1.3. Housing First in Europe
European use of Housing First has been encouraged by the North American research results. Initially, the inspiration came from the original service developed in New York((Padgett, D.K.; Heywood, B.F. and Tsemberis, S.J. (2015) Housing First: Ending Homelessness, Transforming Systems and Changing Lives Oxford: Oxford University Press.)), then from other US Housing First services((Pearson, C.L., Locke, G., Montgomery, A.E. and Buron, L. (2007) The Applicability of Housing First Models to Homeless Persons with a Severe Mental Illness US Department of Housing and Urban Development: Washington DC. https://www.huduser.gov/portal/publications/hsgfirst.pdf)). More recently, some very successful results from the Canadian At Home/ Chez Soi Housing First programme, a randomised control trial (RCT) involving 2,200 homeless people comparing Housing First with existing homelessness services, have become influential in European debates((Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., Nelson, G., McNaughton. E., Streiner, D. and Aubry,
T. (2014) National At Home/Chez Soi Final Report Calgary, AB: Mental Health Commission of Canada. – http://www.mentalhealthcommission.ca/English/system/files/private/document/mhcc_at_home_report_national_cross-site_eng_2.pdf)) (see Chapter 5).
Within Europe, the results of the Housing First Europe research project, led by Volker Busch-Geertsema, were among the first to confirm that Housing First could be successful in European countries((Busch-Geertsema, V. (2013) Housing First Europe: Final Report – http://housingfirstguide.eu/website/wp-content/uploads/2016/03/FinalReportHousingFirstEurope.pdf)) . A large-scale randomised control trial as part of the French Un Chez-Soi d’abord Housing First programme, being conducted by DIHAL, will provide systematic data on Housing First effectiveness across four cities in France, in 2016((Tinland, A., Fortanier, C., Girard, V.,Laval, C., Videau, B., Rhenter, P., Greacen, T., Falissard, B., Apostolidis, T., Lancon, C., Boyer, L. and Auquier, P. (2013) Evaluation of the Housing First program in patients with severe mental disorders in France: study protocol for a randomized controlled trial Trials, 14, p. 309)). A number of observational studies, that look at Housing First but do not compare it with other homelessness services, have also reported very positive results from Denmark((Benjaminsen, L. (2013). Policy Review Up-date: Results from the Housing First-based Danish Homelessness Strategy. European Journal of Homelessness, 7(2), 109-131 – http://housingfirstguide.eu/website/?p=4906)), Finland((Pleace, N., Culhane, D.P., Granfelt, R. and Knutagård, M. (2015) The Finnish Homelessness Strategy: An International Review Helsinki: Ministry of the Environment – https://helda.helsinki.fi/handle/10138/153258)), the Netherlands((Wewerinke, D., Al Shamma, S. and Wolf, J. (2013) Housing First Europe. Local Evaluation Report Amsterdam http://housingfirstguide.eu/website/housing-first-europe-local-evaluation-report-amsterdam)), Portugal((Ornelas, J., Martins, P., Zilhão,M.T. and Duarte, T. (2014) Housing First: An Ecological Approach to Promoting Community Integration European Journal of Homelessness (8.1), 29-56 – http://housingfirstguide.eu/website/housing-first-anecological-approach-to-promoting-community-integration/)), Spain((https://www.raisfundacion.org/sites/default/files/rais/noticias/infografia_habitat_DEF_A3.pdf https://raisfundacion.org/es/informate/noticias_y_eventos/jornada-internacional-h-bitat https://issuu.com/rais_fundacion/docs/presentaciones_habitathf_web?e=5650917/30872088)) and the UK((Bretherton, J. and Pleace, N. (2015) Housing First in England: An Evaluation of Nine Services – https://www.york.ac.uk/media/chp/documents/2015/Housing%20First%20England%20Report%20February%202015.pdf)). Collectively, these findings show that:
In Europe, Housing First is generally more effective than staircase services in ending homelessness among people with high support needs, including people experiencing long-term or repeated homelessness.
Housing First can be more cost-effective than staircase services because it is able to end homelessness more efficiently. Housing First may also generate cost offsets for (reduce the costly use of) other services. For example, Housing First may reduce frequent use of emergency medical and psychiatric services, prevent long and unproductive stays in other forms of homelessness service and lessen rates of contact with the criminal justice system.
Housing First addresses the ethical and humanitarian concerns raised about the operation of some staircase services((Sahlin, I. and Busch-Geertsema, V (2005) The Role of Hostels and Temporary Accommodation.Vid supra)).
In 2016, Housing First was becoming increasingly important in Europe. In some cases, Housing First was integral to comprehensive homelessness strategies, in others, experiments were still underway. The countries where Housing First was being used include:
- The Netherlands
- The United Kingdom
Housing First has been successfully piloted in Vienna((http://www.neunerhaus.at/fileadmin/Bibliothek/Neue_Website/Neunerhaueser/Housing_First/20150925_HousingFirst_ Report_english.pdf)). Nine Housing First projects were tested in Belgium in 2015, with 150 homeless people with high support needs receiving Housing First. The programme is being evaluated with a view to testing whether Housing First could be more widely used((http://www.housingfirstbelgium.be)) (see Appendix).
