4.2. Housing as the Starting Point
Housing is the starting point rather than an end goal for Housing First services. Housing First is very different from some other homelessness services that try make homeless people with high support needs ‘housing ready’ before they are rehoused, i.e. staircase services where housing happens last. In Housing First, being provided with housing is what happens first.
The role of a home in Housing First has been described as providing ontological security. This is an academic idea, but it can be summarised as someone feeling that their life is secure, predictable and safe – the opposite of what is experienced in homelessness, where nothing is secure and both immediate and longer-term risks are everywhere((Pleace, N. and Quilgars. D. (2013) Improving Health and Social Integration through Housing First: A Review Brussels: DIHAL/ FEANTSA.Vid note 94.)). For Housing First service users, having their own home is designed to help them return to, or begin, a normal life. One American academic has described the role of having a home in Housing First in the following way:
Having a ‘home’ may not guarantee recovery in the future, but it does afford a stable platform for re-creating a less stigmatised, normalised life in the present((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.)).
Alongside being designed to deliver a permanent exit from homelessness, a home has the following roles in Housing First:
- A home is the starting point of social integration. Having a home returns, or introduces, Housing First service users to a central part of having a normal life: having their own home. Housing First emphasises the role of housing in beginning a process in which a homeless person with high support needs lives within a community and society and is no longer excluded from it by lacking a home of their own (see Chapter 3).
- Being on the street, or in another insecure place, heightens both the perception and reality of being at physical risk. Emergency and communal homelessness services may also feel and be unsafe. The right home provides both security and predictability. Someone using Housing First knows they have somewhere to sleep and it will be safe.
- A home provides a safe and stable environment that improves the effectiveness of treatment that Housing First service users may opt to use. Sustained experience of trying to provide effective treatment for mental and physical health problems, or help with drug and alcohol use has shown that when someone is living on the street or in homelessness services, the effectiveness of treatment is undermined. If health services are to be effective for homeless people, the first step is to ensure they have somewhere to live in which they are warm, dry, have regular meals and are not subject to the extremes of stress that can accompany homelessness((Quilgars, D. and Pleace, N. (2003) Delivering Health Care to Homeless People: An Effectiveness Review Edinburgh: NHS Scotland. http://www.healthscotland.com/uploads/documents/425-RE04120022003Final.pdf)).
- A home brings control over life. Having a home allows someone to exercise privacy, to socialise and to have a space in which to develop and maintain a partnership. Having a home enables someone to live in the way they want to, something that is not possible when in a communal homelessness service or emergency accommodation – in which all living space is shared – or when on the street.
- When housing needs are met, it becomes possible to prioritise other aspects of life. Housing First shows that life can get better by delivering a settled home and actively engages Housing First service users with the idea that their health, well-being and social integration can also improve. This in turn encourages them to engage with treatment and support services.
A service that does not offer what can be clearly recognised as a home cannot be regarded as Housing First. Emergency or hostel accommodation with shared sleeping space, or that offers only a partially private living space, that is not self-contained, is not Housing First. Equally, a service that allows staff to simply walk into the home of a Housing First service user, or which gives them a key to the door of that person’s home, which they can use without permission, is not Housing First.
Chapter 3 describes the range, extent and organisation of the housing support provided by Housing First services.