housing first dr sarah johnsen. linear ‘treatment first’ models - 1 assist homeless people to...

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’

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Street homeless

Shelter placement

Transitional housing

Permanent housing

Linear ‘Treatment First’ Models - 2

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• But, with complex needs clientele:• high attrition rate / ‘too many hurdles’• allows little room for ‘haphazard’ (non-linear)

recovery from addiction / mental health problems

Introducing Housing First - 1

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• 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

Street homeless

Shelter placement

Transitional housing

Permanent housing

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

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• 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

HF Principles - 2

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• 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

HF Outcomes

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• 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

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?