Stan Burridge is an ex-rough sleeper and an HSCWRU Peer-researcher. He is Director of Expert Focus, a user-led organisation that supports the involvement of people with lived experience in homelessness research and policy. (1,029 words)
Over the past few weeks, I have been thinking about all the people who have been swept from the streets and into hotels because of the COVID-19 pandemic. The old mantra that it was impossible to house all those sleeping rough has been scotched. This event signifies how, with the right amount political will and financial investment, radical change can happen at scale and pace.
Thinking about the next steps for Everybody in (the policy of offering people sleeping rough a hotel room for duration of the lockdown) I would like to urge policymakers to continue to pursue radical change (i.e. doing the right thing). Looking for a real solution to homelessness means taking note of the ‘overwhelming evidence that highlights the effectiveness of Housing First.’[i]
Housing First affords people a permanent home (their own front door) with no requirements beyond accepting the help of a trusted worker to maintain their tenancy. There is no requirement to ‘move on’ with other areas such as addiction and mental health issues, and even if someone were to lose their home, the trusted worker will continue to work with them.
Currently, Housing First is not widely accessible in England; it seems like a best kept secret. Homeless Link (the umbrella organisation for homeless charities) states that: ‘Most Housing First services in England focus their resources on people who have been street homeless for sustained periods or those who have had repeated ineffective accommodation stays resulting in intermittent periods of rough sleeping.’[ii] That sounds very much like ‘Housing Last’ – let the system repeatedly fail people and only then we will offer them what works. This does not sit well with the mantra of evidence-based practice.
In the improvement science literature, it is recognised that too often evidence-based interventions are applied in-equitably, skewing application of the best available practice toward populations and communities with higher capacity and resources.[iii] It is acknowledged that when effective interventions for disadvantaged communities are identified there needs to be an explicit endeavour to disseminate and implement them more rapidly. My argument is that Everybody In should be the catalyst for recognising and acting upon this.
To illustrate the need for this approach, I spoke to Mr. A.
Mr A has been homeless for a long time (since he came out of the armed forces) and he openly admitted he struggles with addictions and PTSD, finding it hard to be around people for a number of reasons. He has been evicted from a number of hostels and has walked away from others.
He appears to be a fairly vulnerable man and potentially easily exploited; someone who finds himself drawn into the drinking and drug taking culture. That same culture, which exists as much in hostels as on the streets, has led to him being evicted on a number of occasions, and he is now struggling with being placed in a hotel (due to COVID-19 policy) for the same reasons.
Mr A told me that he is unable to engage with support services because they are not doing face to face appointments at the moment, and he constantly loses cheap mobile phone handsets and—he is honest enough to say—he has sold the more expensive ones, to fund his addiction.
I asked what he felt he needed to break the cycle and he replied “I just want somewhere to call my own. I want a door with a key, where there is nobody telling me what to do, when I can and can’t go out and when and what I eat”.
I asked him if he would cope with a place of his own. He replied “It has to be a lot better than to be kicked out every time I go off the rails or don’t go in when I am supposed to. I am not a school kid; I should be allowed to make my own decisions, my own mistakes.” I agree with him, and so does Housing First. The model does not enforce abstinence or engagement with mental health services. The only hard and fast rule is engaging with the terms of a tenancy (just like everyone else).
Mr A should be a firm candidate for Housing First.
I began asking around, to see what the referral criteria were, and if it was possible to help in some way. I found that there were many hurdles, not least the local authority he has a connection to does not have a Housing First model; at least not one they were prepared to discuss.
The need for a ‘local connection’ prevents Mr A from approaching another local authority for housing.
My next move was to approach one of the larger national organisations who told me that they are running 20 Housing First tenancies this year and hope to add another 20 next year. Outside of London, I spoke to someone who is coordinating Housing First in the Manchester area, providing 150 tenancies this year, another 150 next year and 100 the year after. So, Housing First can be done at scale, but Mr A would not be able to apply as he is not from the Manchester area.
I’d hit a brick wall. For me sitting in the relative comfort of my front room, this failure leaves a nasty taste. I have been homeless; I have seen the failings in systems and felt rejection either by something being designed into the system or being designed out of it. But what I have never seen before is an approach which clearly has the potential to resolve homelessness, yet is still a myth in some areas and in others another inaccessible service. The challenge remains, how to make evidence-based practice a reality so that Housing First can live up to its name. The first challenge is to push it to the top of the political agenda.
To see Stan Burridge in conversation with Sam Tsemberis (the founder of Housing First) visit: https://www.expertfocus.co.uk/housing-first-and-foremost/
Stan Burridge is Director of Expert Focus.
[iii] McNulty, M., Smith, J.D., Villamar, J.E et al. (2019) Implementation Research Methodologies for Achieving Scientific Equity and Health Equity. Ethnicity and Disease. 29(1) 83-92.