HOUSING
FIRM FOUNDATIONS
We know that substance misuse and addiction disproportionately impact people experiencing homelessness . The two issues are intertwined – substance use can increase risk of homelessness , while the experience of homelessness can lead to substance abuse for a variety of reasons .
Sadly , it ’ s still frequently the case that people experiencing multiple and complex disadvantage see their support needs consistently go unmet . With needs deemed ‘ too high ’ and conditionality placed on their treatments , they typically fall through the gaps between services and cycle through periods of rough sleeping , temporary accommodation , prison stays and hospital admissions .
It doesn ’ t have to be this way . Over the last decade , Housing First has had a growing presence , ending homelessness and acting as a transformative , even lifesaving intervention for this population . Whereas traditional homelessness services place more conditionality on accommodation and do not always guarantee support , Housing First provides people with a secure and unconditional tenancy upfront , alongside flexible , intensive , holistic support for as long as it ' s needed .
Even though homelessness is only one of multiple support needs addressed for people
Housing First is much more than a housing intervention . It ’ s a vital programme that could substantially ease the pressure on treatment services , says Sophie Boobis
accessing Housing First , the conversation surrounding it still sits firmly within the homelessness sector . But it shouldn ’ t . Research published in February by Homeless Link , the membership body for frontline homelessness organisations , shows that Housing First works holistically , reducing people ’ s substance use and offending behaviour and bringing substantial improvements to physical and mental health . At the same time , it increases engagement with drug , alcohol and preventative healthcare services while reducing the use of expensive and overstretched emergency services .
The research looks at outcomes for Housing First residents across many aspects of their lives , over a three-year period . It ’ s based on sources including a national survey of Housing First providers representing 934 residents and peer research among people with lived experience of Housing First .
Beyond positive trends in tenancy sustainment , the survey revealed that substance misuse dropped from 91 per cent of people at the point of entry to Housing First , to 69 per cent after three years – a 22 per cent reduction . This improvement coincided with a steady increase in engagement with drug and alcohol services from 48 per cent initially to 62 per cent at the end of the second year .
Notably , this pattern is
‘ When I first got my flat I was a raging crackhead . Basically , I was shoplifting every day , burgling , you know , injecting myself . And then when they got my flat , within a couple of months , I stopped using needles . And later , I stopped the drug .’
HOUSING FIRST RESIDENT
consistent with the trends we see for engagement with physical and mental health services , affirming the importance of Housing First as the gateway to relevant specialist services and making a strong case for bringing the drugs and alcohol sector on board to co-deliver the approach for this cohort .
Anecdotes from our research show that having – and wanting to keep – a home and the intensive support provided are integral to reducing substance use . Additional drivers include having a stable base from which to establish routine , being accountable with a tenancy to manage and the opportunity of new social networks with peers in a different community ( the number of people reporting positive social networks more than doubled ).
Looking at other areas of their lives the research found that , remarkably , 55 per cent of people had improved mental health , and 39 per cent had improved physical health , while use of GPs rose from 50 per cent to 89 per cent after three years of support . These positive changes coincide with substantial 20 per cent decreases in both resident A & E use and admissions to hospital , and an 18 per cent fall in safeguarding concerns including risk of suicide and self-harm . What all this tells us is that Housing First is so much more than a homelessness intervention . As an effective health and social care intervention , that reduces pressures on substance misuse services , we believe that the drug and alcohol sector would benefit significantly from further involvement with Housing First . We strongly encourage commissioners and service managers to engage and collaborate with other sectors including homelessness , health and criminal justice , on this important intervention to ensure an effective whole-systems approach to supporting the significant cohort of people with complex needs .
Taking this a step further , and supported by this new evidence , Homeless Link are calling on the next government to introduce a sustainably funded , national , cross-departmental Housing First programme . With this in place , we will be empowered to break the cycles of complex disadvantage and transform the lives of the estimated 16,450 people who need it in England . Report at https :// homeless . org . uk / knowledge-hub / researchexploring-holistic-housing-firstoutcomes /
Sophie Boobis is head of research at Homeless Link
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