Housing First as part of the pandemic response

    Over the last year our Housing First service in Brighton has grown rapidly as part of the response to the pandemic. Last summer the service was supporting 22 people and by the end of this year this will increase to 60. We are currently helping 50 people with an imminent five offers made and the final five expected to be completed in October.

    Here, Jonathan* speaks about his experience of this ground breaking initiative that’s fast becoming our flagship service in Brighton.

    My dad died on my 21st birthday and it hit me hard. I moved from County Durham to Brighton to get away from everything. I came with a friend and I remember we partied hard and I woke up on the Green opposite Glenwood Lodge by myself. My friend went home without me and I stayed. That was 26 years ago.

    During that time I had been in a cycle of rough sleeping and time spent in prison. I had survived by shoplifting and doing anything I needed to get through each day. I quickly became addicted to heroin and crack cocaine. Although outreach teams tried to help me over the years, all I was interested in was getting my next fix. To me, I had a sleeping bag and a tent so I was happy as long as I could score. I didn’t think I needed their help.

    I have seen some horrible things and it was hard. I have seen people at their worst on nights out thinking it’s funny to urinate on you while you are sleeping, or chuck beer cans at you and spit on you.

    In 2017 my groin exploded and I went to A&E – this was a turning point for me as they encouraged me to accept help and face my addictions. I was 6.5 stone and I’m 5ft 8” so I was in a bad way. I ended up in prison again though. But once I was released, I met Sophie from St Mungo’s Housing First team and things began to change. On release I was placed in a hotel for two weeks and then offered a one bed flat through Housing First.

    I thought it was a joke, I didn’t trust it and expected to be back on the streets after a few days. I have been here 7 months now. At first I couldn’t get used to being on my own and having my own bed with the choice to come and go as I wanted. My first night I was up and down, I didn’t feel I wanted to be there, I wanted to go back onto the streets. I can’t explain it, I had lived so long on the streets and in prison I couldn’t get my head around having my own space. It’s all thanks to Sophie from Housing First and Emily (CGL Adult Drug & Alcohol Service). They have helped me get a grant so I have everything I need in my flat, a washing machine, furniture and TV.

    I feel ecstatic now. I honestly didn’t think I’d last it out. I didn’t think I would be able to pay my bills but I do. Sophie supports me through this and keeps me on track if I need her help. I feel supported but I also feel independent.

    My hopes for the future are to keep hold of my flat, to keep my two voluntary jobs going, and to remain substance free. Staying clean is the hardest part – I have been off the crack and heroin for 4.5 years and off methadone for one year now.

    I feel like I have woken up. I am part of a community and I chat to my neighbours every day. I love getting up early and catching the bus to work. I enjoy cooking roasts and baking cakes. One of my favourite things is to sit in the communal garden and share my cakes with the seagulls.

    Find out more about Housing First service here.

    Housing First in action: Camden

    One of the largest Housing First services St Mungo’s provides is in Camden, which we began running in 2014 with 20 clients. The service has since expanded four times, mostly through Rough Sleeping Initiative (RSI) funding, although its most recent expansion was through the Next Steps Accommodation Programme, increasing its capacity to 72 clients.

    The power of choice

    Housing First staff have small caseloads. They work intensively over long periods with clients, whose trust and belief in the model is key to its sustainability. Staff in Camden begin by asking a client “do you want to work with us?” It seems a simple question, but the most vulnerable clients may feel that past decisions have been made for or to them. Having choice put firmly in their hands from the outset provides a bedrock of empowerment at odds with past experience. Small caseloads have been consistent throughout expansion, with the service maintaining the necessary staffing to support this through partnership working with Camden Council.

    The service works with a range of housing providers, affording choice to clients on where they want to live. This cements their power over their journey and provides a physical platform for recovery in the right environment. The service works with Camden Council and providers such as One Housing and Notting Hill Genesis with whom the service has negotiated service level agreements. These ensure that housing providers understand the Housing First client group, and streamlines processes to prevent clients being overwhelmed. Staff use personalisation budgets to purchase items clients choose which they feel will turn their tenancy into a home.

    The right support

    Housing First is based on clients’ strengths and aspirations, with no requirement for them to engage with support services. Recovery is not linear and, for many, the rigid structure of statutory services, with fixed treatment programmes and methods, can be difficult.

    When clients are ready to engage, challenging the status quo of a treatment programme is important. Staff support clients to engage with these services but also support the services to engage with a client group that they may be unfamiliar with, attending multi-agency meetings to advocate on a client’s behalf.

    As a result, 96% of clients in Camden Housing First are registered with a GP*, and 100% of clients with a mental, physical or substance misuse issue who need to engage with services are doing so*.

