Reconciling Alternative to Incarceration and Treatment Mandates with a Consumer Choice Housing First Model: A Qualitative Study of Individuals with Psychiatric Disabilities

This study sought to understand how individuals experienced participating in a Housing First (HF) program, which is designed to operate along principles of permanent housing, consumer choice, and harm reduction, while simultaneously participating in an alternative to incarceration (ATI) program that incorporates treatment mandates, abstinence monitoring, and court reporting which tend to be in tension with the HF model. Analysis of semi-structured qualitative interviews with 20 participants suggests that though participants recognized the constraints of the ATI program and legal mandates, they somewhat surprisingly experienced the HF program in accordance with the model's stated principles. The majority of participants remained in the HF program after four years and reported positive outcomes, which many attributed to having a home of their own. Having the ATI program serve as a mediator with the criminal justice system may have allowed the HF program to have a buffer between the participant and the legal system and helped keep the housing and consumer-driven services separate from explicit legal requirements.