‘Housing First’ is a modern homeless assistance approach that prioritises providing people who are experiencing the trauma of homelessness with permanent housing, as quickly as possible.
The principle of housing provision as a priority address to homelessness draws on overwhelming evidence that all people experiencing homelessness can achieve stability in permanent housing, if provided with appropriate levels and variants of accompanying holistic services and support. Housing priority is given to the people who are experiencing homeless with little to no treatment pre-conditions, behavioural contingencies or barriers – and study after study has shown this approach to;
‘Housing First’ approaches are based on the concept that an individual or household experiencing the crisis of homelessness has the first and primary need of obtaining somewhere to live, and that other issues affecting the household should – and can - be addressed once the safety and security of permanent accommodation has been obtained. In contrast, many traditional programmes operate from a model of ‘housing readiness’ — that is, that an individual or household must first address challenges that may have contributed to the episode of homelessness, prior to the re-entering of stable housing.
In San Francisco, one organisation which offers a lifeline to those who desperately need – but would be traditionally excluded from - mainstream housing options, is Delivering Innovation in Supportive Housing (DISH). Founded September 2006, DISH provide property management services for the Direct Access to Housing Programme, a project of the San Francisco Department of Public Health. The guiding principle for DISH was to be a small organisation dedicated to serving adults in a supportive housing environment, specifically for those experiencing substance abuse issues and complex physical and mental health challenges.
DISH aim to be a strong partner in the San Francisco city-collaborative effort to end and prevent homelessness; following proven ‘Housing First’ philosophy, DISH help to get people get off the streets, rebuild their lives and strengthen the communities around them. In the relatively short period of time the organisation has been operational they have obtained 6 housing sites; providing a semi-supported accommodation option for 450 occupants who would otherwise be on the streets. Residents generally arrive with a web of complex issues to work through and they are gently guided by an expert team of both in-house support staff and specialist external agencies.
I was attracted by this approach to ‘no condition’ stable housing and intrigued to learn more of the programme infrastructure which allows residents to occupy their accommodation for as long as they need to; some, for a lifetime. With a fundamental ethos not dissimilar to that of the pilot initiative I developed in 2013-15, in Greater Manchester, UK, I was keen to dissect the infrastructure behind the support services on offer, as well as the revenue and funding model which afforded the obvious high level of resident care.
Le Nain Hotel is a four-story building, offering 86 housing units with additional communal living space, to older people who are homeless and experiencing complex needs. Guided by manager Jack Mclean, I spent time touring facilities and meeting residents, most extraordinarily proud of their homely and comfortable surroundings. With many of Le Nain’s occupants having previously survived within the notorious Tenderloin district - San Francisco's most dangerous neighbourhood, which has become a magnet for those with no home – occupants were keen to talk about their experiences of life before and after DISH; some relaying quite harrowing stories of their rapid descent from the 'American Dream' of middle-class suburbia, to the drug and crime riddled streets of San Francisco.
Tenant occupant Laurie invited me to see her studio space, proudly maintained and personalised to feel like home. Laurie, like all of the other housemates I conversed with, was highly complementary of the integrated care package she received; timetables of programmes including on-site nurse-led health clinics, life-skills training groups and education classes, as well as yoga, movie nights and birthday celebrations. Becoming suddenly homeless following spousal death, it is intervention such as this which in Laurie’s own words, ‘brought her back to life’. Today, she is a valuable member of the household community, providing crucial peer-peer support and companionship to fellow residents.
The prevalence of family estrangement and abandonment amongst those who sleep rough is alarming. All humans have a fundamental need to belong and maintain at least a minimum amount of lasting, positive and significant interpersonal relationships. Satisfying this need requires:
(a) frequent, positive interactions with the same individuals;
(b) engaging in these interactions within a framework of long-term, stable care and concern.
It is therefore unsurprising that a common theme across chronic homeless communities both nationally and internationally is the formation of cliques and groups which band together in order to survive the volatile living conditions which can associated with sleeping in a built-up, urban area. Much of this ‘street influence’ can involve unsavoury or illegal activity and it is unhelpful for a person’s recovery to retain a strong connection to this former destructive lifestyle. If we are to gently lead a person away from potential harm, we must provide a way for them to align with alternative peer or friendship groups.
The benefits of belonging to a community with positive focus and spending leisure time productively are too important to ignore. Those who reside in semi-shared space can save money, divide chores, enjoy group activities, form lasting friendships - and ultimately, provide a unique and invaluable source of support to each other through day-to-day life.
Maslow's hierarchy of needs - a theory in psychology proposed by Abraham Maslow in his 1943 paper ‘A Theory of Human Motivation’ - describes the stages of growth in humans, with deficiency requirements including esteem, friendship and love, security and the meeting of physical needscxvi. The co-living model allows participants to meet
I was deeply touched by my visit to Le Nain; having spent the previous two weeks meeting people living outdoors, many who had seemingly – and almost understandably - lost all hope, here I found a place filled with belief and aspiration about the future. Residents are guided to integrate positively to resolve potential conflict in an appropriate manner. This approach appears to greatly assist in helping rebuild foundations for residents to move more easily into fulfilling relationships with others.
