Housing First (In Focus)

Introduction

Homelessness is a serious problem in our towns and cities, and many rough sleepers are struggling with personal problems, such as mental ill health and addictions. Housing First aims to help homeless people with high and complex needs by providing them with accommodation without any preconditions. This briefing explores this approach and provides examples of successful Housing First projects.

Homelessness

In towns and cities across the country, rough-sleepers have become a common sight on our streets. They are the visible evidence of the UK’s ever-present problem of homelessness.

While in some parts of the UK, levels of rough-sleeping have stabilised, in others the figure has risen sharply. Official figures from the first part of 2024 show that rough sleeping increased in every region of England compared to the previous year. The largest increase in the number of people estimated to be sleeping rough is in London, where there were 1,132 people this year, compared to 858 people in 2022, an increase of 274 people or 32%.

Although there are many reasons for homelessness, such as relationship breakdown and loss of income, many people have ended up on the streets because of mental health problems, addictions and the adverse effects of spending time in local authority care or prison.
As well as dealing with homelessness and struggling with their personal problems, people sleeping on the streets face additional dangers: they are more likely to be victims of crime and exploitation, violence and sexual assault.

In 2022, more than 1,300 homeless people died. These included people sleeping rough, as well as those in emergency accommodation. Hostels and night shelters are provided by councils, charities and housing associations to protect the homeless, but here too there have been reports that vulnerable people feel unsafe, uncomfortable, and find it harder to tackle their mental health or drug and alcohol problems.

For a long time, homelessness strategies for people with high and complex needs have focused on treatment and addiction as a condition of providing housing. This so-called ‘staircase approach’ involves various steps which eventually leads to a homeless person being offered a tenancy. However, the successes achieved by a different, ‘housing-led’ approach to tackling the particular problems faced by the harder-to-reach homeless has been attracting increasing interest.

1. An overview of Housing First
2. The viscious cycle of sleeping rough
3. Case study 1: Housing First in Finland
4. Case study 2: Housing First in Scotland
5. Housing First: criticisms and concerns
6. Funding Housing First
7. Housing First: into the future
8. Conclusion

An overview of Housing First

“There is no better-evidenced or developed service model, and the outcomes recorded for people who have experienced homelessness exceed any comparable approaches.”

Housing First Europe Hub

Housing First turns on its head the notion that vulnerable people are only ‘housing ready’ once they have begun to engage with support services. As the name suggests, Housing First means ensuring that people with high and complex needs are offered permanent, affordable housing, along with specialised support services without any preconditions, other than a willingness to maintain a tenancy.

Housing First has seven core principles:

• people have a right to a home
• flexible support is provided for as long as is needed
• housing and support are separated
• individuals have choice and control
• an active engagement approach is used
• the service is based on people’s strengths, goals and aspirations
• a harm reduction approach is used

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The Housing First approach was first developed in the United States by a not-for-profit organisation founded in 1992 by Sam Tsemberis, a clinical and community psychology practitioner. It has been widely adopted across North America, and has also been successfully demonstrated in Denmark, Finland and France.

Scotland was one of the first parts of the UK to embrace the Housing First approach (see case study). Elsewhere in the UK, three regional Housing First pilots have been launched in Greater Manchester, the West Midlands, and the Liverpool City Region, and Housing First was included in the UK government’s 2018 rough-sleeping strategy.

The Welsh Government has also provided funding to support a range of new projects based on Hous-ing First principles, and two Housing First projects in Belfast and Derry have been funded by the North-ern Ireland Housing Executive.

In England, at a local level, Standing Together and Westminster City Council have used funding from the domestic abuse team at the Department for Levelling Up, Housing and Communities (DLUHC) to develop a Housing First project for women with experience of homelessness, violence against women and girls (VAWG), and multiple disadvantage. Housing First projects have also been developed in the London borough of Newham and in Brighton.

Housing First: costs and cost effectiveness

In March 2019, Homeless Link published a report exploring the cost of Housing First in England. The study reported that Housing First costs an average of approximately £4,128 in total support costs. Total average costs, including housing, for the first year of use are £9,492 per person. Average costs in London were closer to £10-£11,000 for the first year.

The report found that, while Housing First is not a cheap option, it may be more cost effective than some other services on a day-to-day basis, and that the costs usually reduce over time. It concluded that Housing First represents good value for money because it stops long-term and recurrent homelessness.

