Finding the Way Home In looking at the evidence of the success of housing-led is being claimed for the CHF-led strategy in Finland100. The services in ending chronic homelessness in the USA, it is consensus of the academic research is broadly similar, always important to bear in mind the points of comparison. housing-led services are very effective at ending homelessness Some of the staircase services with which housing-led services among people with high needs and sustained experience of were being compared in the USA were strict, abstinence-based homelessness, but that while some other gains in well-being approaches that were already being found to fail many people are being achieved, these services are not necessarily fully who were homeless before PHF started to make a significant meeting all associated support needs or successful with impact97. Ireland is very different from the USA in terms of the everyone they try to work with101 (see Chapter 2). This research context in which housing-led services are going to be and the current evidence base both indicate that housing-led implemented. Existing homelessness services in Ireland reflect approaches should be part of a mix of service responses to and share ideas about homelessness that are integral to the long term homelessness, because these services cannot do housing-led philosophy. Irish homelessness services, while they everything and do not suit everyone. are not for the most part actually housing-led are nevertheless often far closer in operational approach and assumptions to There are risks in ‘diluting’ the housing-led approach when it is housing-led services than is the case for the US staircase deployed in Ireland. While HFL services can be relatively low services. It is also arguable that the Finnish services that CHF cost because of their emphasis on case management, these models replaced, which were emergency hostels, were a more services are predicated on a case manager being able to basic form of homelessness service provision than is delivered orchestrate a package of health, social care and mental health by many homelessness service providers in Ireland, meaning and drug and alcohol services. This means the total cost of HFL services can be considerable. The HFL component is low that the Finnish situation into which housing-led services were cost, but the package of services it assembles through case introduced was not a close parallel with Ireland either. management may be far from cheap. PHF and CHF models Two points are important here. The first is that it cannot simply are, in Irish and Western European terms, an expensive service be assumed that what is already being provided to people who model, they use dedicated ACT teams or equivalent services, are homeless in Ireland, by the Simon Community and other and the range of support they provide, from trained peer homelessness service providers, is actually significantly less support workers through to dedicated teams of psychiatrists effective than a housing-led approach. There are sufficient and intensive case management means they are not low intensity, low cost services. Housing-led services, effective as parallels between how many existing homelessness services they may be at ending long term homelessness, are not work in Ireland and core elements of the housing-led approach necessarily always cheaper than other homelessness to make this question worth asking. It cannot simply be services102. assumed that housing-led services would necessarily be more effective than some existing homelessness services in Ireland, A key message in the existing global evidence base on because some of those existing services - while they are not housing-led services is that, either directly or indirectly, housing-led – do already reflect the logic of the housing-led housing-led services require fairly significant resources to work approach in several respects. well. Housing-led services, except CHF models, need to be in a context where they can secure suitable housing that is Second, the evidence on housing-led does not suggest it is available long term and which people who are homeless can always effective for all long-term or people who are chronically afford. Housing-led approaches also need to be able to directly homeless. While housing-led services successfully house most provide psychiatric, drug and alcohol and other health and of the people experiencing homelessness they work with, care services or to reliably arrange access to those services. housing-led services are not a panacea, they are very effective Getting housing-led models to work and work well is not simply at tackling long-term homelessness but cannot solve all the a matter of replacing supported housing with low intensity support needs associated with long-term homelessness and floating support services and should never be seen in these nor will they necessarily work for all people experiencing long terms. It is not unreasonable for people who are homeless and term homelessness98. service providers in Ireland to ask just where the adequate and affordable housing for a housing-led response to long term The limits of housing-led services need to be recognised along homelessness will come from. with their strengths. Pathways, for example, claims and demonstrates sustained exits from homelessness for highly vulnerable people with severe mental illness and sustained histories of homelessness for the PHF service. Pathways does not claim that drug and alcohol problems or mental health 97 Pleace, N. (2008) op cit. problems are always being successfully treated and entirely 98 Pleace, N. (2012) op cit. overcome, or that isolation, boredom and worklessness do not 99 Tsemberis, S. (2010a) op cit. persist for at least some of the people using PHF, or that PHF is 100 Pleace, N. and Bretherton, J. (2012) op cit. always successful with everyone it is targeted on98 and nor is it 101 Pleace, N. (2012) op cit and see Chapter 2. the case that total success in tackling long-term homelessness 102 Culhane, D.P. (2008) op cit. 31
Finding the Way Home
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