1. Overview of Housing First in Europe Suzanne Fitzpatrick, 9 th May 2014

2. Origins of Housing First  First developed in New York, by ‘Pathways to Housing’, for chronically homeless people with severe mental health problems  Bypasses linear model/transitional accomm; places street homeless directly into independent tenancies with support  ‘Housing first’ cf. ‘treatment first’ (or ‘employment first’) philosophy  Strong evidence base from US, especially on tenancy sustainment  Controversial initially; now widely endorsed

3. HF in European Context Rapid expansion of HF pilots/programmes Endorsed by FEANTSA Promoted by EU - Joint Report on Social Protection and Social Inclusion (2010) Jury of European Consensus Conference on Homelessness (2010) called for: - shift away from use of transitional models - towards increased access to permanent housing (with support)

4. ‘Housing First Europe’ Study Funded by European Commission 2 year project (2011- 2013) involving: a) research; b) mutual learning Examined HF implementation and effectiveness in: Test sites: Amsterdam (Netherlands), Budapest (Hungary), Copenhagen (Denmark), Lisbon (Portugal), Glasgow (UK) Peer sites: Dublin (Ireland), Ghent (Belgium), Gothenburg (Sweden), Helsinki (Finland), Vienna (Austria)

5. Robustness of Evidence Base  The case for HF – and de-institutionalising homeless people – is now compelling  We do not have ‘gold standard’ randomised control trial evidence in Europe, but the sheer consistency and 'weight' of evidence from HFE (and other studies) is utterly convincing  Most homeless people, even with very complex support needs, can sustain ordinary housing if given the right support  There will always be a need for other approaches for a minority, but there is an increasing view that the default should be HF (or housing-led)

6. Scattered-Site Housing is Best  HFE adds to large body of evidence that scattered- site housing is: a) what most homeless people want; and b) what works best for most homeless people  The negative impacts and institutionalising tendencies of congregate settings are now well evidenced, e.g. hostel closure evaluations, problems with Common Ground in Australia, etc.  There will, of course, be a need for (usually small) group settings for a minority of homeless people, but the evidence indicates that the default should be scattered-site

7. Going Forward  Basic case for HF, using scattered-site housing, is now made. But there are important areas which would benefit from future development/research:  long-term sustainability  cost-effectiveness  Assertive Community Treatment – when required/useful  resolving neighbour disputes  whether HF or transitional model most appropriate for young people

8. HFE Study www.socialstyrelsen.dk/housingfirsteurope