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?