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.
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 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 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.
Sophie Boobis is head of research at Homeless Link