    Camden Housing First provides an Occupational Therapist, Rosemary, supported by Homeless Link’s Housing First Fund, to work with clients who have the most difficulty engaging. Using her specialist healthcare knowledge Rosemary works alongside Housing First staff to ensure that clients can access services, especially where those rigid structures and methods have proved insurmountable in keeping clients within treatment and care programmes. Rosemary is able to assess, establish and evidence their clinical requirements and needs. This includes ensuring that capacity is assessed accurately, that adequate care is provided and stepping in when this is not the case.

    Rosemary also works with clients to make sure they have everything they need to meet their support needs within their homes and to access the community through digital inclusion. This has been particularly beneficial during covid, affording access to virtual medical appointments and learning opportunities.

    One client said, “Rose [the OT] is lovely. She gets things done, she don’t turn her back on nothing. She got a laptop for me. I get on fabulous with her and she does everything that’s required”.

    The ecosystem

    Staff also link clients in with other organisations, such as Groundswell, who assist clients through the entire process of attending appointments.  This can include getting ready and travelling to/from, ensuring access to vital medical care.

    During the pandemic staff have been working with services to ensure that medication is dropped directly to clients’ doors where possible. Necessary face-to-face contact has been carried out safely, and food delivered when needed.

    The service and partners in Camden Council identified a real need for a more trauma informed approach when working with female clients. They introduced a women’s worker to ensure a gender-informed approach: understanding and addressing barriers specific to women that they may face in accessing services.  A dedicated women’s worker also allows for more time to be spent building up trust with those clients.

    Support in Housing First services also includes practical things such as cleaning, shopping, and ensuring that the client is in receipt of the correct benefits. This helps people to develop skills which they can carry forward if/when they move on from the service. 100% of the clients at Camden Housing First have increased their ability to manage money as measured by an outcomes star*, and 100% are in receipt of the correct benefits with no sanctions*. The service also works with clients who are subject to court or Anti-Social Behaviour Orders, which staff support them to comply with, with a current compliance rate of 100%*.

    Being a St Mungo’s client also means access to services such as the Recovery College, the Lifeworks psychotherapy service or the Putting Down Roots gardening programme. The St Mungo’s Palliative Care Team have supported staff with hospital and hospice liaison and coping with a client death.

    Patience and persistence   

    It is these vital building blocks and wraparound support which help clients to maintain their tenancies – the ultimate goal of any Housing First service. In Camden, 50 out of 51 service users maintained their tenancies in the most recent quarter*.

    The ethos of Housing First has often been summed up as never giving up on a client. What is perhaps even truer is that clients, who may have every reason to do so, never give up on us.

     

    *Note: figures in this piece are from the reporting quarter 6th July – 4th October 2020

    Housing First – achieving the aim of ending rough sleeping for good

    Housing first was once thought of as a radical rethinking of how homelessness could be tackled – but over the years it has become an increasingly important element to achieving the aim of ending rough sleeping for good.

    One person who has witnessed the scheme’s successes – and a few challenges – over the years is Stephen Brett, Housing First Service Manager in Brighton. Here he shares his thoughts on the scheme.

    A Pilot Scheme and Beyond

    I have worked in homelessness services in Brighton for 20 years. In 2014 I was part of a conversation on how we could adopt different approaches to ending rough sleeping.

    Through this discussion we uncovered aspects of the Housing First model and were afforded the opportunity to run a pilot Housing First scheme.

    It represented an exciting moment in service delivery, a chance to try something genuinely different for people who had exhausted many of the pre-existing resources the city had to offer.

    Housing First is a different model because it provides housing ‘first’, on the basis of right, rather than at the end of a process as a reward.

    And years later the bedrock of the model remains as exciting today as it was in those early stages as we have learned, adapted and grown along the way.

    Challenges and Successes

    I think it’s important to accept that Housing First is not a panacea, but rather as for many people experiencing multiple complex needs offered the prospect of attaining a way out from the risks, rigours and traps of enduring rough sleeping.

    From a burgeoning concept, the approach has now become a valid and established approach to ending rough sleeping. And our experience of delivering Housing First in the intervening years has demonstrated this based upon the achievements of the people that we support through this model. It would however be misleading to say that our growth has been without challenges.

    Housing First workers will work assertively to engage our service users, build lasting supportive relationships, work in a person centred and recovery focused way and manage and respond to any risks. The delivery of the support is therefore both rewarding and challenging. The Housing First model very deliberately attempts to re-frame the typical criteria applied to people sleeping rough accessing self-contained accommodation.

    And part of the journey has, therefore, involved highlighting and indeed contributing to the growing evidence base around efficacy and challenging scepticism.

    We are trying to turn well established processes on their head, we accept that there is an inherent risk within this and related wariness. As people engage in support and maintain their tenancy we aim to break the cycle of rough sleeping so that there is opportunity to address the factors that have contributed to people  ending up on the streets.

    Our longer-term aim is for people to achieve long lasting recovery.

