Bristol houses

Housing First

In Spring 2018, Golden Key, - in partnership with Bristol City Council and the city’s housing associations - set up a Housing First pilot in Bristol.

Housing First is designed for those who have been homeless for a long time or those who repeatedly end up homeless. They are offered housing as a first priority – this is then followed up with additional intensive support, to help the address other needs and help them to maintain their tenancy

More traditional approaches require clients to meet certain conditions to demonstrate they are ‘housing-ready’ before a tenancy is offered. The Housing First approach reverses this- secure housing is offered first as this provides a stable platform from which other issues can be addressed. 

Because the additional support is provided when the client is in a secure and stable environment, is more likely to be successful and so repeated cycles of homelessness are broken.

At present the scheme is being run as a pilot in Bristol involving 10 clients.  If it proves to be successful we would like to see this approach used more widely in the City, although it will always remain a specialist service for those clients with the highest levels of need.

The Housing First approach is already working well elsewhere in the UK, as well as in other countries including Finland and Canada where is has be used more widely.

Evidence of Success

In 2015, the University of York undertook an evaluation of 9 Housing First Services in England.  While the findings only related to a small cohort of clients (60 in total), the results were encouraging in a variety of areas:

Health

  • Of the 60 clients who completed outcomes forms, 43% reported ‘very bad or bad’ physical health a year before using Housing First.  This fell to 28% when asked about current health.

  • 52% of the same group reported ‘bad or very bad’ mental health a year before using Housing First, falling to 18% when asked about current mental health.

Drug and Alcohol Misuse

  • Among the group of 60 service users completing outcomes forms, 71% reported they would ‘drink until they felt drunk’ a year prior to using Housing First.  This fell to 56% when asked about current behaviour.

  • When asked about illegal drug use, 66% of the same group reported drug use a year prior to using Housing First, falling to 53% when asked about current behaviour.

Social Inclusion

  • Among the 60 service users who anonymously shared outcomes data with the research team, 25% reported monthly, weekly or daily contact with family a year prior to using Housing First, rising to 50% when asked about current contact.

  • 78% reported involvement in anti-social behaviour a year prior to using Housing First, compared to 53% when asked about current behaviour.

Cost Benefits

  • The Housing First services cost between £26 and £40 an hour.  Assuming that someone using a Housing First service would otherwise be accommodated in high intensity supported housing, potential annual savings ranged between £4,794 and £3,048 per person in support costs.

  • There was also the potential for reductions in use of emergency medical services and lessening contact with the criminal justice system. Housing First could deliver potential overall savings in public expenditure that could be in excess of £15,000 per person per annum.

(All cost figures are approximate) 

Bretherton and Pleace 2015.

Case Studies

The Housing First Pilot in Bristol has only been running for a short period of time, so we do not yet have any case studies to demonstrate of how it is working.  However, thanks to Homeless Link we are able to share the experiences of Housing First clients elsewhere in the country:

Jane

Jane is 43 years old and had rough slept on and off for the past 10 years. She engaged in heavy IV drug and alcohol use and was a victim of domestic violence. Jane has a diagnosis of Bipolar Disorder.

Jane was constantly getting involved in antisocial behaviour, causing her to have an ASBO against her in Tower Hamlets area. She also has problems maintaining friendships with her female friends without violence occurring between them. She was unable to maintain a hostel, tenancy or healthy relationships with support staff, so has a history of turning back to the streets and her ex-partner. Jane displayed paranoid behaviour and would not attend any appointments or meetings alone.

After being housed by Thames Reach Housing First services Jane has reduced her alcohol intake and now abstinent from IV drug use and has to date reduced her script from 75mls of methadone to 30mls. She has maintained her clearing house tenancy for the past two years, engaging with housing support staff from Housing First to guide her with her managing her tenancy. 

Jane has refrained from returning to the area where she was given the ASBO and has also engaged with support from the Victim Support team and the police around her domestic violence and provided enough evidence for her ex-partner to be given a long sentence.

She has begun independently attending appointments with her GP as well as the drug and alcohol support service that she attends and no longer requires Housing First to attend with her. 

Julio

Julio is a 35-year-old man who had a difficult childhood – as one of five children, he was the only one given up by his mother. The trauma of being rejected as a child has had a lasting impact on his emotional and mental well-being.

He grew up in an environment where drug and alcohol use was common and became an addict himself. While Julio experienced periods of paid employment, he would invariably end up losing jobs and becoming homeless due to his drug and alcohol addiction and mental ill health. 

In 2011, Julio found himself at a particularly low point and deliberately had himself arrested for stealing as he wanted to be sent to prison in an attempt to stop using drugs.

Julio was sleeping rough when he was referred to a Housing First service in July 2013, following his eviction from a hostel for rough sleepers due to his aggressive behaviour.

Julio said: “When they found me I was sleeping in Hyde Park. My ESA benefit had stopped. My depression had gotten a lot worse. I felt I was worth nothing.”

Since receiving support from Housing First, Julio has found work in a café, which has boosted his self-esteem. After many years on antidepressants, Julio was able to stop taking medication. He has started exercising regularly and is considering going back to college.  In spite of periods of disengagement, which Julio says are due to his feelings that he is undeserving of help, the service has been flexible and creative in continuing to offer him consistent support. 

Julio said: “My Housing First support worker was friendly and gentle and this helped me to start to see things being OK again. Whenever I have doubts about myself they will take time to talk to me. They helped me cut down on cannabis and this helped me to decide what is best for me, which was to get a part-time job.

They helped me to tell the benefits people I had done this so that my rent was still paid and I did not end up in the street again. They helped me to get a flat that I’m happy with – I have somewhere that I call home now. I have been thinking about a painting and decorating course and my support worker has shown me where to find information about this. This is the first time in many years that I feel I can do more things for myself.”

Courtesy of Homeless Link.