3.3. Social Integration
Housing First approaches social integration by enabling homeless people with high support needs to live as independently as possible in normal housing in a normal neighbourhood. In the Housing First approach, social integration is expected to result from normalisation of housing and normalisation of living situation. By giving formerly homeless people the option to live in the same way as everyone else; with the same choices and opportunities for neighbourhood-based social interaction as everyone else, Housing First seeks to promote social integration((Tsemberis, S. (2010) Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction Minnesota: Hazelden; Johnson, G., Parkinson, S. and Parsell, C. (2012) Policy shift or program drift? Implementing Housing First in Australia AHURI Final Report No. 184 http://www.ahuri.edu.au/research/final-reports/184 Pleace, N. and Quilgars, D. (2013) Improving Health and Social Integration through Housing First: A Review Brussels: DIHAL/ FEANTSA http://housingfirstguide.eu/website/wp-content/uploads/2016/03/improving_health_and_social_ integration_through_housing_first_a_review.pdf)).
Social integration centres on emotional and practical support that enables someone to be a part of a society in several senses. To live a rewarding life, someone ideally needs to have a partner, and/or family and friendships that provide them with self-esteem, a sense they are valued, companionship and informal support. Someone also has to feel like they are a part of society, accepted by their community and living as part of that community, not stigmatised by their neighbours or by their fellow citizens. In addition, it is important for an individual to have a sense of purpose through a structured activity in which they find meaning, because this too is important in giving a sense of esteem, belonging and being part of society.
Homelessness, particularly when it is repeated or goes on for a long time, often fractures the links between a person and all dimensions of social life. Someone who is homeless may live without a partner, without contact with family and effectively without friends, may be stigmatised and rejected by the people around them and feel isolated from other people and from society as a whole. Housing First is built around a recognition that a lack of emotional support, love, acceptance by society and a place in society, as well as a lack of purpose stemming from some sort of structured activity, is as damaging to a homeless person as untreated health problems are.
Social integration and health are also closely interrelated. Low self-esteem, isolation and experiencing stigmatisation have long been recognised as detrimental to physical and mental health((Pleace, N. and Quilgars, D, (2013) Improving Health and Social Integration through Housing First: A Review Brussels: DIHAL/ FEANTSA. Vid supra)).
3.3.1. Organising Support
The organisation of support towards social integration by Housing First services can include the following elements:
- Peer support, which can be from another Housing First service user, from a specialist peer worker or from Housing First staff who are ‘experts by experience’ because they have lived through similar experiences. A peer-support worker should ideally be employed as an equal member of the Housing First team and not regarded as junior to other staff. Peer support workers can have unique insights because they have experiences mirroring those of service users and can act as positive examples to service users.
- Advice, information, practical support and emotional support from Housing First staff – centred on weekly visits – which can include: Help with accessing education, training, volunteering, paid work and other structured, productive activities, such as arts-based or community-supporting activities.
- Help with creating or re-establishing social support, for example supporting attendance at social events or providing practical support to allow meetings to take place with family (such as paying transport costs).
- Providing information, advice and emotional support to Housing First service users. Weekly visits that give service users an opportunity to talk through anything that is bothering them.
3.2.2. The Support Provided
Social integration is not a fixed concept, but a set of interrelated issues that can require differing levels and forms of support. A long-term or repeatedly homeless person may be totally cut off from family, for example, but another person in the same position may have maintained positive family relationships, despite their circumstances. There is no single type of experience or needs regarding social integration and Housing First must provide a range of flexible services. These can include:
- Emotional support. This can be provided by a Housing First worker through a weekly meeting, taking an interest, listening to concerns and providing practical assistance. This is a relationship that needs to be carefully managed, but can be highly valued by Housing First service users.
- Participation in community life. This is integral to Housing First as a service because the emphasis is very much on providing housing that enables someone to live within and as part of a community. Participation in community events or smaller-scale actions, such as buying things from local shops and talking to neighbours, are all forms of social integration that Housing First is designed to promote. To an extent, Housing First service users may spontaneously start to show this kind of participation once they are housed in a community, but a Housing First worker may also accompany them and encourage them to do this. This can happen at multiple levels: taking them to a local shop, going with them to a community event, being with them when they meet their neighbours and so forth.
- Social support from a partner, friends and family. This can be facilitated by Housing First in multiple ways. One way that Housing First can promote social support is to create opportunities, which may be as simple as buying someone a train ticket to go and see their family, but might be more complex, for example a Housing First worker accompanying someone to meet family with whom they have lost contact. Housing First may also provide or facilitate access to family mediation, providing psychological and counselling support when a Housing First service user’s family relationship has broken down and needs to be repaired. Housing First might also facilitate and encourage opportunities for socialisation, providing emotional support to someone when they are seeking friends or a new partner and arranging, or sometimes accompanying them to, social events.
