‘Doing it Already?’: Stakeholder Perceptions of Housing First in the UK

Abstract

When first developed in the United States, ‘Housing First’ was highly controversial given its departure from mainstream ‘linear’ service models for homeless people with complex support needs. It has nevertheless since been heralded as presenting a key ‘antidote’ to chronic homelessness and is being replicated across North America and Europe with what might be regarded as ‘evangelical’ fervour. Reception to Housing First has been noticeably more reserved in the UK to date. This paper explores the reasons underpinning many UK stakeholders’ scepticism about the model. It argues that this derives, in part, from the fact that Housing First implementation in the UK would not represent the scale of paradigm shift that it has elsewhere, thus the model is considered far less revolutionary. Furthermore, whilst most stakeholders find aspects of the approach very attractive, ideological and pragmatic reservations dictate that robust evidence derived from pilot projects in Britain will be required – especially as regards outcomes for individuals with active substance misuse problems – before any wholesale ‘conversion’ to Housing First is likely in the UK.

Key Words:

• Homelessness
• complex support needs
• housing first
• housing models
• policy transfer
• UK

Acknowledgements

The authors would like to express their sincere thanks to the stakeholder interviewees for sharing their views with us. Thanks are also due to the two anonymous reviewers for their helpful feedback, and to Ronni Michelle Greenwood for her valuable comments on the draft manuscript. The study was funded by the Economic and Social Research Council, grant reference RES-137-27-0191.

Notes

1. The jury uses the term ‘housing-led’ as a broader concept encompassing approaches that aim to provide housing with support as the initial step in addressing all forms of homelessness, that is, not just with the narrowly-defined client group typically supported under Housing First programmes (European Commission & FEANTSA, 2011).

2. Many of these agencies had developed projects branded ‘innovative’ by other stakeholders in the UK homelessness sector (Johnsen & Teixeira, 2010). Some, but not all, exhibited one or more elements of a Housing First type approach.

3. In the US, people are defined as chronically homeless if they have a disabling condition and have either been continually homeless for a year or more or have experienced at least four episodes of homelessness in the past three years (US Department of Housing and Urban Development, 2007).

4. The clinical diagnosis of a mental illness, coupled with chronic homelessness, means that PHF consumers are eligible for Federal Government Section 8 housing vouchers. These rental subsidy vouchers are paid directly to Pathways, thus minimising the risk of service users falling into rent arrears.

5. Guidance on the frequency of meetings, and minimum ‘requirements’ regarding these, varies within PHF literature. Early reports note that service users must agree to meet with staff twice per month (e.g. Tsemberis & Asmussen, 1999; Tsemberis Eisenberg, 2000), but more recent guidance specifies that programme requirements include ‘weekly’ home visits (e.g. Stefancic & Tsemberis, 2007; Tsemberis, 2010b).

6. See, for example: Tsemberis and Eisenberg (2000), Tsemberis et al. (2004), Gulcur et al. (2003, 2007), Greenwood et al. (2005), Padgett et al. (2006, 2011), Perlman and Parvensky (2006), Padgett (2007), Stefancic and Tsemberis (2007), Toronto Shelter Support and Housing Administration (2007), Pearson et al. (2007, 2009), Yanos et al. (2007), Larimer et al. (2009), Kresky-Wolff et al. (2010), Henwood et al. (2011).

7. For further debate on what constitutes ‘success’ in homelessness interventions, see Busch-Geertsema (2005), Busch-Geertsema and Fitzpatrick (2008), and Culhane and Metraux (2008).

8. It is worth noting that the London Clearing House scheme is an exception, however. Access to Clearing House flats is implemented rather more flexibly, especially since the Mayor promised to end rough sleeping in the capital by 2012, and the advent of the rough sleepers ‘205’ initiative which prioritised interventions for the city's most ‘entrenched’ rough sleepers (Teixeira, 2010). The usual one nomination policy for Clearing House flats has been relaxed for individuals classified within the ‘205’ group (Broadway, 2010).

9. The individuals targeted under the London Delivery Board's ‘205’ rough sleepers initiative, so named because there were 205 in number, had been street homeless for five or more years out of the last 10 and/or been witnessed sleeping rough 50 times or more over that period (Teixeira, 2010). Even with this group, however, it seems that providers are only willing to consider trialling the model with those who do not have ‘chaotic’ drug problems and/or histories of antisocial behaviour. That is, although some of them might be classified as ‘high needs’, their behaviour is stable enough that they are not considered ‘high risk’.

10. Although see Falvo's (2009) evaluation of Canada's early ‘version’ of Housing First, Toronto's Streets to Homes programme.