Though typically a small segment of the homeless population, the people experiencing homelessness combined with additional complexities are generally the least-well served by traditional homelessness response models. The combined nature of their challenges is both more complex and more resource-intensive to address. People in this group are the most likely to have frequent contact with costly government services such as hospital accident & emergency departments, emergency respons units including paramedics and police, and even judicial and prison services.

In many countries, such as Finland, the UK, and France, engagement with Housing First services reduces the frequency of contact between people experiencing complex homelessness and emergency services. As a result, it can be a more cost-effective means than some traditional homeless response services. In many cases, people in Housing First programmes are able to access regular social, medical and other services, often with the help of Housing First teams and support workers.

Housing First can work for anyone who is homeless, but not all people who are homeless need such a high level of support. For many homeless people – such as people who have recently been made homeless – ensuring access to suitable, affordable housing is what is needed. The advantage of a Housing First approach is that the support provided can be tailored to the person’s individual needs. Some people will need ongoing support, whereas others will only need high-intensity support for a shorter period of time.

Housing First for Youth (HF4Y) is a rights-based intervention for young people who experience homelessness, or who are at risk of becoming homeless. It is designed to address the needs of developing adolescents and young adults by providing them with immediate access to housing that is safe, affordable and appropriate, and the necessary and age-appropriate supports that focus on health, wellbeing, development, life skills, engagement in education and employment, and social inclusion. For more information, please see our programme model guide for HF4Y.

The term ‘complex needs’ describes ongoing, persistent, inter-related health and/or social care needs, which have an impact on a person’s wellbeing, quality of life, and ability to function in society. Complex needs include, but are not limited to:

• Repeat homelessness – including repeat homeless service use and/or living in substandard, over-crowded housing, or ‘sofa surfing’;

• Mental, psychological or emotional health needs;

• Substance dependency (i.e. drugs, alcohol);

• Contact with the criminal justice system;

• Physical health limitations or needs;

• History or experience as a victim of domestic violence or abuse.

Housing and treatment need to be delivered separately. This is crucial for both the service that is delivering support and the Housing First tenant. In some traditional homeless services, people can be evicted or threatened with being thrown out of their temporary accommodation if they do not agree to the conditions attached to treatment and support. By separating treatment and housing In Housing First, people can feel secure in their homes.

This separation also makes it easier for service and housing providers, as they can deal with any issues around the housing (payment of rent, issues with neighbours, etc.) separately from other support programmes. All Housing First participants are treated as regular tenants and therefore must agree to follow the rules of their tenancy.

Not having a stable, secure and suitable home can cause significant stress and anxiety for individuals experiencing homelessness. The short-term nature of many programmes and supported housing offers come with a sense of built-in stress, as people will be worried about what will happen when the 6 or 12 or 18 month programme and support come to an end. This can lead to low self-esteem, lack of trust in support services and an unwillingness to seek treatment which can help the person to recover. Under these conditions, the effectiveness of support and treatment may be vastly reduced and/or inconsistently delivered, as the service user may be more focused on seeking security than on pursuing recovery. Offering treatment and support services within a context where the service user feels safe and secure – in control of both their environment and level of engagement – allows these supports to be delivered more consistently and more effectively. If a person needs to move to a new apartment, the Housing First support moves with them. This helps to provide a sense of stability as the tenant knows that they will not be abandoned by the programme and end up homeless – a common fear and source of stress – and the tenant can therefore focus on their recovery, knowing that they will be supported for as long as is needed.

A right to housing with no preconditions means that housing and supports are separated. Housing provided via Housing First is not conditional on behavioural change or accepting treatment. Housing First tenants must agree to meet with their Housing First worker on a weekly basis (at least) but have the ability to discuss and decide where and when that meeting will take place. Rather than in a social support worker’s office, Housing First residents might meet their support workers in a cafe, or go for a walk, or invite them to their homes. For a person to remain successfully housed, it is important to build a relationship with that person based on trust, where the person themselves feels that their needs are listened to and that they have control over their degree of engagement with support services. To achieve this, there is a strong emphasis on choice and control for service users, through active engagement without coercion. This means that while service users are actively encouraged to engage with the help they need, it is never a condition that they do so in order to keep their home. Building trust in this way, through positive and ongoing dialogue can help service users to believe that recovery is possible, which may ultimately lead to them choosing to accept support that will help them to do so. The timeline for recovery is not universal and is frequently non-linear. By removing the stress and uncertainty of not having a stable and safe place to call home, a person can begin to focus more fully on their recovery, which facilitates treatment, rather than hindering it

People using Housing First are expected to follow the conditions of their lease, or tenancy, in the same way as any other person renting a home would be, with support being provided to enable them to do this. Housing First services also expect there to be regular contact between someone using their service and a support worker, for example at a weekly meeting, which includes checking whether there are any problems with their home.

Housing can come from:

• Social/Public housing

• Private rental agreements

• Rental agreements using a non-governmental (NGO) intermediary; whereby the NGO has a long-term contract with the landlord or building developer, the tenant then sub-lets the property from the NGO.

• Social Rental Agencies

In most European countries, homeless people who are eligible for Housing First are also eligible for social welfare and housing benefits. Often the funding is combined from different streams of support, e.g. housing benefits, healthcare support for treatment, etc. These benefits can be used to cover the cost of rent and support. Some Housing First programmes are funded by foundations and other project funding, which allows them to work with people who do not have recourse to public funds.

Whilst it’s true that there is a shortage of suitable housing in many places across Europe, this does not mean that there is no housing to be found, and may instead mean that alternative solutions to identifying suitable housing are required. Housing First is a pragmatic approach to people who would otherwise sleep on the streets or be in temporary accommodation. Whilst an overheated housing market dominates some of Europe’s capital cities, in many large to medium-sized cities, the numbers of people who are homeless and would need Housing First support are quite manageable. It will be more difficult to find enough housing in larger capital cities.

As the coronavirus crisis forced people to ‘shelter in place’ and ‘stay at home’, cities and governments took rapid measures to ensure that people were not forced to sleep on the streets. Many overnight shelters and some temporary homeless accommodation do not provide sufficient space for people to be sufficiently distant from each other, and the risk of spreading a virus is high in over-crowded spaces. Housing First can be seen as an effective health intervention to prevent the spread of Covid-19 as people are able to live in their own homes and follow government guidelines regarding social distancing, and self-isolating in the case of infection. Many homeless people have underlying health conditions and are particularly susceptible to being infected with viruses, such as the coronavirus that causes Covid-19. Housing First can help to protect people’s health and prevent further spread of such viruses, now and in the future.