2.3. Separation of Housing and Treatment

Housing First ensures the human right to housing is not compromised by requiring service users to engage with treatment either to access housing, or to remain in housing. Housing is therefore separate from treatment.

In practice this means:

Access to housing, being offered a home by a Housing First service, is not conditional on behavioural change or accepting treatment. In practice, this means housing is still offered if someone does not stop drinking, will not accept treatment for mental health problems or turns down other offers of support.
Remaining in housing provided via Housing First does not require someone to change their behaviour or accept treatment. Housing First does support someone to follow the terms of a lease or tenancy in the same way as anyone else renting a home would. Housing First also requires regular meetings with Housing First staff, which includes monitoring housing sustainment. However, Housing First does not remove people from housing for not changing their behaviour, or not using treatment.
If someone is evicted, it should usually only be by a landlord because of lease or tenancy violations. Housing First is designed to re-house a service user who is evicted and to offer them support during the re-housing process. The support services offered by Housing First are continuous and not connected to the housing. This allows a Housing First service to continue to provide continuity in support through residential changes or a clinical crisis (a critical turning point in a person’s physical or mental health).

Housing is separated from treatment in another positive sense. While Housing First offers support for as long as may be required (see 2.8), when and if someone’s use of Housing First support services stops, they keep their existing home. If someone no longer needs Housing First, they do not need to move somewhere else.

Unlike some other homelessness services, Housing First is committed to the person and not to their housing. Housing First is person-based, not place-based.

This means that:

When someone decides to move home, Housing First support and treatment services remain in contact with them and continue to support them in their new home.
When someone loses a home that Housing First helped them access, either through eviction or because they abandon their home, Housing First support and treatment services remain in contact with them. If a Housing First service user has lost their home, the Housing First service seeks to find them another home as soon as possible.
If someone goes into an institutional setting, Housing First support and treatment services remain in touch. For example, if someone has to go into a psychiatric hospital, Housing First will remain in contact with them and either seek to retain their existing housing or arrange new housing in time for when they leave hospital. Housing First will also remain engaged on the same basis if someone is given a short prison sentence.

One challenge for Housing First services can be when apartments are provided in a dedicated congregate or communal setting. This means that housing is provided in an apartment block or block of flats that is only for people using Housing First. Here, it is important to ensure that the rights someone has to their housing are the same as anyone renting ordinary accommodation. This can mean, in theory, that someone can live in an apartment block for Housing First service users after their support has ended by mutual consent with the Housing First team, or if they have decided to stop using Housing First support and treatment. Their housing and their housing rights are separate from the treatment and support they can receive. This may seem an extreme example, but the core principle of separation of housing and treatment cannot be compromised if a service is following a Housing First model. This approach has been adopted in some Finnish Housing First services((Pleace N., Culhane D., Granfelt R., Knutagard M. The Finnish Homelessness Strategy: An International Review (2015) http://works.bepress.com/dennis_culhane/145/)) (see Chapter 4).

Some Housing First services sub-let or sub-lease housing units to service users. This can be for two reasons. First, it can provide reassurance when working with landlords in the private and social rented sectors that legal responsibility for their housing is with the Housing First service, not with an individual using that service. Second, if there is a problem with someone’s housing, Housing First can rapidly move someone away and, equally rapidly, place them in alternative housing, because they are not the tenant or leaseholder.

Such arrangements involve striking a balance between ensuring someone’s human right to housing while simultaneously placing limitations on their legal right to that housing. Ethical behaviour by Housing First services using these arrangements is of very great importance, if the core principle of separation between housing and treatment is to be properly maintained. Some British Housing First services immediately give all Housing First service users a full tenancy, giving them the same housing rights as anyone else renting social or private rented housing would have((https://www.york.ac.uk/media/chp/documents/2015/Housing%20First%20England%20Report%20February%202015.pdf)) (see Chapter 4).