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Robert Marbutt: 'Stop housing first. Replace it with treatment,' says homelessness policy needs new focus
Summary
Former federal homelessness official Robert Marbutt told Washington Policy Center listeners that the Housing First approach has not solved street-level homelessness, which he says is rising; he urged a shift to treatment‑linked housing, stronger accountability and more empowered first responders.
Robert Marbutt, a senior fellow at the Discovery Institute’s Center on Wealth and Poverty and the former executive director of the U.S. Interagency Council on Homelessness, told Washington Policy Center listeners that the federally promoted 'Housing First' policy has failed to reduce street-level homelessness and should be replaced with treatment-focused, accountable programs.
"Stop housing first. Replace it with treatment," Marbutt said when asked what a medium‑sized city should do if it could take just one action to reduce homelessness. He argued that giving housing without requiring or providing clinical treatment for untreated mental illness and substance use disorders leaves people exposed to the same risks that led them to lose housing in the first place.
Marbutt framed homelessness as a multi-step collapse that often begins with untreated mental illness and substance misuse, followed by job loss, transportation loss and fractured relationships. "Seventy‑five percent of the time is substance use disorders and untreated mental illness," he said, stressing the need to address those clinical drivers before expecting housing alone to produce stable outcomes.
Citing national trends, Marbutt said street-level homelessness is increasing rapidly and said prior federal targets were not met. He referenced research and coroner accounts in arguing that mortality among people living in single-room government-provided housing has risen: "In the last 24 months, 25 months, death rate has doubled," he said, and recounted a coroner’s observation that many people are discovered days after death.
Marbutt pointed to local examples where he said treatment-centered strategies produced faster declines in visible homelessness. He said San Antonio achieved an "85% reduction off the baseline" after 15 years using an emphasis on treatment and accountability; he also cited Fort Smith, Arkansas (he reported a 90% reduction in year six) and Pinellas County, Florida (an 11‑year, roughly 85% baseline reduction) as comparative successes. He contrasted those accounts with cities he described as doubling down on Housing First and harm-reduction practices.
On the role of first responders, Marbutt described an on‑street rescue in Seattle in which an overdose victim who had been revived repeatedly refused transport or treatment; he argued that many people in that condition are not capable of making informed choices and urged legal and practical reforms that would allow first responders to intervene more directly and promptly to secure treatment rather than relying on slower judicial mechanisms.
Bowes, the program’s host and communications director for the Washington Policy Center, framed the conversation as part of the center’s promotion for an upcoming Sept. 20 dinner in Spokane where Marbutt and actor William Baldwin are scheduled to appear.
The exchange on Washington Policy on the Go was an interview and did not record a formal policy vote or new local action; Marbutt’s comments focused on his assessment of national trends, examples of local programs he described as successful, and a prescription to prioritize treatment and accountability alongside housing.
