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Housing First

This article examines the 'Housing First' approach compared to traditional 'Treatment First' models in addressing homelessness. The Housing First model, developed by Pathways to Housing in New York City in 1992, emphasizes placing chronically homeless individuals directly into permanent housing without preconditions, treating housing as a human right. Flexible support and a harm reduction philosophy promote stability, making it applicable even for those with complex needs. This model has shown promising retention rates and is endorsed in various regions, including Scotland.

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Housing First

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  1. Housing First Dr Sarah Johnsen

  2. Linear ‘Treatment First’ models - 1 Permanent housing • Assist homeless people to move ‘up’ staircase, into progressively more ‘normal’ accommodation • ‘Treatment first’ philosophy: indept. housing only provided when deemed ‘housing ready’ Transitional housing Shelter placement Street homeless 2

  3. Linear ‘Treatment First’ Models - 2 • • But, with complex needs clientele: • high attrition rate / ‘too many hurdles’ • allows little room for ‘haphazard’ (non-linear) recovery from addiction / mental health problems 3

  4. Introducing Housing First - 1 •Developed in NYC in1992, by Pathways to Housing, for chronically homeless with severe mental health problems •Bypasses transitional accomm; places homeless people directly into independent tenancies with support Permanent housing Transitional housing Shelter placement Street homeless Ongoing flexible support 4

  5. Introducing Housing First - 2 •‘Housing first’ (cf. ‘treatment first’) philosophy: no readiness or treatment prerequisites •Housing as a human right, not something to be earned or used as enticement to treatment • Independent permanent housing as stable platform from which other issues can be addressed

  6. HF Principles - 1 • •Provides mainstreamhousing • independent self-contained flats (in PRS), leased by Pathways • scatter-site • 30% of income paid toward rent / utilities • •No ‘housing readiness’ prerequisites • do not need to exhibit indept. living skills • no requirements re sobriety / abstinence • •Harm reduction approach • separates clinical issues from housing issues; clinical crisis (e.g. relapse) does not compromise housing 6

  7. HF Principles - 2 • •Permanent housing and support • accomm. retained if incarcerated or hospitalised • only evicted for same reasons as other tenants; evictees re-accommodated elsewhere • no time limits on support • •Comprehensive multidisciplinary support • ACTs: social workers, nurses, psychiatrists, peer counsellors, employment workers • assertively delivered in home and community • •Consumer choice philosophy • choice re apartment / furnishings • choice re degree of engagement with support (above minimum level) • • Targets most vulnerable 7

  8. HF Outcomes • • Housing outcomes excellent (80%+ retention over 2 years) • • Challenges assumption that people with complex needs unable to sustain independent tenancy • • Clinical outcomes mixed, but generally positive: • Positive impact on mental health • Reduced alcohol consumption • No increase in drug use • • Highly cost-effective 8

  9. HF Replication • •Controversial initially, but now: • endorsed by US Federal Govt. • widely replicated across Europe • endorsed in European policy • •Increasing interest in HF within UK • a potentially valuable complement to services, esp. for ‘hardest to reach’? • first UK pilot in Glasgow (Turning Point Scotland): 18 homeless people actively involved in substance misuse

  10. What added value might Housing First bring to homelessness policy and practice in Scotland?

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