Housing First: helping people experiencing poor mental health to find stability
By Jo Prestidge
Housing First is a social innovation that is becoming increasingly popular across the UK and Europe. Jo Prestidge from Homeless Link explains how the approach is supporting people to improve their lives.
Research has found that there is higher prevalence of mental illness amongst those experiencing homelessness compared to the general population. Poor mental health can lead people to lose accommodation but can also be a consequence of experiencing homelessness. Either way, there’s a strong link between the two.
Sadly, we’ve been told that this group of people really struggle to access mental health services, often due to structural factors of the services e.g. thresholds for access and flexibility around appointments, but also due to coinciding needs around drug and alcohol use. Histories of adversity, experiences of trauma and a range of other complex and interrelated needs makes it difficult for them to access mainstream support.
Histories of adversity, experiences of trauma and a range of other complex and interrelated needs makes it difficult for [homeless people with mental health difficulties] to access mainstream support.
One intervention that seems to be working really well however is Housing First. Developed in the US in the 1990s to break the cycle between homelessness and inpatient hospital stays, psychiatrist Dr Sam Tsemberis decided to try something different. He gave people experiencing mental illness, addiction and homelessness their own apartment and provided intensive and flexible wraparound support.
The approach is widely evidenced and now used across much of North America and Europe. It offers an alternative to the traditional housing and support provided to people with very high and complex needs. Instead of expecting people to be ‘housing ready’ and engaging in treatment and support before they get their own home, Housing First services see housing as the stable base from which people can begin recovery.
Instead of expecting people to be ‘housing ready’ and engaging in support before they get their own home, Housing First services see housing as the stable base from which people can begin recovery.
The approach is underpinned by a set of key principles detailing how the housing and support should be provided. Services that are delivered in line with these principles achieve the best outcomes with those they are supporting. In fact, internationally, Housing First services support around 80% of people to remain housed, many of whom would otherwise continue to experience instability and ineffective contact with services.
Positive changes in mental health, whilst not uniform, are also seen in those supported by Housing First. In an evaluation of nine services in England, 66% of people reported improvements in their mental health and in an evaluation of a London-based service, all of those supported said they had a significant improvement in mental health with half of people reporting their mental health as ‘good’, compared to none before being housed.
Use of acute and expensive services is often reduced through Housing First support which enable people to access other services in a more planned way. In the London service mentioned above, none of the individuals had a psychiatric admission once housed. And in Manchester a Housing First scheme has seen a 43% reduction in A&E presentations, and a 96% reduction in inpatient hospital stays across a 15 month period.
Support from, and effective partnership with the mental health sector is much needed by those working in and those accessing Housing First services.
There is a great deal of momentum for Housing First in the UK, with Centre for Mental Health amongst others highlighting that the approach can improve engagement with health and support services, as well as improving quality of life. There are also indications that the Government will include it as a core component of their proposed rough sleeping strategy. Whilst the benefits of Housing First are far reaching for both individuals and across sectors, the current delivery of services still sits firmly with homelessness services. Support from, and effective partnership with the mental health sector is much needed by those working in and those accessing Housing First services. Many have struggled to engage with housing, health and social care services for years but Housing First provides them with an opportunity to begin doing so. We are really keen to build links with policy makers and service providers across the sectors who can help eradicate the homelessness of people with poor mental health.
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