Finding the Way Home Table 2.1: Broad Types of Housing-Led Services Pathways Communal Housing Service offered Housing First Housing First First Light Housing with security of tenure in private rented sector or in social housing provided immediately or as soon as possible Yes* No Yes Offers communal housing (single rooms or apartments) with security of tenure provided immediately in a building only lived in by people who are homeless using the service No Yes No People who are homeless have to stop using drugs No No No People who are homeless have to stop drinking alcohol No No No People who are homeless have to use mental health services No No No Harm reduction approach Yes Yes Yes Recovery orientation Yes Yes Yes Uses mobile teams to provide services Yes No Yes Directly provides drug and alcohol services Yes Yes No Directly provides psychiatric and medical services Yes Yes No Uses case management Yes** Yes Yes Uses Assertive Community Treatment (ACT) team Yes Yes*** No Provides support to promote housing stability Yes Yes Yes . Based on Pleace 201235 *Sub-tenancy arrangements are commonly used **Intensive Case Management ***Services are similar in scope but do not necessarily function the same way as an ACT team would work in the community. to having their own housing, which tends to lessen use of drugs • Life in the community can be isolating, as people who have and alcohol and improve mental health, reducing overall use of been homeless may have poor peer support, low self esteem, detoxification and mental health services40. poor education and find it difficult to enter training, education or employment or undertake other productive activities. PHF is dependent on a supply of adequate, affordable housing Although it ends homelessness for the majority of service which can offer security of tenure. Equally, the ICM component users, PHF has been criticised for not doing more to of PHF is dependent on good working relationships with and counteract relative isolation, worklessness and a lack of sufficient access to externally provided health, social work and productive activity44. other support and welfare services. • It can be argued that PHF has less ‘ambition’ than staircase Evidence of limitations models. This is because staircase models seek to fully address support needs in a drive to make people ‘housing ready’, i.e. Critics of PHF present four main arguments: the theoretical outcome of a staircase service is someone who • PHF uses dispersed housing with mobile support workers can sustain independent housing without further assistance45. and so may not always be able to meet the needs of people with the highest support needs who (arguably) need to be closely monitored. Alongside this, it is pointed out that while 40 Pearson, C.; Montgomery, A.E.; Locke, G. (2009) ‘Housing Stability among Homeless Individuals it is highly successful in ending long-term homelessness for with Serious Mental Illness participating in Housing First programs’ Journal of Community people with high needs, PHF does not work for everyone Psychology Vol. 37, Part 3, pp.404-417. 41 Kertesez, S.G.; Crouch, K.; Milby. J.B.; Cusimano, R.E. and Schumacher, J.E. (2009) ‘Housing First who uses it41. for Homeless Persons with Active Addiction: Are we overreaching?’ The Milbank Quarterly Vol. 87, • PHF provides stable housing that helps enhance well-being. Part 2, pp. 495-534. 42 Tsemberis, S. 2010b op cit. However, while support needs can lessen in both their extent 43 Johnson et al (2012) op cit; Stanhope, V. and Dunn, K. (2011) ‘The curious case of Housing First: and degree among PHF service users42, it is also the case the limits of evidence based policy’ International Journal of Law and Psychiatry 32, pp. 275-282. that mental health problems, social and economic exclusion 44 Pleace, N. (2011) ‘The Ambiguities, Limits and Risks of Housing First from a European and problematic drug and alcohol use often persist among Perspective’ European Journal of Homelessness 5(2), pp.113-127; McNaughton-Nicholls, C. and PHF service users, even after they have been rehoused for Atohmetlen,sIPeopl1e1wi‘thousuntgpFlersteeCdosn’sHdersiinnggCSotudpiene2n6t(s5f)opp.uc6c7e-s7s77.l Resettlement ofuf7Srsomuoi:NiiliMH)02(.soreH several years43. 45 Edens, E.L; Mares, A.S.; Tsai, J. and Rosenheck, R.A. (2011) ‘Does Active Substance Use at Housing Entry Impair Outcomes in Supported Housing for Chronically Homeless Persons?’ Psychiatric Services Vol. 62, Part 2, pp. 171-178. 13
Finding the Way Home
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