1. Housing First Dr Sarah Johnsen

2. Linear ‘Treatment First’ models - 1 Assist homeless people to move ‘up’ staircase, into progressively more ‘normal’ accommodation ‘Treatment first’ philosophy: indept. housing only provided when deemed ‘housing ready’ 2 Street homeless Shelter placement Transitional housing Permanent housing

3. Linear ‘Treatment First’ Models - 2 3 But, with complex needs clientele: high attrition rate / ‘too many hurdles’ allows little room for ‘haphazard’ (non-linear) recovery from addiction / mental health problems

4. Introducing Housing First - 1 4 Developed in NYC in1992, by Pathways to Housing, for chronically homeless with severe mental health problems Bypasses transitional accomm; places homeless people directly into independent tenancies with support Street homeless Shelter placement Transitional housing Permanent housing Ongoing flexible support

5. Introducing Housing First - 2 ‘Housing first’ (cf. ‘treatment first’) philosophy: no readiness or treatment prerequisites Housing as a human right, not something to be earned or used as enticement to treatment Independent permanent housing as stable platform from which other issues can be addressed

6. HF Principles - 1 6 Provides mainstream housing independent self-contained flats (in PRS), leased by Pathways scatter-site 30% of income paid toward rent / utilities No ‘housing readiness’ prerequisites do not need to exhibit indept. living skills no requirements re sobriety / abstinence Harm reduction approach separates clinical issues from housing issues; clinical crisis (e.g. relapse) does not compromise housing

7. HF Principles - 2 7 Permanent housing and support accomm. retained if incarcerated or hospitalised only evicted for same reasons as other tenants; evictees re- accommodated elsewhere no time limits on support Comprehensive multidisciplinary support ACTs: social workers, nurses, psychiatrists, peer counsellors, employment workers assertively delivered in home and community Consumer choice philosophy choice re apartment / furnishings choice re degree of engagement with support (above minimum level) Targets most vulnerable

8. HF Outcomes 8 Housing outcomes excellent (80%+ retention over 2 years) Challenges assumption that people with complex needs unable to sustain independent tenancy Clinical outcomes mixed, but generally positive: Positive impact on mental health Reduced alcohol consumption No increase in drug use Highly cost-effective

9. HF Replication Controversial initially, but now: endorsed by US Federal Govt. widely replicated across Europe endorsed in European policy Increasing interest in HF within UK a potentially valuable complement to services, esp. for ‘hardest to reach’? first UK pilot in Glasgow (Turning Point Scotland): 18 homeless people actively involved in substance misuse

10. What added value might Housing First bring to homelessness policy and practice in Scotland?