Sleepless on the Street: An Argument for Housing First

See if you can recall an experience that almost everyone has had: trying to function without adequate sleep. What did it feel like, pushing yourself wearily through a day when your body wanted slumber? How much did you get done as you fought back that velvety longing, your brain's need to rest, to be quiet and discharge the noise and stress of the previous day, your body's need to be absorbing nutrients, to give your muscles and nerves time to recover as your closed eyes move in dreams?

I think about what it would be like to lack a secure place to sleep, night after night. No structure or room where you can lock the door. No comfortable, clean bed. Ever-present worries about hostility and harassment. Exposure to elements. 

Serious side effects can occur fairly quickly with sleep deprivation. I've felt some symptoms after a single night without sleep, including hallucinations and inability to concentrate. A WebMD page on sleep deprivation mentions several known impacts. Concentration problems are common, as well as a weakened immune system, diminished circulation throughout the body, and impaired production of anti-aging growth hormones which your body produces during sleep to repair itself. According to the CDC, sleep deprivation can be a contributing factor to depression, type 2 diabetes, obesity, and cardiovascular disease. An article by Brandon Peters MD describes how healthy people can exhibit serious mental health system with sleep deprivation, including hallucinations, heightened stress, paranoia, and anxiety. As described in another article on healthline.com, recovering from sleep deprivation can take time - up to four days to recover from a single hour of lost sleep.

People experiencing homelessness may never have the chance to recover from chronic symptoms of sleep deprivation. When we look at the host of issues that lack of sleep causes, from mental impairment to immune deficiency and even interruption of the body's ability to absorb nutrients and repair itself, it's clear that treating those symptoms without addressing sleep deprivation will always be a losing battle. No amount of nutrition, mental health services, part-time work, or addiction treatment can overcome the effects of chronic sleep loss on someone experiencing homelessness.

The relationship between sleep deprivation and the stress of experiencing homelessness is getting more attention in recent years, but it does not seem to have resulted in widespread awareness yet, or reflection on the way more tangential assistance programs may fail to address this core issue. The Atlantic published a significant feature article "Homelessness and the Impossibility of a Good Night's Sleep" back in 2014; a study cited in that article mentions that even healthy adults can develop symptoms of schizophrenia due to sleep deprivation. But still today one can see public discussions of houseless communities and related social challenges completely fail to mention this key factor. As Portland non-profit JOIN states on their blog post "Sleep Deprivation Impacts Individuals Experiencing Homelessness",

...although staying at a transitional shelter can be helpful to improve short term sleep-debt, it is not enough to solve the long-term problem of sleep deprivation among the homeless.

Most of us take for granted a few things needed to sleep: a bed, a roof, security. This is why housing - a comfortable and secure place to sleep - should not be treated as a reward offered at the end of some long administered process for people without homes. As the National Alliance to End Homelessness notes, the housing first model can provide people a pathway to stable housing that is more likely to be maintained over time. With housing, sleep can return to normal and healthy patterns, and other services can be offered. Without housing, the cycles of stress and instability will continue, caused in no small part by sleep deprivation.

Thinking of my own experiences with sleep deprivation, I would not be surprised if the effectiveness of the housing-first model is strongly connected to the human need for a good night's sleep. 

You can support housing first in your community. If you are in Portland, support local groups like JOIN that advocate providing housing for houseless individuals, and support local policy initiatives that move in this direction. You can also get more information on housing first from the National Alliance to End Homelessness: click here for more.

Christopher Corbell, Fall 2021, Portland State University