Policy Brief 65 - Housing First or Treatment First?

Turning the EU’s Anti-Poverty Strategy into Action
IEP Bocconi and the European Commission bring together researchers, policymakers and civil society to discuss affordable housing, access to quality jobs and policies to tackle poverty.
Speakers include Giulia Giupponi, who will join the session on “Quality Jobs and Protection Against Poverty”.
9 October 2026, 10:00–17:00 | Bocconi University, Leonardo Del Vecchio Building, Room N01, Piazza Sraffa 13, Milan.

Register here.

Executive Summary

A national study of 289,932 Veterans uses variation in voucher and caseworker availability to compare the causal effects of the two most common homelessness interventions: Housing First and transitional housing.

The empirical evidence shows that Housing First dominates Treatment First approaches to homelessness: it saves both lives and money. The EU should redirect funding away from transitional housing or Treatment First type programs towards ones that operate from a Housing First model.

Housing First protects individuals from extreme circumstances generated by unsheltered homelessness: death from extreme weather and violence. It also protects an especially vulnerable group: homeless injection drug users, who are much more likely to die if they are living on the streets.

Despite the effectiveness of Housing First, policymakers still have a long way to go to solve the problems of this extremely disadvantaged population. In particular, Housing First is not enough to address the mental health needs of these individuals: it does not lead to an increase in mental health treatment nor improve the rate of appointment attendance.

In contrast, Treatment First models do improve adherence to mental health treatment in the short term, but effects are short-lasting and do not translate into large health gains. Thus, for the large population of unhoused, mentally ill individuals, additional interventions are necessary to improve long term engagement with mental health care.

Nevertheless, Housing First is the essential starting point, keeping individuals stably housed and shielded from the most severe consequences of homelessness.

IEP Bocconi does not express opinions of its own. The opinions expressed in this publication are those of the authors. Any errors or omissions are the responsibility of the authors.

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