    In Brighton, where I have worked for St Mungo’s since 2016, we have received extra funding from NSAP (Next Steps Accommodation Fund) to offer an additional 20 places – growing from 40 to 60 offers of Housing First.

    The accommodation is dispersed across the city, consciously so and the bedrock of Housing First remains ‘housing as a human right’. We believe that for some people living within a congregated setting hinders their chances of moving away from homelessness.

    We also acknowledge that there are challenges inherent within this offer, and work hard with people to reduce the risk of isolation, maintain regular and consistent contact, coordinate support and provide motivation and encouragement to engage in their recovery goals thereafter, and indeed their new community.

    We make the offer of stable accommodation alongside intensive long-term support, but don’t act as landlords. If people choose not to engage with the support or indeed get to a place whereby the support we offer is no longer required they can still occupy their home.

    That said, the model works best when people engage with intensive support and the adoption of assertive engagement is crucial to this relationship.

    There has been many compelling stories of success:

    • We have had high rates of tenancy retention and continue to contribute to ending rough sleeping in the city
    • We have seen positive engagements with health care support such as completion of treatments for hepatitis and cancer and more generally a reduction in missed appointments
    • We have seen people move away from a cycle of offending
    • We have seen a reduction is substance misuse
    • We have seen abstinence based recovery
    • We have seen people parenting their children
    • We have worked with people on longer term aspirations such as accessing training and employment
    • We have seen people reconnecting with family after many years of disconnect
    • We have seen people connecting with the community they live in

    Hopes for the future of Housing First

    Key to what we are attempting is to offer something of quality to someone experiencing multiple disadvantage that they in turn actually want to accept – I hope that this facet of the Housing First model becomes more prevalent in our approaches to ending rough sleeping as we move forward.

    Given the challenges presented to us all during the pandemic, one of the clear silver linings has been the opportunities created to reduce street homelessness and the incredible work undertaken to implement such opportunity.

    My desire is to see a continuum of this trajectory by affording people lasting, well considered, move on options alongside person-centred, robust support.

    St Mungo’s Housing First

    St Mungo’s is one of the largest providers of Housing First services in England, supporting more than 282 clients and currently delivers Housing First to 14% of places available.

    We have Housing First services in Bournemouth, Brent, Brighton, Camden, Ealing, Hackney and City of London, Hammersmith and Fulham, Haringey, Reading, Sutton, Tower Hamlets and Westminster. Camden and Brighton are our largest schemes, supporting 72 and 60 clients respectively, while our Reading and Sutton services each support five clients.

    As an experienced Housing First provider we have been at the forefront of designing, implementing and running Housing First services in the UK for several years.

    For more information about St Mungo’s Housing First schemes click here.

    Housing First can be an integral part of ending homelessness

    As new research is published about Housing First in England, St Mungo’s Chief Executive Steve Douglas CBE explains why its client-centred focus means it can be an ideal fit for us and our clients and echoes our recovery approach. A version of this blog has been published in Inside Housing magazine.

    I read a great piece this week about Housing First by the chair of the All Party Parliamentary group for Ending Homelessness Bob Blackman MP.

    He recognised the diversity and range of needs our clients have and that “homelessness is complex and every case is unique”, before calling for a much wider roll out of Housing First.

    We agree. Housing First may not be the right option for every person but it is an important contribution to accommodation and support solutions to end homelessness and rough sleeping.

    This is evidenced in the research published today by Housing First England and Homeless Link.

    This detailed and comprehensive research estimates an almost six-fold increase in the capacity of Housing First services across England since 2017.

    I am pleased that, working with our local authority partners and housing associations, St Mungo’s has been part of that expansion. We now run 11 Housing First schemes in London, Brighton, Bournemouth and Reading.

    And in the last few weeks we have been given approval to expand our existing service in the London Borough of Camden, meaning we will soon be able to support more than 70 clients there.

    We also have a new expanded contract for our Brighton Housing First service to support up to 40 clients.

    These service expansions give us confidence that our Housing First models work for our clients and for our local authority commissioners. We’ve seen the results.

    Importantly, though, we think that this is linked to following certain principles carefully. It’s not a ‘quick fix’.

    As many readers will know, Housing First is an internationally recognised approach to tackling homelessness for people with high and complex needs who have been unable to sustain a long term home.

    In the model there are no conditions attached to being ‘housing ready’. Instead people are provided with accommodation first and then given access to intensive, multi-faceted ‘wrap around’ long term support with case workers who are able to work intensively with just a small number of clients. 

    It is based on people having control of the services they receive. That client centred recovery approach is very much our ethos overall at St Mungo’s.

    Housing First projects, by their very nature, are time and resource intensive. They don’t work for every person experiencing homelessness, but for a specific cohort of clients they are extremely effective.

