1.1. Introducing Housing First
Housing First is probably the single most important innovation in homelessness service design in the last 30 years. Developed by Dr. Sam Tsemberis in New York, the Housing First model has proven very successful in ending homelessness among people with high support needs in the USA and Canada and in several European countries.
Housing First is designed for people who need significant levels of help to enable them to leave homelessness. Among the groups who Housing First services can help are people who are homeless with severe mental illnesses or mental health problems, homeless people with problematic drug and alcohol use, and homeless people with poor physical health, limiting illness and disabilities. Housing First services have also proven effective with people who are experiencing long-term or repeated homelessness who, in addition to other support needs, often lack social supports, i.e. help from friends or family and are not part of a community. In the United States and Canada, Housing First programmes are also used with homeless families and young people.
Housing First uses housing as a starting point rather than an end goal. Providing housing is what a Housing First service does before it does anything else, which is why it is called ‘Housing First’. A Housing First service is able to focus immediately on enabling someone to successfully live in their own home as part of a community. Housing First is also focused on improving the health, well-being and social support networks of the homeless people it works with. This is very different from homelessness services that try make homeless people with high support needs ‘housing ready’ before they are rehoused. Some existing models of homelessness services require someone to show sobriety and, engagement with treatment and to be trained in living independently before housing is provided for them. In these types of homelessness service, housing happens ‘last’.
Housing First is designed to ensure homeless people have a high degree of choice and control. Housing First service users are actively encouraged to minimise harm from drugs and alcohol and to use treatment; they are not required to do so. Other homelessness services, such as staircase services, often require homeless people to use treatment and to abstain from drugs and alcohol, before they are allowed access to housing and may also remove someone from housing if they do not comply with treatment or do not show abstinence from drugs and alcohol.
In the USA, Canada and in Europe, research shows that Housing First generally ends homelessness for at least eight out of every ten people ((Based on a review of existing evidence, see: Pleace, N. and Bretherton, J. (2013) The Case for Housing First in the European Union: A Critical Evaluation of Concerns about Effectiveness. European Journal of Homelessness, 7(2), 21-41 http://housingfirstguide.eu/website/the-case-for-housing-first-in-the-european-union-a-critical-evaluation-of-concernsabout-effectiveness/.The figure refers to formerly homeless people housed for at least one year by a Housing First service (see later in this chapter for more details on the evidence for Housing First). )). Success has also been reported with diverse groups of homeless people. Housing First has worked very well for people who are not well integrated in society after long-term or repeated homelessness, homeless people with severe mental illness and/or problematic drug and alcohol use and homeless people with poor physical health.
Housing First in Europe can be described as following eight core principles. These core principles are very closely based on those developed by Dr. Sam Tsemberis, who created the first Housing First service in New York in the early 1990s ((Tsemberis, S.J. (2010) Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction Minneapolis: Hazelden.)). These principles were defined in consultation with Dr. Tsemberis and the advisory board for this Guide.
Operating within these core principles, Housing First pursues a range of service priorities, which include offering help with sustaining a suitable home and with improving health, well-being and social integration. Housing First is designed to provide opportunities to access treatment and help with integration into a community. There is also the option to get help with strengthening social supports and with pursuing rewarding opportunities, such as arts-based activities, education, training and paid work.