6.1. The Strategic Roles of Housing First

6.1.1. Incorporating Housing First into Strategies to Fight Homelessness

Research shows that homelessness should not be seen as simply being the result of individual actions or untreated mental illness. Homelessness exists in multiple forms in Europe. Some homelessness does not involve people who use drugs, drink to excess or have mental health problems, but is instead linked primarily to their economic position, a wider lack of community integration, poor social support and difficulties in accessing services((Busch-Geertsema, V., Edgar, W., O’Sullivan, E. and Pleace, N. (2010) Homelessness and Homeless Policies in Europe: Lessons from Research, Brussels, Directorate-General for Employment, Social Affairs and Equal Opportunities. Vid. Note 91)). Homelessness can also vary between different groups. For example, women’s homelessness is much more likely to be linked to escaping domestic violence than men’s. Homeless women may also avoid some forms of homelessness service, often relying on informal relationships to temporarily find accommodation(8Baptista, I. (2010) ’Women and Homelessness in Europe‘ in O’Sullivan, E., Busch-Geertsema, V., Quilgars, D. and Pleace, N. (eds.) Homelessness Research in Europe Brussels: FEANTSA.)). Women experiencing homelessness can therefore require different services from those provided to single homeless men. Some groups of homeless people, such as teenagers with experience of social work-based child protection systems, people who have been in prison and army veterans, may also require specialised forms of support.

Preventing and reducing homelessness involves a range of policies and services, including enhancing access to housing, enabling development of new affordable housing, providing preventative services and a range of other support services. Some homeless people will only require advice and perhaps some short-term support to prevent or quickly end an experience of homelessness. Others may need low-intensity support for a few weeks, or months, to help them find and sustain a home.aSome may require more support for a longer period of time to either exit or avoid homelessness. Data on homelessness in Europe are often limited, but there is evidence that European countries with highly integrated homelessness strategies, providing a range of well-coordinated services, such as Denmark and Finland, have very low levels of homelessness((Busch-Geertsema, V., Benjaminsen, L., Filipovič Hrast, M. and Pleace, N. (2014) Extent and Profile of Homelessness in European Member States: A Statistical Update Brussels: FEANTSA – http://housingfirstguide.eu/website/wp-content/ uploads/2016/04/feantsa-studies_04-web2.pdf)).

Guidance on integrated homelessness strategies is available on the FEANTSA website((Toolkits on Homelessness Strategies: www.feantsa.org)). A review of the successful Finnish integrated homelessness strategy was published in 2015((Pleace, N., Culhane, D.P., Granfelt, R. and Knutagård, M. (2015) The Finnish Homelessness Strategy: An International Review Helsinki: Ministry of the Environment – https://helda.helsinki.fi/handle/10138/153258)). A range of discussion on homelessness strategies in Europe, including descriptions and critical evaluations, is available in the European Journal of Homelessness((http://www.feantsaresearch.org – The European Journal of Homelessness is also indexed on Google Scholar.)).

6.1.2. Housing First Alongside Other Services

Housing First is not designed to act as a solution to all forms of homelessness. Nor is Housing First intended to work in isolation: it requires support from the health and social work sectors and from other homelessness services. As part of an integrated homelessness strategy, Housing First works with those people whose homelessness cannot be prevented or whose needs cannot be met by housing alone, or by housing and low-intensity support services.

The originator of Housing First, Dr. Sam Tsemberis, has suggested a role for Housing First within an integrated homelessness strategy, in which homeless people with high support needs are initially offered Housing First and those whose needs cannot be met by Housing First are then offered long-term, congregate or communal supported housing with on-site support staff or institutional care.

An integrated homelessness strategy might have the following kind of structure:

• Preventative services, offering housing advice, support and practical help with accessing housing and support services for people with higher needs who are at risk of homelessness.
• Emergency accommodation for people who suddenly become homeless, working in close coordination with preventative services to try to avoid any experience of homelessness becoming prolonged or repeated.
• Lower-intensity support services for people who require some support to leave homelessness, but whose needs can be met by rapidly providing them with housing and low-level contact with a case-management service offering limited support.
• Housing First services for homeless people with high support needs, rapidly providing housing and intensive support. The evidence is that Housing First will be effective in ending homelessness for most of the homeless people in this group (see Chapter 1).
• Supported housing models offering congregate or communal housing with support staff on-site, which can be used to provide medium and long-term support to homeless people with high support needs, whose needs or preferences are not met by Housing First.

There is some evidence that some European countries have a long-term homeless population whose needs have not been met through existing homelessness services. In countries such as the UK, there is evidence of a homeless population who make repeated or long-term use of existing homelessness services, without their homelessness permanently ending as a result((Bretherton, J. and Pleace, N. (2015) Housing First in England: An Evaluation of Nine Services https://www.york.ac.uk/media/ chp/documents/2015/Housing%20First%20England%20Report%20February%202015.pdf)). Housing First often has the capacity to end this form of long-term homelessness, alongside helping high-need homeless people who spend very long periods of time living on the street, or in emergency shelters, to exit homelessness.

At a strategic level, the use of Housing First services can:

• Significantly reduce levels of long-term and repeated homelessness associated with high support needs.
• Potentially reduce costs of long-term and repeated homelessness for emergency health and mental health services, criminal justice systems and other homelessness services.
• Enable homeless people with high and complex support needs to live stably in their own homes.