The first stage of the Danish Homelessness Strategy from 2009-2013 was one of the first large-scale Housing First programmes in Europe and housed more than 1,000 people((Benjaminsen, L. (2013). Policy Review Up-date: Results from the Housing First-based Danish Homelessness Strategy. European Journal of Homelessness, 7(2), 109-131. Vid supra)). A summary of the Danish programme is included in the Appendix.
Finland has made extensive use of Housing First within its national strategy to reduce and prevent homelessness((http://www.housingfirst.fi/)). Absolute and relative reductions in long-term homelessness have been achieved by using a mix of Housing First service models, including both congregate and scattered housing models (see Chapter 3 and Chapter 4).((Pleace, N.; Culhane, D.P.; Granfelt, R. and Knutagård, M. (2015) The Finnish Homelessness Strategy: An International Review Helsinki: Ministry of the Environment. – https://helda.helsinki.fi/handle/10138/153258)) An example of a Finnish Housing First service is described in the Appendix. Initial results from the French Un Chez Soi d’abord Housing First pilot programme are positive((http://hf.aeips.pt/wp-content/uploads/2013/10/Pascale.pdf)), with the existing work to continue through 2017 before use of Housing First is expanded from 2018 onwards (see Appendix).
In Italy in 2015, homelessness service providers and academics cooperated to form the Housing First Italian Network((http://www.housingfirstitalia.org/en/)), a confederation of organisations providing, or with an interest in, Housing First. Housing First Italia had 51 members in 10 Italian regions, of which 35 had operational projects in 2015. Two Italian examples of Housing First services are summarised in the Appendix.
In 2014 17, Housing First services were operating across the Netherlands. In Amsterdam, the Discus Housing First project had been operating successfully since 2006((Wewerinke, D., Al Shamma, S. and Wolf, J. (2013) Housing First Europe Local Evaluation Report Amsterdam. Vid supra)). In Portugal, the Casas Primeiro ((http://www.aeips.pt)) service in Lisbon has pioneered the use of Housing First((Ornelas, J., Martins, P., Zilhão, M.T. and Duarte, T. (2014) Housing First: An Ecological Approach to Promoting Community Integration European Journal of Homelessness (8.1), 29-56. – http://housingfirstguide.eu/website/housing-first-anecological-approach-to-promoting-community-integration/)). A summary of Casas Primeiro is presented in the Appendix. In Spain, the first Housing First service, HÁBITAT, began operations in May 2014, working in Madrid, Barcelona and Málaga((https://raisfundacion.org/es/que_hacemos/habitat)). The HÁBITAT project was evaluated throughout and Housing First has now become part of wider Spanish homelessness strategy((http://www.msssi.gob.es/ssi/familiasInfancia/inclusionSocial/docs/ENIPSH.pdf)) (see Appendix).
Norwegian use of Housing First has expanded quite rapidly from 12 Housing First services with 135 service users in December 2014 to 16 Housing First services with a total of 237 service users in July 2015((Source: Norwegian State Housing Bank. Note that not all 16 Housing First services were fully operational in July 2015, some were yet to start supporting homeless people.)). In Norway, Housing First is one of a range of services used within an integrated homelessness strategy (see Appendix).
In Poland, a practitioner conference on Housing First was held in Warsaw in February 2016((http://www.czynajpierwmieszkanie.pl/en/)). Promotion of Housing First is being pursued by an evidence-based advocacy project.
In Sweden, the University of Lund has been actively promoting the idea of Housing First with homelessness service providers and policy makers. In 2009, the University hosted a national conference on Housing First. Two municipalities, Stockholm and Helsingborg, began to operate Housing First services soon afterwards, as a direct result of this conference. Since that time, another 11 municipalities have started up Housing First services. It seems that Housing First has spread even more widely in Sweden, since 94 municipalities state that they provide Housing First services to their citizens (according to one of the ‘Open Comparisons’ conducted by the National Board of Health and Welfare). These on-going initiatives have been developed at local level rather than as a result of national policy((For more information see: http://www.soch.lu.se/en/research/research-groups/housing-first)) (see Appendix).
In the UK, the first successful experiment with Housing First was run by Turning Point in Scotland in 2010((http://www.turningpointscotland.com/what-we-do/homelessness/glasgow-housing-first/)). An observational evaluation conducted over the course of 2014-2015 also showed that early experiments with Housing First in England were also proving successful((Bretherton, J. and Pleace, N. (2015) Housing First in England: An Evaluation of Nine Services – https://www.york.ac.uk/ media/chp/documents/2015/Housing%20First%20England%20Report%20February%202015.pdf)), although as in Sweden, development was often at local level. In England, there was not yet a national Housing First policy as of early 2016, but the English federation of homelessness organisations (Homeless Link) had launched a Housing First England initiative to promote the use of Housing First in the country. Additionally, the Welsh Government recommended the use of Housing First models in its guidance for its recently revised homelessness laws in 2015 (see Appendix).
In some countries in Central and Eastern Europe, Housing First was still in the process of being developed in 2015/16. Experiments with Housing First have taken place in the Czech Republic and Hungary.