My doubts about the value of Housing First

There is a growing consensus that Housing First is the way to go in combatting homelessness. Housing First is defined as “an approach that offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections to the community-based supports people need to keep their housing and avoid returning to homelessness”.

The concept of Housing First has been around since 1988 but in recent years it has been championed by Homeless Link and, as a result, has attracted more interest and support.

The concept, as applied in the U.K., is that street homeless people, usually with addictions and chaotic lifestyles, get housing and open-ended support in order to avoid further periods of homelessness. This is not conditional on any change of behaviour or the need to engage with support services.

There is very informative research carried out by Joanne Bretherton and Nicholas Pleace from the Centre for Housing Policy at the University of York that is very positive about the nine pilots that have been run around England, including one in Brighton run by CGL (Change, Grow, Live, formerly CRI – Crime Reduction Initiatives).

I can see the positive aspects and achievements of Housing First, but I don’t think it is the panacea it is sometimes presented, and I think it has some fundamental flaws in principle.

The research found many positive outcomes had been achieved, for example:

  • 74% remained housed for over a year;
  • Bad or very bad health fell from 43% to 28%; and
  • Bad or very bad mental health fell from 52% to 18%.

But while there have been improvements in other areas, the situation remains depressingly poor:

  • Drug use fell only from 66% to 53%;
  • Those who “drank until they felt drunk” reduced only from 71% to 56%; and
  • Anti-social behaviour, compared to the year before entering Housing First, remained at 53% compared to 78%.

I am not sure whether we can regard a scheme as a success when the majority continue to use drugs, drink until they are drunk, and continue to commit anti-social behaviour.

In other areas of their lives, the improvements, while welcome, are not very encouraging. Begging dropped from 71% to 51%. Why, we should ask, are people who are housed, and getting support to claim benefits, still begging? 36% of those housed had been arrested, compared to 53% before they were housed.

For most of us, when we meet someone for the first time, the first two bits of information we share about ourselves are our names and what we do, be it paid or unpaid, work or hobbies. In the Housing First research, there was absolutely no change in the number of clients entering work, remaining stubbornly low at just 3%. Those in Housing First schemes are at risk of continuing to be defined by what they do: drinking until they are drunk, using drug, begging, perpetrating anti-social behaviour. Housing First hardly helps people to achieve their aspirations and their full potential.

My doubts about Housing First are those very principles that its advocates regard as its strengths:

  • It is based on a harm reduction model;
  • It offers open-ended support;
  • It is not conditional on engagement: and
  • Retention is not based on behaviour modification.

At its heart, Housing First lacks ambition, that change is possible, that people can achieve their aspirations and full potential. It embeds dependency, on welfare benefits and support. As one interviewee put it: he gets “help with everything”. At BHT, part of our ethos has seen a move away from staff always doing things for clients, helping with everything, to promoting change so that people can take advantage of the opportunities available to them so that they can combat their homelessness, poverty, mental ill health and addictions.

Economically, can the modest savings be regarded as adequate? The report found that savings were £15,000 per person per annum. While that is not to be dismissed, by being more ambitious, greater savings can be made. Our Addiction Services, for example, will see 60 individuals each year with a history of homelessness and addiction becoming abstinent and housed. Most go on to training and employment. Relationships strengthen, they don’t beg or steal, and their health improves. As a result, crime rates plummet and there are no demands on the police and criminal justice, there are fewer ambulance call outs, fewer attendances at A&E, welfare dependency reduces, people begin paying taxes.

For how long should landlords tolerate rent arrears and damage to property, disturbance to neighbours and the community excused, high levels of public funds be expended?

Housing First is an open-ended commitment. It would be great if we had open-ended resources, if we had plentiful housing, if we had homes with no neighbours being impacted by anti-social behaviour. But even then, I don’t find it acceptable, morally or economically, to leave people in action addiction, committing anti-social behaviour, begging and offending, when better outcomes are possible. Surely we can do better.

