Housing First Dr Sarah Johnsen Linear ‘Treatment First’ models - 1 • Assist homeless people to move ‘up’ staircase, into progressively more ‘normal’ accommodation • ‘Treatment first’ philosophy: indept. housing only provided when deemed ‘housing ready’ Permanent housing Transitional housing Shelter placement Street homeless 2 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 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 4 Street homeless Ongoing flexible support 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 HF Principles - 1 • Provides mainstream housing • 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 HF Principles - 2 • Permanent housing and support • accomm. retained if incarcerated or hospitalised • only evicted for same reasons as other tenants; evictees reaccommodated 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 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 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 What added value might Housing First bring to homelessness policy and practice in Scotland?