- Managing negative relationships. This can be an issue where Housing First service users need support. ‘Door control’ when someone has been in the homelessness service system or on the streets for a considerable time can be an issue, with guests who are not really wanted turning up and staying in the home of a Housing First service user. Vulnerable individuals might also be exploited by other homeless people when they are housed by a Housing First service. Here, Housing First can offer practical and emotional support to ensure that a Housing First service user retains control over their own home and is not hosting unwanted parties, or unwillingly providing a venue for nuisance or criminal behaviour.
- Challenging, nuisance and criminal behaviour. These will be characteristics of some individuals using Housing First services. Part of the management of these issues centres on access to treatment, for example noise and nuisance that upsets neighbours may be linked to problem drug/alcohol use that is in turn associated with mental health problems that require treatment. Housing First staff may also provide ‘coaching’ or access to services and activities that enable Housing First service users to become better at handling interpersonal communication through increased emotional literacy and anger management. Here, an array of support, from counselling through to arts-based activities, alongside talking about problems with Housing First support workers, can be beneficial.
- Handling Stigmatisation. This can be a challenge for homeless people with high support needs, both in the sense that they may experience prejudice due to their experience of homelessness itself, and because they may have other characteristics (e.g. be experiencing severe mental illness, having been in prison) that produce fear or negative responses in other people. Part of the process of managing stigmatisation is passing, i.e. appearing to be the same as everyone else. In emphasising the importance of living an ordinary life in an ordinary community, a key goal of the original Housing First service developed by Dr. Sam Tsemberis was to ‘jump over’ the barriers that can exist between homeless people, society and social integration. Both by appearing to be the same as everyone else and in living the same way as everyone else, the social barriers that exist between a housed citizen and a homeless person on the street or in a homelessness service, are potentially reduced. Equally, when a Housing First service user opts to use treatment and to orientate themselves towards recovery, the markers – or sets of characteristics and behaviours – that can create stigmatisation can also be reduced. Living within and being visibly part of a community is seen by the Housing First approach as creating scope for overcoming stigmatisation.
- Structured and meaningful activity. This can be particularly important in giving someone a sense of purpose and promoting their sense of self-esteem. This can be directed, in the sense of progressing someone towards the point where volunteering or paid work (see below) may become possible for them. In the UK and Finland, as well as elsewhere in Europe and North America, arts-based activities are used as a means of helping homeless people engage with structured activity and working with others, that promotes their self-esteem and emotional literacy. This can be an end in itself, or it may be used as part of a process that is designed to persuade and support homeless people to engage with (basic) adult education and further education or training. Housing First services might provide some of these services directly, or use a mix of case management and direct practical and emotional support to encourage homeless people to engage with local services.
- Paid work. This is possible for some Housing First service users, although they may need considerable time and support before they reach the point where it becomes a realistic prospect. Supporting people into paid work is a feature of the French Housing First programme((The “Un chez soi d’abord” Housing First programme in France has developed a partnership following the Individual Placement and Support (IPS) model (Douglas Institute, Montreal). The “working first” programme in Marseille is designed to enable access to work and to support work among people using Housing First.)). Movement towards formal economic activity might involve a pathway that starts with arts-based activities, moves into basic education and eventually volunteering, and then reaches the point of applying for work. Employer attitudes and underlying economic conditions are important factors in keeping people out of work, and it may be that Housing First has to work with employers directly, encouraging and supporting them to consider offering work to Housing First service users (in much the same way as it may work with private rented sector landlords, see Chapter 4).
- Ontological security. This refers to what might be called a sense of safety and predictability in life and, in Housing First, centres on the role of providing someone with a settled home. Disconnection from other people, from society and from local community occurs in homelessness because someone has no place in society, most immediately because they lack a home, but also because that lack of settled home undermines or removes their chance to have a place in a community or a place in wider social and economic life. In giving someone their own home as starting point, Housing First is designed to give homeless people with high support needs a place in society. Housing First is intended to integrate homeless people into society at this fundamental level, using housing to give a sense of security, certainty and predictability that comes from knowing where one lives and belongs((Padgett, D.K. (2007). There’s no place like (a) home: Ontological security among persons with serious mental illness in the United States. Social science & medicine, 64(9), 1925-1936, p. 1934.))
In emphasising support with social integration, Housing First is addressing a set of needs that are as significant to recovery as access to settled housing and treatment is. However, it is always important not to lose sight of the core values of choice and control in the Housing First model((Hansen Löfstrand, C. and Juhila, K. (2012) The Discourse of Consumer Choice in the Pathways Housing First Model European Journal of Homelessness 6(2), 47-68 http://housingfirstguide.eu/website/the-discourse-of-consumerchoice-in-the-pathways-housing-first-model/)). Housing First is intended to create opportunities for social integration, within a framework that emphasises recovery but also choice. Using Housing First should not mean someone is expected to behave in one set way. For example, no-one should have to talk to a neighbour or attend a course or a community event if they do not want to, because another ordinary citizen, in another ordinary home, would be able to exercise choice in the matter.