This article is the second in ChangeWA’s three-part series on the increasing costs of our region’s homeless strategy. We asked treatment advocate and founder of the O-UT Program Ginny Burton to examine the long-term costs associated with current policies addressing homelessness.

ChangeWA supports a treatment-based approach to homelessness. Data shows that the expensive “Housing First” method has led to a 68% rise in King County’s homeless population over the past decade. It’s vital for the region to adopt a new strategy with proven positive results.

A Response to King County’s Health Through Housing Report

King County’s recent Health Through Housing report celebrates keeping 95% of residents housed for one year at $33,000 per unit annually. But this metric reveals a fundamental flaw in our approach: we’re measuring success by maintaining dependency, not by fostering independence. The report’s vague language about “improved health outcomes” obscures the reality that we’re creating expensive, indefinite warehousing systems. With Washington state reporting 31,554 homeless individuals in 2024—a 12.5% increase from the previous year—it’s clear that our current housing-first strategy is failing to address the crisis at scale.

The True Lifetime Cost

The numbers tell a devastating story that Housing First advocates refuse to acknowledge. Washington currently provides approximately 100,000 subsidized housing units, yet homelessness continues to surge. But the reported $33,000 annual cost vastly understates the true expense of maintaining individuals in permanent dependency.

Consider the real lifetime cost: A typical person entering chronic homelessness at age 45 will remain in the system for approximately 18 years until death (homeless individuals die 10-20 years earlier than average). The true annual cost includes not just housing ($33,000) but medical expenses averaging $18,500 yearly for typical users and up to $44,400 for frequent emergency room visitors, plus additional services. The total lifetime cost per individual ranges from $1.0 to $1.5 million per person.

We’re funding a trillion-dollar industry that perpetuates the very problems it claims to solve. Research indicates that incarceration costs our communities over $1.2 trillion annually, while chronically homeless individuals cost taxpayers $30,000 to $50,000 per year in emergency services alone. This creates a poverty-to-prison-to-housing pipeline that enriches service providers while trapping vulnerable individuals in cycles of managed dependency until death.

The Housing First Fallacy and Safety Crisis

Housing First policies, while well-intentioned, create environments that often mirror the dangerous conditions people fled. The report misleadingly references the 1811 Eastlake building as a success story, conveniently omitting its recent track record: two homicides in nine months, with residents stabbed multiple times in common areas. The building, which houses 75 adults with alcohol use disorders, has seen victims brutally killed by fellow residents—including a man stabbed 22 times in a laundry room and another who died from blunt force trauma to the head.

These aren’t isolated incidents. In 2015, staff at 1811 Eastlake waited ten hours to report an assault that led to a man’s death. Residents describe broken security cameras that go unrepaired for months, lack of criminal background checks, and minimal supportive services despite the program’s $1.1 million annual operating cost. When advocates celebrate buildings where people are murdered while doing laundry, we’ve lost sight of basic human dignity and safety.

Without requirements for sobriety, skill development, or personal accountability, these facilities become staging grounds for continued dysfunction and victimization. The report acknowledges that only 58% of emergency housing residents maintain their placement—revealing that even with no strings attached, the approach fails nearly half the time.

A Proven Alternative: The O-UT Model

There is a better way. The O-UT (Overhaul-Unrelenting Transformation) program, operating within Washington’s correctional system, demonstrates that addressing underlying causes yields dramatically different outcomes. Our approach assesses each individual’s specific deficits, dismantles destructive thinking patterns, and rebuilds futures through intensive programming focused on personal accountability and self-sufficiency.

Unlike housing-first models that avoid requirements, O-UT mandates abstinence throughout the program because recovery is impossible while under the influence of replacement drugs or street substances. Our approach is methodical: we address root causes first, then teach practical skills, and finally connect graduates to intentional community partnerships. We provide rigorous training in budgeting, finance, rational decision-making, and workforce development over approximately two years, during which participants rapidly gain self-sufficiency skills in a structured environment.

The results speak for themselves: of our 23 released participants, only one has reoffended, and he’s working to re-enter the program. Our graduates are attending the University of Washington, becoming skilled welders and fabricators, working as peer counselors, and—critically—reuniting with their families. They’re achieving what housing-first programs rarely deliver: true independence and self-sufficiency.

Our total cost is approximately $5,000 per person per year over roughly two years—$10,000 total per person compared to Housing First’s $1.0-$1.5 million lifetime cost. This represents just 0.7% to 1.0% of Housing First lifetime expenses while delivering outcomes that end dependency rather than managing it indefinitely.

The Sustainability Crisis

Washington’s five-year homelessness plan calls for 200,000 new housing units over four years, requiring massive taxpayer investment with no guarantee of reduced homelessness. Meanwhile, affordable housing providers are failing, with organizations selling buildings due to unsustainable operating costs.

This approach is fundamentally unsustainable. We cannot solve homelessness by creating permanent classes of dependents. Real solutions require honest assessment of individual deficits, intensive intervention to address root causes, and programming designed to produce self-sufficient citizens—not lifelong clients.

A Call for Evidence-Based Reform

We must shift from managing homelessness to ending it. This means:

• Requiring sobriety and participation in intensive programming as conditions for housing assistance
• Conducting thorough criminal background checks and maintaining functional security systems
• Assessing and addressing underlying causes rather than simply providing shelter
• Measuring success by independence achieved, not dependency maintained
• Investing in programs that demonstrate measurable outcomes in self-sufficiency

The O-UT model proves that even the most challenged individuals can transform their lives when held to high standards and provided with intensive, evidence-based support. Our budget is a fraction of housing-first programs, yet our outcomes in terms of true recovery and community reintegration far exceed the current approach. Most importantly, our participants become productive, self-sufficient citizens rather than permanent clients in a system that profits from their continued dependency.

The Time for Change

Every dollar spent maintaining the status quo is a dollar not invested in real solutions. Every person trapped in dependency—or worse, victimized in facilities like 1811 Eastlake—is a life not fully realized. We can either continue funding a system that warehouses problems at a cost of over $1 million per person over their lifetime, or invest $10,000 per person in approaches that solve them—a 99% cost reduction while delivering actual transformation.

The choice is clear: perpetual care that enriches service providers while impoverishing human potential, or permanent transformation that restores dignity, safety, and self-sufficiency. Our communities, our families, and the vulnerable individuals we serve deserve better than managed dependency punctuated by violence. They deserve the opportunity to reclaim their lives.

The author is Ginny Burton, the founder of the O-UT Program, a holistic lived experience behavior change program focused on addressing underlying causes of homelessness, incarceration, and addiction.