Housing First

All parties have pledged support for Housing First as the new approach to solving homelessness and rough sleeping. Sajid Javid has vowed to visit Housing First services in Finland to find out how this model is solving the problem of homelessness there, and Andy Burnham the new Mayor of the Northern Powerhouse that is Greater Manchester, has also stated interest in promoting Housing First.

Those working with rough sleepers could be forgiven for thinking that, though welcome this interest in the model is, politicians are playing catch up with the sector. There is no need to visit Finland! We have several Housing First projects operating in the UK already, and some have even been running long enough to be evaluated by academics and to have proved that as well as providing housing stability, they are having a marked improvement on people’s well-being and ability to engage with drug and mental health treatment services.

So what is Housing First and why has it now become the new holy grail for dealing with homelessness and rough sleeping?

The approach was first pioneered by Pathways to Housing, a homelessness organisation founded in 1992 in New York with a mission to transform individual lives by ending homelessness and supporting recovery. The founder Dr. Sam Tsemberis treated housing as a human right, not as the end point of a pathway approach to homelessness, but as something fundamental that everyone should have.

Rough sleepers, with often significant histories of substance misuse, poor mental health, anti-social behaviour, and long term worklessness, who would find themselves in and out of traditional pathway based services (services designed to train and support people to become increasingly self-reliant and step down from 24/7 supported hostels to semi-independent and then independent living), were given their own tenancy in a neighbourhood of their choosing and provided with intensive visiting support.

The results speak for themselves[1].People trapped in a revolving door of homelessness services retained their tenancies and began to engage with services. Indeed, one longitudinal study found that 80% of the participants assigned to Pathways to Housing were in stable housing after 12 months compared to just 24% for other three stage pathway services.

The model has been adopted by many other countries, (including Finland), and there is in fact a European network of Housing First pioneers.

Housing First works and has had success with some of the most entrenched and complex rough sleepers.  But why does it work?

At its heart is common sense – give a home to a homeless person and they will slowly, with the right intense support – provided by highly skilled support workers who understand trauma and can work effectively with people who often demonstrate anti-social and chaotic behaviour – benefit from the stability a home gives. It is the basic tenet of Maslow’s hierarchy of need – the need for shelter and safety.

While the sector might be happy to see the model promoted and be pleased to hear about promised investment to establish more Housing First services in the UK , I can’t help but feel cautious.

Housing First works, however it’s not cheap.  The approach requires highly skilled staff, a pipeline of suitable stable accommodation (usually flats or studios) as well as willing landlords. Time and effort is needed to find housing and in London this is more than likely to be provided by the private rented sector. Persuading landlords, who have far less risky and more lucrative options, to provide units for Housing First clients requires building good relationships as well as providing some funding for guarantees.

Successful Housing First is based on intensive visiting support – often daily or at least twice weekly at the beginning at least, and significant amounts of partnership working and information sharing with other agencies to make it work. As such, it also needs a sensible approach from Commissioners to paying for the number of hours needed and worker’s traveling time and back-office work – both of which need to be costed in to any hourly rate of support.

It requires well-trained, resourceful and resilient support workers who can work in a psychologically informed way, understand the impact of trauma, and are skilled in supporting behaviour modification and strengths based recovery approaches, as well as having the skills to build trust with difficult to engage clients.

The new interest in this tried and tested approach is very welcome, but the housing and the support that underpins the approach needs to be there and be properly resourced if it is to work as it is meant to.

We should also remember that pathway services will still be needed – for the people for whom that mode of service delivery works – and so we should not see Housing First as the alternative to hostel services, but a model that works for those who are failed by the pathway model.

A tanking economy, continuous cuts to public services and a chronic undersupply of affordable housing do not inspire much confidence that the warm words will be met with required resources. However, if there are landlords (social and private) willing to commit housing units and commissioners that see the sense in investing properly in the support required to make it work, then there is a good chance to really achieve a step change intervention in rough sleeping.

Liz Zacharias is a Senior Consultant at Campbell Tickell. For more information or to discuss this article, please contact: liz@campbelltickell.com


Further reading:


Camden Housing First A Housing First Experiment in London:  http://hfe.homeless.org.uk/sites/default/files/attachments/Camden%20Housing%20First%20Final%20Report%202013.pdf


[1] Tsemberis, S., Gulcur, L. and Nakae, M. (2004). Housing first, consumer choice and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94, 4, p. 651-656

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