    It naturally follows that people with the most complex needs often need the greatest support.

    However, long term help, requires long term funding.

    That is why the Government’s recent commitment to provide multi-year support via the Next Steps and Rough Sleeping Accommodation Programmes is so important, with several Housing First projects already in line for this funding.

    But, as highlighted in today’s research, the lack of more secure long term revenue streams is often a factor in why local authorities don’t commission more Housing First services.

    If these projects are to have the longevity they need, dedicated mutli-year Government spending commitments are vital. 

    There is the determination and increasing momentum to end rough sleeping and homelessness, and our experience and this research shows that Housing First can be an integral part of achieving that.

    Read more about St Mungo’s Housing First services here.

    Calling on the Government for Housing First, not housing only

    Photo of St Mungo's staff during appointment with client

    The centrepiece of the new Conservative Government’s commitment to end rough sleeping is an expansion of the Housing First scheme. Dave Wilson, Impact & Evaluation Officer, shares some new research about St Mungo’s own Housing First services and discusses how they offer a potential solution to our rough sleeping crisis.

    It was easy to miss it, but the major parties made big commitments on homelessness in this election. The Conservatives, Labour and the Liberal Democrats all gave manifesto pledges to eliminate rough sleeping – the most extreme and dangerous form of homelessness – from our streets altogether.

    As the dust settles on the result, one of the things we at St Mungo’s have been thinking about is how the new Conservative government will deliver on their pledge to end rough sleeping by 2024.

    The Conservative manifesto makes it clear that the government sees an expansion of Housing First – an internationally proven approach to tackling rough sleeping – as a big part of the answer.

    And so, now seems like a good time to share the work we have been doing recently about some of our own Housing First services, in Brighton and Hove, and Westminster.

    An in-depth look at how Housing First operates in the UK

    Housing First services look quite different to conventional homelessness services. In Housing First, individuals who are sleeping rough are given direct access to independent accommodation without going through a homeless hostel or shelter. From there they are offered intensive, holistic support from support workers.

    Study after study has shown Housing First to be a very effective solution to homelessness. But much of this research comes from the US and the housing system and homelessness services work very differently there. We wanted to explore in more detail what Housing First looks like in practice in a UK setting.

    Our new research, published this week in partnership with the University of Salford, looks at two St Mungo’s Housing First services in Brighton and Hove, and Westminster. Both areas face very similar challenges: an overheated housing market, a severe shortage of social housing and some of the highest levels of rough sleeping in the country.

    An effective solution, but practical constraints

    For us, there are three main lessons from the research:

    1. Housing First can be an effective solution to rough sleeping in the UK.
      Both projects work with clients who have chaotic housing histories. In many cases, these individuals had been through and struggled with the system of conventional homelessness services on multiple occasions. But the research found that the Housing First teams were very effective at supporting these clients to sustain independent tenancies. Crucially, even when clients struggled to maintain the tenancy or were evicted, they continued to receive support from their Housing First support worker. This was often an important platform to help them get things back on track.
    2. Some of the Housing First principles are compromised by lack of housing options.
      We learned that there are serious challenges to operating a Housing First service in the form originally intended in these areas. One of the principles underlying Housing First is that clients should have choice and control over where they live and security of tenure. Both of those are hard to achieve in cities where private housing is shockingly expensive and social housing waiting lists stretch thousands long.
    3. Partnership working is key to success in Housing First.
      Clients in Housing First services often have a range of complex, interrelated needs. Support is most effective when it is provided by a skilled, multidisciplinary team covering specialisms like drug and alcohol treatment, mental health and employment skills. The model is at its best when it is Housing First, not housing only. It is also vital for services to cultivate good relationships with private sector and social landlords. The research highlighted this in Westminster in particular, where all Housing First clients were able to access secure social accommodation via a single housing association, Sanctuary.

    Housing First should be part of a wider strategy to tackle rough sleeping

    Last year, the government announced £28 million of new funding for three Housing First pilots, in the West Midlands, Liverpool and Greater Manchester.

    Our research strengthens the case that Housing First is an effective solution to rough sleeping, and we welcome these schemes.

    But we also know that Housing First works best if the wider environment is right. £1 billion has been cut from vital homelessness services in the past decade. There is a lot of ground to make up to ensure everyone sleeping rough has the right, tailored package of support for them.

    That is why we are calling on the government in our Home for Good campaign to take the bold action needed to end rough sleeping for good.

    • Firstly, it must ensure an adequate supply of social housing.
    • Secondly, it must make the private rented sector more secure and more affordable.
    • And thirdly, it needs to provide long-term guaranteed funding for homelessness services. This includes Housing First, but it should not be limited to it.

    More Housing First is a good idea, but without these wider changes, the Government will not be able to follow through on its pledge and end rough sleeping for good.

    Read the full report and our summary.

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