Housing First

The highly acclaimed research work of Canadian clinical and community psychology practitioner Dr Sam J. Tsemberis Skoura initially was – and to a large degree still is - thought of as sensational, as it radically identifies homelessness primarily as a housing crisis, which should be addressed, without stipulation or barrier, precisely through housing. The experience of homelessness is also a form of trauma - and so the preventing and ending of that trauma should be of paramount importancexxxii.

In 1992, Under Dr Tsemberis’ direction, a randomised controlled trial of the ‘Pathways to Housing’ model was conducted, enabling ‘Housing First’ ideology to evolve and gain traction in the United States of America. In the widely circulated, critically acclaimed evaluation, published in 2000, Tsemberis and Eisenberg reported on a practical study undertaken from 1993 to 1997, which examined the effectiveness of a five-year supported housing programme on 242 homeless New Yorkersxxxiii. The programme provided immediate access to independent scatter-site apartments for individuals with severe psychiatric disabilities and addictions, who were of no fixed abode and living on the streets.

With 88% of participants remaining in stable accommodation and not returning to their former destructive lifestyles, ‘Pathways to Housing’ was considered a game-changer in the way that the United States of America addressed homelessness. It has revealed since to be a highly effective, cost-efficient and sustainable method of compassionate response when directed towards individuals experiencing all types homelessness, across many developed nations. There are examples to study in Italy, Sweden, Spain,
Finland and Demark, to name but a fewxxxiv.

Across pilot schemes undertaken internationally, ‘Housing First’ demonstrates unprecedented success in retaining engagement with traditionally ‘hard to reach’ members of the homeless community; helping them to secure accommodation, remain in their housing and work towards recovery and a stable lifestylexxxvxxxvi. Typically, 80-90% of participants will remain in housing after one yearxxxvii.

Whilst there is no singular, official definition of ‘Housing First’, replication of the original ‘Pathways’ model in New York generally focuses on the following key principles:

  • Housing as a basic human right;
  • Immediate provision of permanent scattered site housing with no requirement
    regarding housing readiness;
  • Respect, warmth and compassion for all clients;
  • A separate identity of housing and supporting services;
  • Use of case management teams;
  • Consumer directed care with recovery orientation;
  • Harm reduction rather than abstinence with regards to substance misuse;
  • A commitment to providing support to clients for as long as it is requiredxxxviii.
housing first, part of Varle Report, 2016
Graphic by Abode Services, California's largest Housing First provider. www.abodeservices.org.

The impact of supportive housing on services used by homeless persons with mental illness in New York City was measured by the Centre for Mental Health Policy and Services Research between 1989 and 1997. It showed that each unit of permanent supportive housing saved $16,282 per year in public costs for shelter, health care, mental health, and criminal justice. The savings alone offset nearly all of the $17,277 cost of providing a supportive housing packagexxxix.

More recently, taking direct action via the implementation of transformational service plans, the Canadian town of Medicine Hat has ‘eradicated’ their long-term homelessness problem via the ‘Housing First’ strategy, reporting to have maintained its ‘homelessness-free’ stature for two years at the date of concluding this reportxl.

With such pressing need for rapid solutions towards its street-sleeping crisis, could Manchester be the first UK city to adopt exclusivity in Housing First approach? Changing Lives, in partnership with a range of specialist agencies and organisations, has led ground-breaking research on long-term homelessness in the UK. Their investigations indicate that utilising a housing-led approach to tackling long-term homelessness in Britain can potentially reduce the number of people who are homeless, whilst providing significant cost savings to the government and public servicesxli.

When Housing Link, national membership charity for organisations working directly with people who become homeless in England, evaluated nine UK-based Housing First projects, they found that between 70-90% of participants had sustained their accommodation and were living more fulfilling and productive livesxlii.

Copyright © by Amy.F.Varle, January 2018.
The moral right of the author has been asserted.

The views and opinions expressed in this report and its content are those of the author and not of the Winston Churchill Memorial Trust, which has no responsibility or liability for any part of the report.


xxxii. https://books.google.co.uk/books?hl=en&lr=&id=Gr5WAwAAQBAJ&oi=fnd&pg=PA37&dq=housing+crisis+trauma+housing+first&ots=onMRqeYKEy&sig=3DaPsrmc

xxxiii. https://www.researchgate.net/profile/Sam_Tsemberis/publication/12578092_Pathways_to_Housing_Supported_Housing_for_Street_Dwelling_Homeless_Individuals

xxxiv. https://www.homeless.org.uk/sites/default/files/siteattachments/Housing%20First%20in%20England%20The%20Principles.pdf (Web version unavailable) New link found: https://homeless.org.uk/knowledge-hub/the-principles-of-housing-first/
xxxv. https://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199989805.001.0001/acprof9780199989805-chapter-8
xxxvi. https://feantsaresearch.org/IMG/pdf/np_and_jb.pdf (Web version unavailable)
xxxvii. http://www.homeless.org.uk/sites/default/files/site-attachments/Evidence%20base%20-%20Sarah%20Johnson%20-%20London.pdf (Web version unavailable)

xxxviii. http://www.homeless.org.uk/sites/default/files/siteattachments/Housing%20First%20or%20Housing%20Led.pdf (Web version unavailable)

xxxix. https://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=D0D92BDFAFCA8C9F16275CC96B607FAD?doi= (Sign Up / Token required to view)
xl. https://www.cbc.ca/news/canada/calgary/medicine-hat-homeless-free-update-1.3949030
xli. https://www.changing-lives.org.uk/news/housing-first-groundbreaking-research-homelessness-approach/ (Web version unavailable)

xlii. https://www.homeless.org.uk/connect/blogs/2016/feb/08/help-us-make-housing-first-viable-accommodation-option-in-england-join (Web version unavailable)



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