‘Housing First’: An alternative approach to addressing homelessness?

Homelessness strategies across Europe have traditionally focused on a housing-led approach. This approach prioritises treatment and addiction recovery. Service users transition through stages of temporary accommodation before permanent housing is made available. In contrast, the ‘Housing First’ model gives service users immediate access to permanent accommodation. Because the ‘Housing First’ model views housing as a human right, engagement with treatment services or sobriety isn’t used as a condition of their tenancy. Following on from a blog post yesterday about the many different forms of homelessness in Northern Ireland, this article looks at what the ‘Housing First’ approach is and how it has been implemented across Europe, with specific focus on its use in Northern Ireland.

Homelessness is a significant problem in Northern Ireland. The latest Northern Ireland Housing Bulletin reveals that in 2015/16, 18,628 households presented themselves as homeless to the Northern Ireland Housing Executive. The unreasonableness of current accommodation followed by sharing breakdown/family disputes are the most commonly cited reason for presenting as homeless. Single males and families make up the largest proportion of homeless presenters.

In the past, treatment-led approaches have traditionally been used in Northern Ireland as a means of addressing homelessness. This is a gradual process through which homeless people are moved from temporary to permanent housing based on successful engagement with treatment services for issues such as drug and alcohol addiction. However, the ‘Housing First’ approach has been gaining credibility as a new way of tackling homelessness. This removes the gradual process from temporary to permanent accommodation and instead ‘uses housing as a starting point rather than an end point out of homelessness‘.

What is Housing First?

The ‘Housing First’ model emerged in the US in the 1990s as a response to the failure of treatment-led approaches to sufficiently address the needs of the ‘chronically homeless’.  It has since gained credibility as an effective model for providing permanent housing for homeless people with critical needs such as drug and alcohol addiction or severe mental illness. Traditionally, homelessness strategies across the European Union have been modelled on the ‘staircase approach’. This treatment-led model requires service users to address their addiction issues before progressing through the stages from temporary accommodation towards permanent housing.

The ‘Housing First’ model instead uses permanent housing as a starting point rather than an end goal. It seeks to provide immediate access to permanent housing for people who are homeless. Ongoing support services are provided to help people successfully maintain a tenancy and integrate into the community. Compliance with normal residential tenancy laws is typically the only requirement. While the ‘Housing First’ approach encourages its service users to receive treatment for drug or alcohol addiction, it is not a condition of their housing support. This is because it views access to housing as a human right and not as an incentive for successful treatment or sobriety. The model is also founded on the belief that access to a permanent accommodation helps to eliminate the chaos of homelessness by providing a safe and stable environment. This stability then improves the effectiveness of treatment that service users may choose to engage in.

Support in the ‘Housing First’ model can take a number of different forms:

• Individual Case Management (ICM): this approach uses a one-to-one case manager to client relationship. Case managers make connections between the service users and treatment services.
• Assertive Community Treatment (ACT): this approach uses a multidisciplinary team to provide direct support to service users for a range of needs including mental and physical health treatments and addiction services. This approach is generally used for homeless people with very high support needs.
• Critical Time Intervention (CTI): similar to the ICM approach, this approach uses an individual case manager but this support is limited to a nine month period after which support for service users will be integrated into mainstream services.

How Effective is the ‘Housing First’ Approach?

This model is becoming increasingly popular for addressing homelessness across the EU. It has been endorsed by the European Commission which encourages the use of ‘Housing First’ approaches in its Social Investment Package. Housing-led approaches have yielded positive results, particularly in regards to tenancy retention rates. Housing First Europe (HFE), a project funded by the European Commission, piloted housing-led schemes in five European cities (Amsterdam, Copenhagen, Glasgow, Lisbon and Budapest) between 2011 and 2013. In its evaluation report HFE found that the ‘Housing First’ programmes produced very high tenancy retention rates in four out of the five cities e.g. Glasgow’s programme reported a retention rate of 92.2%. Several EU Member States have incorporated ‘Housing First’ approaches into their national homeless strategies, including Denmark, France and Spain. Several other Member States are currently piloting or supporting smaller ‘Housing First’ programmes.

There has, however, been some debate around the overall effectiveness of the ‘Housing First’ approach. Some argue that the approach does not sufficiently address non-housing issues such as drug and alcohol addiction[1]. Indeed, many ‘Housing First’ programmes acknowledge that access to permanent housing does not make individual nor structural issues, such as mental illness or poverty, disappear. As such, it is argued that permanent housing can provide a stable environment to support treatment, but it should not be seen as a cure-all solution.

‘Housing First’ Programmes in Northern Ireland

In its Homeless Strategy for Northern Ireland 2012-2017 the Northern Ireland Housing Executive made a commitment to ‘examine the ‘Housing Led’ model to consider its applicability to Northern Ireland’. The NIHE have since funded a ‘Housing First’ pilot in Belfast in partnership with the homeless charity Depaul.

Depaul, supported by the NIHE, piloted Northern Ireland’s first housing-led project. The 18-month pilot programme engaged with homeless people with critical needs in Belfast. The pilot yielded positive results. An evaluation of the programme, commissioned by the Housing Executive, found that by the end of 2014, 19 out of the 24 service users were still in their tenancy. This amounts to a tenancy retention rate of 79%. Additionally, 63% of service users achieved a significant or moderate reduction in the use of drugs or alcohol. Following the early success of the programme, the Housing Executive extended the programme’s funding in 2015. The programme has since increased in its scope to include a Housing First programme in Derry/ Londonderry.

Ending Homelessness Together: The Homelessness Strategy for 2017-22 plans to further develop the ‘Housing First’ pathway model developed during the previous strategy. The intention is to explore the potential for other types of housing-led pathway models and examine existing Outreach Models that provide services to rough sleepers as part of Rough Sleeping Action Plans.

[1] Atherton, Iain, and Carol McNaughton Nicholls. (2008) ”Housing First’ as a means of addressing multiple needs and homelessness.’ European Journal of Homelessness 2: 289-303.