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’ 2 Street homeless Shelter placement Transitional housing Permanent housing

Linear ‘Treatment First’ Models 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 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 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 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 8 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?