the remainder. For those with no income, rent may be $0 while they stabilize.

The Services

Services in PSH are voluntary, flexible, and individualized. Common services include:

• • Case management: A dedicated point of contact helps navigate systems and coordinate care
• • Mental health services: Therapy, psychiatric care, medication management
• • Substance use treatment: Harm reduction, recovery support, treatment connections
• • Physical health: Primary care connections, medication management, health education
• • Benefits assistance: Help obtaining SSI, SSDI, food stamps, Medicaid
• • Life skills: Budgeting, cooking, cleaning, tenant responsibilities
• • Employment services: Job training, placement, supported employment
• • Community building: Social activities, peer support, connection to community resources

The intensity of services varies based on individual need. Someone in early recovery might need daily contact. Someone who has stabilized might check in monthly. The key is that services remain available for as long as needed.

The Housing First Philosophy

Most PSH operates under a Housing First philosophy, which differs significantly from traditional approaches:

Housing First recognizes that it is nearly impossible to address mental illness, addiction, or other issues while living on the street. Stable housing provides the foundation for everything else. This does not mean services are unimportant—just that housing comes first.

Does PSH Actually Work?

The evidence for PSH is robust. Decades of research and implementation have demonstrated:

Housing Retention

PSH consistently shows housing retention rates of 80-90% after one year. This means the vast majority of people placed in PSH remain housed, often after years or decades of chronic homelessness. The common belief that "those people can't be housed" is simply false.

Cost Effectiveness

Multiple studies have shown that PSH reduces overall system costs:

• • Seattle study: $2,449 monthly savings per person in emergency services
• • Denver study: 73% reduction in emergency room costs
• • Portland study: $8,724 average Medicaid cost reduction per person
• • Multiple studies show reduced jail bookings and incarceration

PSH costs approximately $12,000-18,000 per person per year. Chronic homelessness costs $30,000-50,000 per person per year in emergency services. The math is clear.

Health Outcomes

PSH residents show significant improvements in health:

• • 59% reduction in overall healthcare costs
• • 61% reduction in emergency room visits
• • 77% reduction in inpatient hospital stays
• • Improved medication adherence
• • Better management of chronic conditions

Quality of Life

Beyond measurable outcomes, PSH dramatically improves quality of life. Having a home means:

• • Safety from violence and weather
• • Privacy and dignity
• • Ability to cook, bathe, and care for oneself
• • A place to store medications and belongings
• • An address for mail, benefits, and employment
• • The foundation for everything else in life

Common Criticisms and Responses

"It enables bad behavior"

Critics argue that housing people without requiring sobriety or treatment enables addiction. But research shows the opposite: people are more likely to engage in treatment voluntarily when they have stable housing. Forcing treatment as a condition of housing has poor outcomes. Meeting people where they are and offering services works better.

"It's too expensive"

PSH does cost money. But chronic homelessness costs more. When we do not provide housing, we pay for emergency rooms, jails, shelters, police responses, and crisis services. PSH redirects that spending to something that actually works. It is not new spending—it is smarter spending.

"It doesn't solve the root problem"

PSH was never meant to solve all homelessness. It is specifically designed for chronic homelessness—the hardest cases. Addressing homelessness broadly requires affordable housing, mental health systems, living wages, and other systemic changes. PSH is one essential tool, not the only tool.

"It harms neighborhoods"

NIMBYism is real, but evidence does not support it. Studies consistently show that well-managed PSH does not increase crime or decrease property values. In fact, reducing street homelessness often improves neighborhood conditions. The alternative—people sleeping in parks and doorways—is worse for everyone.

PSH vs. Other Housing Models

Understanding how PSH differs from other options clarifies when it is appropriate:

• •
  Emergency Shelter: Short-term crisis intervention, typically night-by-night or up to 90 days. No services beyond basic needs. Not a housing solution.
• •
  Transitional Housing: Time-limited housing (6-24 months) with required services and benchmarks. Good for people who need structure and can progress to independence. Not appropriate for chronic, disabling conditions.
• •
  Rapid Rehousing: Short-term rental assistance (3-24 months) to help people who can maintain housing independently with temporary support. For situational homelessness, not chronic.
• •
  Permanent Supportive Housing: Long-term housing with ongoing services for those with disabling conditions who need sustained support. For chronic homelessness.

Different people need different interventions. PSH is not appropriate for everyone, but for chronic homelessness, it is the most effective model we have.

How The Steady Ground Integrates PSH Principles

Our model at The Steady Ground incorporates the proven elements of PSH while adding components we believe enhance outcomes:

• • Long-term housing commitment with no arbitrary time limits
• • Comprehensive services including mental health, addiction treatment, and physical health
• • Individualized assessment through the Stronghold Assessment
• • Job training and employment services to build income and purpose
• • Faith integration for those who want it
• • Brotherhood and community that provides peer support
• • Graduated housing options as men stabilize and progress

We believe housing is necessary but not sufficient. Men need purpose, community, and hope alongside a roof over their heads. That is what we are building.