It is difficult to provide an accurate assessment of the cost savings generated by Housing First. The Housing First approach may reduce instances of homeless people coming into contact with the criminal justice system and emergency medical services, and may also reduce prolonged use of hostels. However, the frequency and duration of support services for Housing First tenants will vary greatly.

A 2014 evaluation of Housing First in five European cities found some evidence that the costs of Housing First projects compare favourably with the other existing services at the local level. In addition, a briefing paper published by the House of Commons Library highlighted several UK studies indicating that, while the savings from Housing First may not be substantial, the wider societal benefits should also be considered when weighing up the benefits of this approach.

Case study 1: Housing First in Finland

‘It’s a miracle’: Helsinki’s radical solution to homelessness
The city with no homeless on its streets
How Finland solved homelessness

With headlines like these, it’s no surprise that Finland has been attracting worldwide attention for its dramatic reductions in long- term homelessness. Since 2008, the Finnish government has been working with housing agencies on a Housing First approach. In its first seven years, the programme achieved a 35% fall in long-term homelessness, and Finland is now the only European Union country where homelessness continues to fall. In the capital of Helsinki, rough-sleeping has been totally eradicated.

One of the key players in Finland’s Housing First strategy is the Y-Foundation, an association of local authorities, church, construction, trade union and health organisations that has been supporting homeless people for more than thirty years. Starting in 2008, the foundation converted homeless shelters in Finland’s biggest cities into rental housing. At the same time, the government set targets for local authorities to build new flats in mixed housing developments. The programme is backed by money from government grants and the proceeds from Finland’s not-for-profit gambling monopoly.

Housing First has been integrated into Finland’s national housing programme, and the government has spent €250m creating new homes and hiring 300 extra support workers. Juha Kaakinen, chief executive of the Y-Foundation, has no doubts about its value for money. In an interview with Inside Housing, he explained:

“It’s not only good social policy; it has a big safety and security angle, as the more homeless people there are on the streets, the more unsafe the city is. And there’s an economic argument, too: taking care of these people is a good investment.”

Kaakinen estimates that taking each homeless person off the streets saves social, health, justice and emergency services around €15,000 a year.

Many believe the Finnish approach to Housing First has been uniquely successful because it has ensured that a sufficient supply of social housing is available to support the programme. The city of Helsinki owns 60,000 social housing units, and 70% of the land, as well as running its own construction company, and so is well placed to support the principles of Housing First. In addition, support services are made available to treat addiction and mental health problems, to help people into work and prevent them from losing their home.

Contrary to the media reports, Finland has not solved homelessness: the country still has around 7,000 homeless people, most of whom are lodging with friends or relatives. But that figure is substantially down from the 18,000 homeless recorded in the 1980s, and rough-sleeping has been even more dramatically reduced. The mayor of Helsinki acknowledges that a lot has been achieved, but promises that the efforts to eradicate homelessness will continue:

“We have reduced long-term homelessness by a remarkable amount. We must do more.”

The following year, the Finnish government committed to completely ending homelessness by 2027. Housing First will be a significant factor if this ambitious target is to be achieved.

Case study 2: Housing First in Scotland

The UK’s first Housing First project was developed in Glasgow by Turning Point Scotland (TPS), a social care charity providing support to people with complex needs. The Housing First project started in 2010 as a response to the high levels of drug deaths among Glasgow’s long-term homeless population. The three-year pilot programme was funded by TPS, the Big Lottery Fund, and Greater Glasgow and Clyde Health Board, and received support from the Wheatley Group and several housing associations.

In 2013, an evaluation reported on the project’s outcomes, finding that:

• Housing retention outcomes exceeded expectations: the vast majority of project participants retained their tenancies continuously after they were allocated their property.
• The physical health of participants in the project improved, with improvements in diets and reductions in alcohol or drug use.
• There was an overall reduction in the severity of participants’ dependence on drugs, but little observable change regarding overall levels of alcohol.
• Involvement with the criminal justice system declined overall.
• Participants’ financial wellbeing improved overall, but most continued to struggle to cope financially on low incomes.
• Inclusion of peer support workers in the staff team was universally welcomed by participants.
• Any dissatisfaction expressed by participants related predominantly to substantial delays in the allocation of flats.