On reflection, is it feasible to expect individuals experiencing chronic homelessness to transition wholly independently to a totally private space, away from their peers and those they may see as their surrogate ‘family’?
Further exploration of the co-living model as part of a long-term plan for chronic homeless address and rehabilitation is key to understanding the sustainability of solutions. Affording vulnerable people - and those who are perhaps perceived as ‘troubled’ - the opportunity to become part of a safe, supported and solution-focused community, where they are encouraged to thrive and guide others, surely has many undiscovered benefits. Furthermore, the co-housing (US) or House of Multiple Occupation (UK) model is a way to maximise both building space and rental return.
DISH demonstrate the street-to-home model with exceptional efficiency, recognising and humanising the vagrant on the sidewalk and allowing and empowering them to become part of their own solution and destiny. Residents are encouraged to interact and support each other’s journey and as individuals they are valued as assets in each member of the household’s recovery. DISH operate a rounded and whole service which is very much led by its members and residents and the success of its approach is evident at every angle.
Similar practice has been applied in New York, with the pioneering work undertaken by the internationally-acclaimed Breaking Ground (formally known as Common Ground). Breaking Ground revolutionised how New York City addressed homelessness in the 1990’s with its mission to strengthen society by developing and sustaining exceptional affordable housing options for homeless and vulnerable New Yorkers. The belief that everyone deserves a home is at the heart of everything Breaking Ground does.
Beginning with a single building in Times Square, Breaking Ground are now New York City’s largest provider of supportive housing, owning and/or operating 19 properties with a total of 3,530 apartments. For chronically homeless people, Breaking Ground create safe, secure housing with essential on-site support services to help them address the psychosocial, mental and physical health problems that are obstacles to their independent living. For those at risk of homelessness, their affordable housing options provide an all-important safety net.
Offering a variety of housing-led solutions, Breaking Ground are renowned for conducting their work with respect, kindness, and persistence and this is reflective in the form of both high long-term stability rates and the strong sense of trust in the communities in which they work. When engaging with those who are chronically homeless, staff members aim to support each person individually to determine what is best for them: their outreach team meet people ‘where they are’ – both literally and figuratively. They explain this means in practice, conducting a psychiatric evaluation on a street corner, or arranging specialist workers who can speak to clients in their native languages. This personalised approach provides a lifeline to those most displaced from mainstream society; those who are most often ignored, those who need help the most.
More than half of homeless single adults in the United States struggle with substance abuse issues, mental illness and chronic health problems like HIV/AIDS – factors that contribute to and maintain their homelessnesscxviii. Breaking Ground quite radically state that individuals facing these challenges are not helped by street-based support services, shelters or soup kitchens. In fact, they identify that the chronically homeless community often reject such short-term fixes, instead cycling repeatedly through
emergency rooms, psychiatric hospitals and prisons – the costliest ‘shelters’ of all.
Supported housing, by contrast, is a permanent and humane solution, one which Breaking Ground reveals to be a financially attractive option for the city: The annual cost to provide a single adult with supported housing is $24,190, or less than half the cost of providing emergency, in-patient, and other crisis services to an unhoused individual with mental illnesscxix.
Leading in their stunning execution of the ‘Housing First’ philosophy, Breaking Ground place no barriers on applicants when offering housing and support programmes and they aim to reach clients at every stage of their journey; from the streets to home, during illness and health, and from youth to old age. How do they rehabilitate individuals who have such varied, complex and challenging needs?
In extending a person-centred approach to all they aim to serve, ultimately, Breaking Ground foster strong, vibrant communities, which are contained within beautiful living spaces and complimented by life-enriching experiences. This unique style of interaction enables their household residents to harbour a sense of belonging and inspires both individual and collective aspiration about the future. Breaking Ground identify and evidence that once a person is stably housed, they are vastly more likely to achieve sobriety and other important needs for healthier and sustainable living.
Operating with complex infrastructure to support a commercial business plan with mission at its heart, Breaking Ground incorporate innovative elements of social enterprise within their funding and revenue models; one example of this is the leasing of public event space, another is hosting a Ben & Jerry’s ice cream store within the ground floor of one of their residential buildings. I was interested in the thoughts of Vice President of External Affairs, Jeff Scheuer, when analysing adaptations of inhouse social enterprise models for a UK-based Breaking Ground-style project; the inclusion of such allowing the development of training and employment opportunities which would fall within the bracket of rehabilitation, social isolation reduction, community engagement and pro-active tenant support.
I was grateful for the critique and compliment of the conceptual ideas I shared, having the opportunity to discuss both opportunities and challenges within the transferable lessons identified.
cxv. https://www.usich.gov/federal-strategic-plan/overview
cxvi. https://www.academia.edu/16446323/Maslow
cxvii. http://sites.nd.edu/socialenterpriseandpublicpolicy/files/2011/05/Appendices-Promoting-SocialEnterprise-through-Public-Policy.pdf (Web version unavailable)
cxviii. https://www.breakingground.org/who-we-are/
cxix. https://www.breakingground.org/who-we-are/
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.
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