NICHOLAS PLEACE HOMELESSNESS AND MENTAL HOMELESSNESS IS NOT

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NICHOLAS PLEACE HOMELESSNESS AND MENTAL

NICHOLAS PLEACE HOMELESSNESS AND MENTAL

HOMELESSNESS IS NOT WHAT YOU THINK IT IS ▸ People living rough are a

HOMELESSNESS IS NOT WHAT YOU THINK IT IS ▸ People living rough are a fraction of the population ▸ Only a tiny number of people experience recurrent and sustained homelessness associated with high and complex needs ▸ North American, Australian and European research, 10 -20% of lone adult homeless populations have high and complex needs

HOMELESSNESS THE NATURE OF THE NEED ▸ 4, 751 rough sleepers at the last

HOMELESSNESS THE NATURE OF THE NEED ▸ 4, 751 rough sleepers at the last count in England ▸ Actual numbers may be double or triple that ▸ Counts are inherently inaccurate ▸ Another 34, 000 in services for lone homeless people ▸ But there were 78, 930 statutorily homeless households in temporary accommodation during the period when the count occurred ▸ Those households contained 121, 340 children

HOMELESSNESS HIDDEN HOMELESSNESS ▸ Strong associations between homelessness and poverty ▸ People living without

HOMELESSNESS HIDDEN HOMELESSNESS ▸ Strong associations between homelessness and poverty ▸ People living without security of tenure, without private space, without physical security is much greater than the number of people living on the street ▸ This population is subject to constant stress, worry and often poor, or very poor, living conditions ▸ Under a roof, but without anything recognisable as a “home”

HOMELESSNESS HIDDEN PROBLEMS ▸ So when thinking about homelessness and mental health we need

HOMELESSNESS HIDDEN PROBLEMS ▸ So when thinking about homelessness and mental health we need to avoid thinking only in terms of street-using populations ▸ There is a much bigger population, very poor, very marginalised, often highly stressed that is difficult to treat effectively ▸ Environment is often ‘toxic’ ▸ Hard to maintain continuity of care

SOLUTIONS FAMILIES, COUPLES AND PEOPLE WITH LOWER SUPPORT NEEDS ▸ Basically they need a

SOLUTIONS FAMILIES, COUPLES AND PEOPLE WITH LOWER SUPPORT NEEDS ▸ Basically they need a home ▸ Affordable ▸ Secure ▸ Adequate ▸ Some support will be necessary ▸ family homelessness strongly associated with domestic abuse ▸ rates of depression can be high ▸ but unlikely to see severe mental illness or addiction

SOLUTIONS LONG TERM AND RECURRENT HOMELESSNESS ▸ As said, a small fraction of total

SOLUTIONS LONG TERM AND RECURRENT HOMELESSNESS ▸ As said, a small fraction of total homelessness ▸ There are mutually reinforcing relationships in this population ▸ Addiction, severe mental illness, offending and prison, extreme social and economic marginalisation, poor physical health, contact with child protection as kids

SOLUTIONS LONG TERM AND RECURRENT HOMELESSNESS ▸ Linear residential treatment or staircase models ▸

SOLUTIONS LONG TERM AND RECURRENT HOMELESSNESS ▸ Linear residential treatment or staircase models ▸ Directly modelled on early resettlement systems employed when long-stay psychiatric hospitals were closed ▸ Move from highly regulated, highly supportive environments into increasingly home-like situations ▸ Eventually made “housing ready” ▸ Abstinence-based, strictly enforced behavioural expectations

SOLUTIONS LONG TERM AND RECURRENT HOMELESSNESS ▸ Staircase model effectiveness was between 40 -60%,

SOLUTIONS LONG TERM AND RECURRENT HOMELESSNESS ▸ Staircase model effectiveness was between 40 -60%, lost 4 -6 out of every long-term/recurrent homeless person engaged with ▸ People got stuck, unable to complete the required steps ▸ Or ran away ▸ The model was dumped by Canada, Denmark, Finland, France and the USA

HOUSING FIRST THE HOUSING FIRST REVOLUTION ▸ Housing First uses ordinary or congregate housing

HOUSING FIRST THE HOUSING FIRST REVOLUTION ▸ Housing First uses ordinary or congregate housing (self contained flats with a normal tenancy) ▸ People are rehoused immediately or as soon as possible ▸ Harm reduction, consumer choice model (ICM and ACT) following principles of co-production ▸ Intensive floating support model ▸ Now official government policy in England, £ 28 million for three pilots one of which is here

HOUSING FIRST MANCHESTER HOUSING FIRST ▸ Threshold Housing First ▸ Women with a history

HOUSING FIRST MANCHESTER HOUSING FIRST ▸ Threshold Housing First ▸ Women with a history of offending, high and complex needs ▸ Early evaluation results are good ▸ Inspiring Change Manchester Housing First ▸ Focused on long-term and recurrently homeless people with high and complex needs in the city centre ▸ Evaluation results positive ▸ Greater Manchester Combined Authority Pilot

HOUSING FIRST LIMITATIONS ▸ Very strong on ending homelessness among people with high and

HOUSING FIRST LIMITATIONS ▸ Very strong on ending homelessness among people with high and complex needs ▸ Very strong on ending long-term and recurrent homelessness which has not been stopped by existing services ▸ 80 -90% success rates ▸ People in settled housing @1 year

HOUSING FIRST LIMITATIONS ▸ People are stably and adequately housed ▸ But experience around

HOUSING FIRST LIMITATIONS ▸ People are stably and adequately housed ▸ But experience around addiction is variable ▸ Same with mental health ▸ Global evidence shows the same pattern ▸ One reason is that these are high need people cannot expect overnight change ▸ Another is expecting too much from any single intervention

BEST PRACTICE FINLAND ▸ Has reduced all forms of homelessness ▸ Including long-term and

BEST PRACTICE FINLAND ▸ Has reduced all forms of homelessness ▸ Including long-term and recurrent associated with high support/treatment needs ▸ Used a housing-led, highly integrated, comprehensive strategy ▸ Mental health, social work, social housing, homelessness sector, addiction services all interacting to provide packages of housing and support, prevention, supported housing, Housing First ▸ Housing First does this on a case-by-case basis, the Finnish strategy does it at system level

SOLVING HOMELESSNESS FIXING THE PROBLEM ▸ Integrated, strategic responses are best ▸ Should not

SOLVING HOMELESSNESS FIXING THE PROBLEM ▸ Integrated, strategic responses are best ▸ Should not look to a particular model to ‘solve’ the issue on its own ▸ And recognise that homelessness - the bulk of homelessness is not about people on the street ▸ And that even among those on the street, only a handful have the high and complex needs Housing First and similar services are designed for

MORE ON HOUSING FIRST

MORE ON HOUSING FIRST

NICHOLAS PLEACE THANKS FOR LISTENING ▸ Nicholas Pleace, Director, Centre for Housing Policy ▸

NICHOLAS PLEACE THANKS FOR LISTENING ▸ Nicholas Pleace, Director, Centre for Housing Policy ▸ http: //www. york. ac. uk/chp/ ▸ European Observatory on Homelessness ▸ http: //www. feantsaresearch. org/ ▸ Women’s Homelessness in Europe Network (WHEN) ▸ http: //womenshomelessness. org/