The success of the Glasgow project attracted greater interest in Housing First, and further projects were launched in other parts of Scotland. In 2018 the Scottish Government announced it was investing £6.5m in a three-year Housing First pilot covering projects in Aberdeen, Dundee, Glasgow, Edinburgh and Stirling. Managed by Homeless Network Scotland and Corra Foundation, and part-funded by the Scottish Government, Merchants House Glasgow and the Social Bite homelessness charity, this is the largest Housing First project of its kind in the UK. It has a target of creating 830 tenancies, with support from local authorities, the third sector and housing providers.

In November 2019, the project passed a significant milestone, announcing the creation of more than 150 tenancies. In response, Dr Sam Tsemberis, who established the Housing First model observed:

“What’s happening in Scotland should inspire everyone involved in Housing First projects across Europe. More than 150 people have received a home of their own and that speaks to the commitment of the Housing First Scotland initiative, now well on their way to establish Housing First as the best response for the most vulnerable.”

An evaluation of the project by Heriot Watt University, published in 2021 found that by the end of June, 531 individuals had been housed by the Housing First initiative, the vast majority (98%) of whom were allocated tenancies in social housing.

A 2023 article in the European Journal of Homelessness set out nine key lessons from Scotland’s Housing First project and concluded:

“Housing First delivery at scale in the Scottish context may well be difficult, but is achievable, and is indisputably worth pursuing given its effectiveness at resolving homelessness for a group traditionally poorly served by mainstream services and potential for substantial costs savings to boot.”

Housing First: criticisms and concerns

Despite the great success of Housing First programmes, the approach is not without its critics. Concerns have been raised in the UK about the long-term availability of both accommodation and funding for mental health and support services, and there has been some resistance to the idea of providing housing without any preconditions.

Some critics of Housing First are uneasy about providing housing to people who continue to use alcohol and drugs. At the same time, communities where Housing First participants will be housed may have concerns about vulnerable individuals being placed there without adequate support. Addressing the misconceptions about Housing First requires engagement with the public about the Housing
First model and its key components. A toolkit published in Canada, where Housing First has become a recognised best practice, offers guidance on strategies for overcoming confusion, resistance, and concerns about Housing First.

Housing First works best with purpose-built social housing, and one of the main reasons given for the success of the programme in Finland has been the construction of new affordable housing for lone homeless people. However, the UK is currently experiencing a serious shortage of affordable housing, and securing adequate accommodation for Housing First is proving to be a challenge. In February 2019, Sheffield City Council cancelled its Housing First Scheme, explaining that the lack of affordable accommodation for single people was one of a number of challenges encountered by the council. However, the city council relaunched its Housing First programme in 2020, and has subsequently helped vulnerable homeless people in the city to find accommodation.

Concerns have been raised about the availability of mental health and support services, which have been experiencing increasing financial pressures due to increased demand within a context of reduced budgets. As Tony Cain, policy manager for the Association of Local Authority Chief Housing Officers told Inside Housing magazine, Housing First is dependent on the support of mental health and other support services:

“It requires a coordinated and consistent high-level support response. If there’s a concern at the moment, it’s that the support is not there.”

There are also critics of the Housing First model who believe the approaches to Housing First in other countries cannot be replicated in the UK because of differences in welfare systems. In Finland, for example, Housing First rents and utilities charges are heavily subsidised and fully covered by housing benefits.

There are some concerns that the success of Housing First could give the misleading impression that homelessness has been solved. A 2008 study of Housing First highlighted this criticism, noting that:

“In the US, some commentators have argued that permanent supportive housing programmes are a means to ‘reallocate the lifeboats’ rather than solve structural poverty.”

However, the proponents of Housing First do not claim that it is a cure-all answer for solving mental ill health, addiction, poverty, or even homelessness itself. They do, believe, however, that any attempt to end homelessness that does not include Housing First will not work.

Funding Housing First

In the UK, Housing First programmes have largely been short-term projects, small in scale and funded by local or central government and grant-making charities. If Housing First is to achieve further success in the UK, sufficient and sustainable funding will be imperative.

In 2024, research published by Homeless Link found positive impacts of Housing First on the physical and mental health of Housing First participants, as well as improved access to health services and reductions in substance misuse and anti-social behaviour. But the Homeless
Link report also underlined the crucial the role of funding in ensuring the long-term support given to Housing First residents.

The report argued that short-term funding cycles affect services’ ability to plan long-term operationally and logistically as well as affecting their capacity to provide long-term and consistent support to the residents. In addition, the coming to the end of the funding cycle without any extension of contract takes away the lifeline support for residents who are most in need and in critical stages in the programme.