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3 thoughts on “My doubts about the value of Housing First

  1. Why are you trying to set up a Housing First project then?

    Additionally can you provide a comparison to clients with multiple and complex needs accommodated in your own hostel services? Are the outcomes better/worse or the same? You seem to be talking in a vacuum!

  2. Another bitter comment by yesterdays man, with his “12 steps is the only way” philosophy. BHT keeps losing contracts and not winning bids, yet all Mr Winter does is blame the council and the commissioners and slags off the new providers. How about having a good long look internally at why no-one trusts BHT any more i.e. get your own house in order, before criticising others? You were never that important mate, certainly not as important as you thought you were, and you’re not important now.

  3. I feel the need to respectfully offer a counterbalance to the blog questioning the value of Housing First.

    Andy you are quite correct that the Pleace and Bretherton research conducted in 2015 showed modest improvements in mental and physical health, maintenance of accommodation and reductions in ASB and criminality of the individuals living in Housing First projects it studied. It also concluded that it is really too early to assess the success or otherwise of the model, and this will only be possible when taking a much longer term view.

    Housing First should be seen to complement existing services rather than replace any of them. The linear housing and support pathway towards independence is a successful model for many people, but there is clear evidence that for some individuals, often those with very complex mental and physical health needs, it simply doesn’t work. If we do nothing, there will continue to be a cohort of individuals who either can’t or won’t access the prescribed accommodation options available, remaining on the street or in a costly cycle of offending and/or crisis health admissions with no solutions in sight.
    In order to be able to properly evaluate Housing First’s cost effectiveness and build an evidence base for the approach, a small leap of faith is required from local commissioners and stakeholders. Via the South East Fulfilling Lives Project, BHT will be working with local stakeholders to craft a set of principles which are relevant to our local area and responsive to the needs of individuals for whom the current system simply does not work.

    When considering the development (or expansion in Brighton & Hove) of Housing First locally it is important to consider very carefully the “who”. As I write, around half of the clients on the Fulfilling Lives caseload in East Sussex have no current identified housing option and continue to sleep rough with all the associated risks. For some of them, Housing First may just be the thing that could give them dignity and hope; a route off the street and an opportunity to start to consider that they may actually have a future to think about.

    Surely we should be ambitious for all homeless clients, not merely those who are motivated and ready to engage with a support programme? I would challenge the view that Housing First lacks ambition. The early work course consists of harm reduction and stabilisation but long term assertive and intensive case management support is an essential part of the package. Services should be underpinned by a philosophy that there is always a possibility for positive change and improved health and wellbeing.

    As a systems change and learning project, the South East Fulfilling Lives project intends to support the delivery, evaluation and replication of the Housing First model locally. To be successful the model requires input from adult social care, criminal justice, health and substance misuse in order to provide effective wrap-around support. Being Big Lottery Funded and sitting outside of mainstream commissioned services we are well placed to broker discussions across siloes and encourage joint commissioning relationships to develop which may eventually lead to mainstream funding.

    We have an opportunity now in East Sussex with a number of enlightened individuals in leadership roles in local authorities and providers across the county, central government funding as well as strategic initiatives looking to innovate for improved health outcomes such as East Sussex BetterTogether which this project could really speak to.

    There are of course risks associated with the rapid growth of the Housing First movement and its publicity from Homeless Link could be a double edged sword, risking dilution of the model. Homeless Link have produced a set of key principles which are a useful reference when considering what Housing First is and what it is not. (http://www.homeless.org.uk/sites/default/files/site-attachments/Housing First in England The Principles.pdf)

    Housing First is not a panacea; it will not necessarily work well with all the people for whom it is intended, even if the evidence is that it successfully engages with most of them, however, it could well have an important place in the range of routes off the street for homeless individuals in Sussex with the most complex needs. It could end up saving lives, offering dignity and stability where currently there is chaos and hopelessness. It may even provide savings to the public purse.

    We have a great opportunity in East Sussex currently, and we want others to be part of the conversation. Will you join us?

    Jo Rogers
    Senior Manager
    BHT Fulfilling Lives Multiple Complex Needs Project

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