Supported Housing and Substance Misusers: What’s the Score? Jenny PannellStuart Priestley January 2007

Outline of the presentations Stuart Drug and alcohol strategy and targets 4 Tiers of drug and alcohol services Drug and Alcohol delivery structures Integrated treatment, care and housing (ICPs) Jenny Interface between substance misuse services and housing Barriers to service development Eg’s effective service development Questions to discuss and take away

Strategy National Drug Strategy – updated 2002 Alcohol Harm Reduction Strategy for England Treatment Effectiveness Strategy (drugs)

Targets PSA targets: Increase the participation of problem drug users in drug treatment programmes …by 100% by 2008, against a 1998 baseline, and to increase year on year the proportion of users successfully sustaining or completing treatment programmes 1,000 drug-misusing offenders into treatment every week by 2008

Drug and Alcohol services a 4 tiered approach Tier 1: Drug and alcohol related information and advice, screening, assessment, and referral to specialised treatment Tier 2: Open access, non-care-planned drug and alcohol specific interventions Tier 3: Structured, care-planned drug and alcohol treatment Tier 4: Drug and alcohol specialist inpatient treatment and residential rehabilitation

Delivery Structures Drugs DH/HO NTA / SHAs DAAT/CDRP Treatment / Prevention / Crime Reduction Alcohol DH RPHG / SHA / GO PCT / LA Treatment / Prevention / Crime Reduction

Alcohol Needs Assessment Research Project (ANARP) 2004 The study found a high level of need across all categories of drinkers 26% of are drinking above “safe” levels – Hazardous or Harmful drinking –32% of men and –15% of women –This equates to 7.1 million people 3.6% are alcohol dependent –6% of men and –2% of women –This equates to 1.1 million people

Drugs – Headline needs Problem Drug Users estimate: Performance against PSA: 181, /06 (113% increase on 1998, 13% increase on 2004/05)

The client’s journey (theory) EngageDeliver Completion or maintenance Reintegrate

The client’s journey (practice) EngageDeliver/ Maintain Completion Reintegrate

What are the challenges? Delivering treatment effectively through Integrated Care Pathways, and commissioning services to make Integrated Care Pathways work Developing links between treatment services, the criminal justice system, housing and support : key national policy objective to improve joint working on housing-related support services for drug misusers (DH, NTA, Home Office, DCLG, SP, Housing Corporation) Achieving a Whole Systems approach

The interface between substance misuse services and housing Settled housing is essential if people are to address their substance misuse and their other physical, mental and emotional health needs. Housing related support is just as important. If someone’s housing and related support needs are not met, they are much less likely to: –enter or remain in treatment for their substance misuse –address their other ‘social’ needs eg training, education, work, other ‘meaningful occupation’ –address their other physical and mental health needs –maintain an existing tenancy successfully –avoid involvement with the criminal justice system

Housing provides the architecture that underpins all stages of the “treatment journey”

Range of homeless, housing and support services working with substance misusers –Services to rough sleepers: health services for homeless people, street outreach work –First stage or direct access hostels and shelters –Specialist short-stay hostels and supported housing –Medium to long-stay supported housing (some with linked move-on) –Tenancy sustainment and floating support for people in mainstream tenancies (including sheltered housing) All providers are RSLs; much of their work with substance users is funded through housing funding (homelessness, SP) with limited or no health funding

Barriers to service development Limited understanding of housing models (by DATs/DAATs, some health staff) and of treatment services and agencies (by housing staff) Mainstream housing providers often fearful of rehousing substance misusers Cross-authority issues Links not always effective between strategies, targets, capital & revenue funding Limited joint funding of services

Key strategies Health: Drugs Alcohol Mental health Public health Housing: Regional & local housing strategies Planning & regeneration Homelessness Criminal justice: Crime prevention & community safety Substance misuse Prison Health and Offender Partnerships Care and support: Supporting People Older people, vulnerable adults Learning disability

Effective service development (1): better commissioning, joint budgets ‘Virtual’ adult drug treatment budget (Bristol) using combined budget to commission joined-up services including supported housing and floating support: budgets from PCT, Probation, Social Care, Safer Communities (DAT), Neighbourhood Renewal, Community Care, SP Joint commissioning of new-build abstinence-based supported housing (Stockton on Tees): HC capital funding; SP, DAT & rents revenue funding project group including RSL, Adult and Young People’s Social Care Teams, Housing, Probation, carer and user organisations

Effective service development (2): within homeless provision Substance Misuse Units with specialist staff within homeless hostels: London, Westminster and Tower Hamlets, and Look Ahead The Dawn Centre, Leicester: new purpose-built centre funded through DCLG (Hostels Capital Improvement Programme): Primary Health Care Centre with DAT-funded drug worker and GP, drop-in centre (YMCA) 42-bed night shelter (Leicester CC Housing) with single en-suite rooms

Effective service development (3): specialist supported housing Wide range of provision across age ranges (young people, adults, older people) with either harm minimisation or abstinence ethos; length of stay varies from short-stay to permanent Examples in the reports include: Brighton Housing Trust: residential detoxification, abstinence- based supported housing and linked move-on Stonham abstinence-based projects, including Exeter Prospects short stay abstinence based project for men leaving Devon prisons (Home Office capital and revenue funding) St Eugene’s Court, Birmingham: permanent supported extra-care housing for older Irish men (Focus Futures)

Effective service development (4a): specialist floating support Safer Communities floating support for people with multiple and complex needs and forensic issues (incl. substance misuse, mental health, challenging behaviour) providing intensive floating support for people in social and private tenancies and in supported housing referrals through RBKC Housing & Multi-Agency Public Protection Panels (London: Kensington & Chelsea, Threshold Support) Intensive floating support for Probation clients with substance misuse issues living in private rented housing (LA leading/deposit bond) commissioned jointly through SP, Probation and Drug Interventions Programme includes supporting clients to keep to Probation or Treatment Orders (London: Newham, Single Homeless Project)

Effective service development (4b): specialist floating support Intensive floating support for LA tenants with complex needs (substance misuse, criminal justice, mental health, ASBOs) to prevent repeat homelessness and family breakdown working in partnership with local authority ASBO and Homelessness staff (South Tyneside and Byker Bridge HA) Intensive floating support for ex-prisoners who wish to remain abstinent after detox in prison living in dispersed flats from the ALMO client will take over tenancy after 12 months if comply with DIP programme (Oldham and Turning Point) Specialist floating support for older people with alcohol issues moving into sheltered housing (London: Brent and St Mungo’s)

Questions (1) Do national, regional and local strategies, policies and procedures take sufficient account of the importance of housing and housing related support for substance misusers and their treatment journeys? What could be done to increase the importance of housing and housing related support for this client group?

Questions (2) Do the different strategies in your local area, and at regional level, complement each other? What can be done to improve service development and the interface between housing and substance misuse services  by government?  by commissioners?  by providers?

Supported Housing and Substance Misusers: What’s the Score? Stuart Priestley: Jenny Pannell :