The report found that only 5% of Housing First services in England have indefinite funding, and very
few receive local authority funding from adult social care (9%) or public health (6%). This highlights the urgent need to diversify funding sources, particularly from sectors beyond homelessness.

The report recommended sustainable funding for long-term support of Housing First participants:

“Our findings strongly evidence that benefits and positive outcomes
emerge when ample time is given. Funding and commissioning cycles for Housing First projects need to facilitate sustainable long-term support to ensure impact. There is also a need for more funding into Housing First as a preventive, proactive and cost-effective intervention to reduce burden on emergency services and public funds across sectors. There is a need to review current funding practice and eradicate short-term contracts and allocate the estimated £150.3 million per annum required to fund Housing First at scale.”

Housing First: into the future

Housing First has come a long way in a short period of time. A decade ago, the Housing First approach was largely confined to North America. Since then, it has taken root in Europe, and has attracted strong interest in parts of the UK.

It seems likely that Housing First will continue to grow in many countries. At the same time, many rough-sleeping interventions have borrowed from Housing First to adapt existing ‘staircase’ models of support.

As has been noted, Housing First projects have demonstrated successful outcomes in the UK, but there is a clear need for sustainable funding if the benefits are to be experienced more widely. In addition, sufficient, adequate, affordable housing with security of tenure is essential to the success of future Housing First projects, as well as the long-term provision of adequately funded mental health and support services.

In September 2024, following a number of successful pilots in the area, the Greater Manchester Combined Authority launched a pioneering Housing First Unit to support work already going on at the Combined Authority to tackle the roots of the housing crisis, including exploring housing supply and standards, and tackling unsuitable temporary housing solutions. This approach looks to be gaining traction among a number of local and combined authorities who are exploring the implementation of something similar.

There is also growing evidence that Housing First can have positive impacts on particular groups of vulnerable people. Domestic abuse survivors have multiple complex needs which could be addressed by the Housing First approach. This has been demonstrated by a project managed by Standing Together and Westminster City Council, which developed a Housing First project for women with experience of homelessness, violence against women and girls (VAWG), and multiple disadvantage. Two years into the project, an evaluation found positive outcomes concerning tenancy sustainment, physical and mental health and substance/alcohol use. The team in Westminster have worked creatively to increase safety and agency for women at risk of domestic abuse.

The Centre for Social Justice has suggested the establishment of a Housing First for Domestic Abuse Survivors programme. With its provision of accommodation and wrap around support, the new programme would unlock a wide range of potential benefits for this most vulnerable of groups, including improvements in mental and physical health, keeping or regaining their children, and reduced contact with the criminal justice system. The model would also deliver benefits to the wider community, in terms of safer neighbourhoods, less pressure on services and greater community cohesion.

Further research suggests that Housing First has a key role to play in a gendered approach to homelessness.

There is also an important role for housing associations to play in delivering Housing First, something explored in a 2020 report from the National Housing Federation. The report highlighted existing examples of Housing First projects involving housing associations. It found that housing associations considered Housing First an attractive model because it aligned with their organisational objectives, notably on addressing all forms of housing need, and included fully funded support.

Overall, the report found housing associations’ experiences of Housing First to be positive, although challenges such as finding suitable properties and the risks around short-term support funding were raised as potential stumbling blocks. The authors made a number of recommendations, including that government and commissioners should ensure long-term funding of contracts for support, and that housing associations should be key partners in delivery.

Conclusion

The Housing First approach will not work for everyone. It will not provide solutions for people with severe learning disabilities, those with particular healthcare needs, and people who do not want the responsibility of an independent tenancy, perhaps because they don’t want to live on their own.

But for the vast majority of homeless people in need of support, Housing First is a significant development. The evidence suggests that it has positive and widespread effects, and housing professionals recognise that Housing First will be a key component in effective homelessness strategies.

As the 2019 report from the Housing First Europe Hub underlines:

“The extent to which Housing First is used will reflect the nature of homelessness in different countries and also be influenced by other aspects of homelessness strategy, such as the nature and extent of prevention. However, as the evidence indicates the presence of recurrently and long-term homeless people with high and complex needs throughout Europe – albeit that they do not always represent a majority of the homeless population – Housing First services should have an important role in every effective homelessness strategy”