Housing First Glasgow Evaluation and Findings Dr Sarah Johnsen

Introducing the Pilot Project Background: response to high levels of repeat homelessness amongst people with substance misuse issues in Glasgow Client group: 22 homeless people involved in active substance misuse 3 year pilot (Oct 2010 – Sept 2013) First project of its kind in UK 2

Project Aims Main aim to reduce re-occurring homelessness Specific objectives: 1.Improvement in personal living situation 2.Reduction, or no increase, in substance misuse (as per users’ personal goals) 3.Reduction, or no increase, in injecting or associated risk behaviours 4.Reduction in involvement with criminal activity 5.Improved psychological wellbeing 6.Improvement in overall physical health 7.Improved capacity to participate in and be valued by society 3

Project Principles Founded on belief that security of own home + support = better position to begin journey toward recovery from addiction Key principles: 1.Provision of scatter-site housing (‘ordinary’ social housing) 2.No ‘housing readiness’ prerequisites 3.Harm reduction approach 4.No time limits on duration of support or length of tenancy (standard Scottish Secure Tenancy) 5.Respect for consumer choice (insofar as supply allows) 6.Holistic support 24/7 (assertive outreach and motivational interviewing; staff on-call outside office hours)

Project Details Eligibility criteria: 18+ years Homeless (statutorily and eligible for s.5 referral) Current drug, alcohol or polysubstance problem Needs not being met by current services Desire to sustain a tenancy Staff team Service coordinator Assistant service coordinators Peer support workers

Pilot Evaluation Independently evaluated by Heriot-Watt University Longitudinal study involving: Interviews with TPS staff and key stakeholders (x2) Interviews with pilot service users (x2) Case file analysis Fieldwork phaseType of intervieweeNo. of interviews Wave 1Stakeholder9 Staff4 Service user22 Wave 2Stakeholder12 Staff5 Service user21* Total 73

Service User Profile at Recruitment Most aged 25-44; 18 male/ 4 female; all White British Backgrounds of revolving door of homelessness / institutional care Substance misuse problems typically date back to early teens For many, drug addictions severe; alcohol dependencies less so Almost all been involved with criminal justice system (mostly minor acquisitive offences, some more serious/violent) Weak (and often damaging) social support networks, but some benefited from positive family support Approx half had never had paid work

Outcomes: Housing Stability OutcomeNo. of service users Housed and retained tenancy: (…of whom housed for 24+ months) (…of whom housed for months) (…of whom housed for 6-11 months) (…of whom housed for < 6 months) 15 (9) (2) (3) (1) Housed but subsequently lost/gave up tenancy 2 Not housed 4 Deceased 1 Total 22 NB: no evictions

Outcomes: Health Physical health improved for majority Less substance misuse and better diet …but some still in poor health Mental health outcomes also good on balance Stable housing and ‘stickability’ of support = ↑ psychological wellbeing But, ‘dip in mood’ not uncommon after being housed (often accompanied by ↑ substance misuse / relapse)

Outcomes: Substance Misuse Outcomes mixed, but positive on balance Drugs: ↓ in severity of drug misuse for majority 10 abstinent at end of pilot period …but minority still reported high level of dependence at wave 2 Alcohol: less change in severity of alcohol dependence 2 former problematic drinkers abstinent at end of pilot period some substitution of alcohol for drugs Most met / closer to meeting substance misuse goals

Outcomes: Criminal Activity & Financial Wellbeing Criminality and street culture Overall ↓ in concert with ↓ in substance (esp. drug) misuse Similarly, general ↓ in street culture activities (e.g. begging, sex work), but minority continue to beg regularly Financial wellbeing Improved for most (due to ↓ in drug misuse) But, majority still find it difficult to cope financially

Outcomes: Social Support Family support important for some; a few have (re)established contact with estranged children Friendship/ peer networks complicated: Some cut ties with other users; vulnerable to isolation and very reliant on staff for social/emotional support Others still in contact; less likely to be lonely but had greater difficulty ‘managing the door’ and higher risk of relapse

Outcomes: Meaningful Activity & Community Integration Employment and meaningful activity Outcomes better than anticipated: 7 in training/education; 5 attending day services (e.g. NA); 2 voluntary work Majority view paid employment as long-term goal Community integration Know neighbours ‘well enough to say hello to’ Instances of neighbourhood disturbance rare Neighbour complaints resolved without resorting to eviction

Trajectories Three general trajectories re direction and extent of behaviour change / ‘distance travelled’ on recovery journey 1.Sustained positive change – outcomes largely or uniformly positive overall and sustained; c.½ service users (n=11) 2.Fluctuating experiences – periods of relative stability punctuated by ‘slips’ on recovery journey; c.¼ service users (n=6) 3.Little observable change – housing stability achieved, but little evidence of change re other outcomes; c.¼ service users (n=5)

Service User & Stakeholder Views Very high levels of service user satisfaction; esp. re: Flexibility and ‘stickability’ of support Understanding and non-judgemental approach of staff Ability to be able to be ‘honest’ about their addiction Generally viewed as highly successful by stakeholders; ‘conversion’ of ‘sceptics’, in large part due to: High rates of tenancy sustainment for ‘serial disengagers’ Far fewer instances of neighbourhood disturbance than anticipated

‘Lessons Learned’ Critical importance of communication with police and housing officers Delays in accessing flats/furnishings demotivating ‘Making house a home’ mitigates against ‘dips in mood’ Peer support workers ‘add value’ Value of informal/ unstructured recreational activities

Conclusion Housing First ‘works’ with people involved in active substance (esp. illicit drug) misuse … … and the Glasgow pilot is already informing the development of other projects throughout the UK and beyond