People in Chile who are experiencing long-term homelessness often have high rates of drug and alcohol use. As current drug laws criminalise the possession and use of drugs, people in street situations are at high risk of being arrested and incarcerated. The financial toll of this on the country is estimated at USD 7,558,545 between 2005 and 2018.

In 2000, psychologists and social workers studied treatment outcomes from abstinence-based rehabilitation programmes among people experiencing homelessness. They found this punishment-based and zero-tolerance model had high dropout rates and little impact, especially in relation to improving mental health and supporting social reintegration.

These findings led to the innovative Housing First programme. Here, housing is made available to people experiencing homelessness as a first step, accompanied by professional support and access to health services. The support provided is based on people’s individual needs, respecting self-determination and autonomy. The Housing First programme has housed hundreds of people in Chile and made a significant difference to people’s lives, as reflected by the Chilean Ministry of Finance’s positive assessment of the programme and its increased financial support. Housing First has high retention, with 95% of participants staying in the programme for at least three consecutive months and 77% for six months. A survey of participants found 80% reported improvements in social integration and 96% reported improvements in one or more dimensions of their health. This programme is a clear example of the gains that can be made by shifting from punitive approaches to drug use to focus on the health and wellbeing of individuals and communities.