1. PERMANENT SUPPORTIVE HOUSING A DISCUSSION September 2009 Felicity Reynolds CEO, Mercy Foundation Churchill Fellow 2007

2. Overview

• Costs associated with crisis care for people who are chronically homeless

• Key elements and benefits of permanent supportive housing and

• A few examples of supportive housing models

• Australian context

• How do we get there from here?

3.

• Although chronic homelessness represents a small share of the overall homeless population, chronically homeless people use up more than 50 percent of the services (for single homeless adults). The most successful model for housing people who experience chronic homelessness is permanent supportive housing using a Housing First approach. NAEH

4. Chronic homelessness much more than chronic houselessness

• People who have experienced multiple episodes of homelessness over a year or people who have experienced ongoing street homelessness for at least 6 months.

• Disconnectedness and social exclusion.

• Often a background of trauma and abuse.

• Trust of other people and services.

• May develop social connections, networks and supports and become entrenched. This should not be mistaken for a lifestyle choice.

5. Cost of crisis care to this population

• Now well understood that some chronically homeless people are high users of crisis services. That is acute mental health, EDs, IPUs, detoxes, ambulance, police, legal, shelter etc.

• NYC study US $41,000

• Sydney estimate AUD $34,000

• As long as the individual remains homeless, these costs are recurrent.

• We are spending this money anyway why not improve the outcomes.

6.

7.

• Berry (2003) noted that a study in the USA showed that it costs an additional US$3196 for each person to provide substance abuse and mental health services to homeless people, compared to clients who were housed.

• Culhane (2004) concluded that It costs essentially the same amount to house people as it does to leave them homeless.

8. Cost/benefit studies

• Many US cities have now done cost/benefit studies and now understand that it is not only morally responsible, it is fiscally responsible to assist chronically homeless people off the streets and into permanent supportive housing (many models: private housing, public housing, safe havens, community homes etc).

• Now, good evidence that service use reduces once people are in stable housing and have adequate support.

9. Follow-up survey by S2H Toronto (after being housed)

• • Are you happy with housing?

• • Very Happy 50%

• • Mostly Satisfied 37%

• • Somewhat Unsatisfied 8%

• • Very Unhappy 5%

• • Has housing changed your life?

• • Improved a lot 61%

• • Somewhat improved 30%

• • Stayed the same 7%

• • Gotten worse 2%

10.

• • 17% reported no drinking since being in housing.

• • Homeless 2+ years much more likely to report decrease in alcohol use ( 59% vs. 27% ).

• • 31% reported they had quit using drugs completely since being in housing.

• • Those homeless 2+ years most likely to report decrease in drug use ( 78% vs. 62% ).

11.

• Reduced use of crisis and emergency services

• Clinics - 28%

• ER - 40%

• Hospital - 25%

• 911 (emergency call) - 35%

• Ambulance - 38%

• Fire - 71%

• Police detox (Drunk Tank) - 75%

• Getting arrested - 56%

• Jail - 68%

• Court - 58%

• Probation - 38%

12. An example of a supportive housing model

• House/Unit +

• Person/People +

• Support ( little or lots ) =

• Supportive Housing

13. Key components of Housing First

• People do not have to be assessed as Housing Ready.

• Housing is provided as quickly as possible.

• People are provided with adequate and appropriate support services in their home.

• People with alcohol or other drug addictions can access housing.

• People do not need to be compliant with mental health treatment separate the behaviour from the diagnoses

• Separate the management of the housing from the support.

14. A few models we need many

• HASI (NSW) but similar to other models in other States.

• Common Ground (more about that in a moment).

• Pathways to Housing (NYC) or S2H (Toronto).

• Safe havens a useful model for some.

• Harm minimisation accommodation services work very well with this group (Seaton House Annex a good example).

• Ready, Willing and Able (The Doe Fund) in NYC is a good example of an abstinence based, work skills residential program.

15. Common Ground

• Core components of CG

• • • Permanent housing with on-site support

• • • Own self contained apartment

• • • Safe and secure (24 hour concierge)

• • • Tenancy manager and support service are separate services.

• • • High quality housing and mixed tenancies formerly homeless and those who are not, but who work in low income jobs or study.

• • • Sense of community use of community spaces etc.

16. Permanent NOT Transitional

• From a funding and systems point of view medium support and transitional accommodation seems to make sense (shares those finite resources around!).

• However from an individual point of view it may undermine stability, connecting with local communities and with social inclusion.

• Some people may move elsewhere eventually anyhow after gaining some stability. Some may not and, perhaps, may always need some level of ongoing support. Thats ok.

17. Joe

• 20 years street homeless.

• Excluded from many services.

• Ended his homelessness when provided with a high quality place to stay no matter what.

• This encouraged him to give detox a go he wouldnt make himself homeless if he failed (which he thought he probably would).

• Now almost 20 years working and managing homelessness services.

18. Australian context

• Federal White Paper initiatives prevention, improving services and breaking the cycle.

• Some State plans (NSW as example) complement Federal vision and plan.

• Permanent supportive housing models help break the cycle also helps prevent further episodes of homelessness.

19. How do we get there from here?

• • • Need paradigm shift from managing crises to ending homelessness.

• • • We have an existing large and mostly well qualified workforce of support workers/case managers just need to provide the support within peoples homes rather than in other environments.

• • • Urgent need for permanent housing stock. Councils can perform a role here by introducing policies and planning controls that encourage this.

20. Getting there from here (cont.)

• • • Adopt Housing First and rapid re-housing approaches (but need housing to do this).

• • • Stop over-servicing people who dont need it (some people just need somewhere to live and do not require support).

• • • Funding incentives that encourage long term outcomes.

21. Discussion

• How else might we get there from here?

• What are some additional barriers to housing first or rapid re-housing?

• How should we evaluate these types of programs?

22. Contact details

• Felicity Reynolds

• CEO, Mercy Foundation

• [email_address]

• 02 9699 8726