Can Housing First help homeless people address their drug and alcohol use?
A new project in Dundee gives homeless people unconditional homes and support. What impact has it had on the ‘drug death capital of Europe’?
Down the quiet backstreets of Dundee, a world away from the flashy new V&A museum, Angie opens the door to an unremarkable domestic scene. She’s lived in her flat for nearly three months and has decided it’s “time to put my stamp on it.” Her cousin is lending a helping hand repainting the living room while Angie talks of planning to create a feature wall in her bedroom. She cooks a mean Spaghetti Bolognese, although she won’t reveal her secret recipe, and is a soap connoisseur who can discuss the finer details of everything from Eastenders to Hollyoaks through to Casualty.
But not so long ago Angie’s life was very different. She grew up in care before spending years in and out of “toxic relationships”, sometimes sleeping rough when they broke down. At the start of 2019 she found herself living in one of Dundee’s homeless hostels. It was from there that her key worker referred her into the city’s new Housing First program.
The Housing First approach to tackling homeless was first developed in New York in the 1990s. It aims to support people with multiple complex needs such as repeated homelessness, mental and/or physical health issues and substance use. Traditionally, homeless people have to work their way through a ‘staircase’ of supported housing such as hostels until they prove they’re ready to manage a tenancy on their own. Instead, Housing First moves people straight into their own home and wraps intensive, personalised support around them. It’s based on the premise that everyone has a right to housing while the security and stability it provides helps people address long-term issues such as drug use.
The policy is gathering momentum in the UK in response to a dramatic rise in homelessness since 2010. In England, official figures show rough sleeping has increased by 165% in the last nine years. In Scotland the rise is less dramatic yet there’s still been a 10% increase since 2015, while the number of homeless people living in hostels in the country is up by 43% since 2010. At the same time, drug related deaths are also increasing in the UK, with Dundee holding the unenviable title of the ‘drug death capital of Europe’. Conversely, since the Finnish government rolled out Housing First as a national policy, rough sleeping has all but disappeared and it’s the only EU country where homelessness in general is decreasing.
In Dundee Housing First is run by a consortium of groups, led by the housing and support charity Transform Community Development, and supported by the Dundee Survival Group, drug and alcohol charity Addaction and The Salvation Army. The majority of the funding was raised by the social enterprise Social Bite. It currently houses and supports 22 people, with plans to expand further in the near future. Daz is one of their new recruits. In the Housing First office he sips on a sugary coffee, while Stephanie from the housing association Home Scotland talks him through the ins and outs of his new tenancy. The program sources the majority of homes through Dundee council or local housing associations, with housing benefit usually covering the rent.
Although Daz has been homeless for years — sofa surfing, sleeping rough and in and out of hostels — this isn’t the first time he’s moved into his own place. A few years ago he moved into a flat through Dundee council but once they gave him the keys he was on his own. He describes the feeling of walking into a bare, unfurnished flat as “horrible” and says he found ordering furniture and sorting out bills himself “really stressful and triggering.” Daz has used heroin as a way to cope with homophobic abuse since his late teens. He tried to maintain the flat but when news of his sexuality spread around the area people started writing things on his door and kicking it in. Eventually, on returning home from a stint in hospital, he found his door ajar and many of his belongings stolen. At this point he abandoned the flat.
Emma Paterson is Project Coordinator for Housing First Dundee. She says “every time a person is put into a tenancy with very little furniture, say a mattress on a bare floor, it’s traumatic for them. And then when they’re evicted because they can’t cope, it’s another trauma. So they’re never going to get out of that horrible traumatic state.” This time around Daz has Lyndsey, his support worker seconded into the project from Addaction Dundee. She sits across from him soothing any worries he has and helps explain the particularities of the tenancy agreement. When he asks about bills and setting up his housing benefit Lyndsey says she will sort this out for him. They also arrange to go and buy new furniture the next day, to “make sure it feels like a home.” Paterson says “the onus is on us to take care of the practical side of things, to help maintain the tenancy while they can focus specifically on recovery.”
This is helped by Housing First workers having far smaller caseloads than other comparative support services. Joanne Prestidge leads Homeless Link’s Housing First England programme which established a set of core principles Housing First services should follow. She says staff should only support a “maximum of seven clients at one time, with an optimum of five or six.” This allows them to give “very intensive, very personalised and very reactive support.” Prestidge says the relationship between the Housing First worker/workers and the client should develop before a property is found. Moving can be a stressful experience so “that trust has to be there.” Housing First, unlike the ‘staircase model’, also doesn’t require people to be abstinent before moving into their own tenancy. Prestidge says this is important as “expecting people to have to take away their coping mechanisms in order to get a house is often counterproductive.”
Angie says a lot of people have given up on her in the past, “they promise you the world but they don’t really do anything.” Although she “grew used to people letting me down”, it made her feel “angry all the time.” She initially thought the offer of a home and unconditional support was “bullshit”, but, over time, her and her support worker Lisa have developed a relationship to the point that she “can tell her almost anything.” She even plans to make her famous bolognese for the two of them one night. This kind of intensive support may seem expensive. But reducing people’s contact with emergency services and the criminal justice system means Housing First is actually much cheaper for the public purse in the long run. And research by Homeless Link found it’s also more cost effective than comparative homeless services such as hostels and temporary accommodation.
However, it’s not all fairy stories. Lyndsey arrives at work sleep deprived after receiving a call from one of her clients in the middle of the night, worried their friend had overdosed. Meanwhile, the vodka bottles huddled in the corner of Angie’s kitchen are a reminder that she’s still “struggling to deal with my past.” But there’s also evidence of the green shoots of change beginning to sprout. Dave Barrie is the service manager of Addaction Dundee. He believes stability allows people to “start to address some of the underlying issues in terms of trauma or loss which may have led to them using substances”, with the evidence showing a stable home and intensive support provides fertile ground for “the conditions of change.”
This is true for Angie who’s soon going into a local rehabilitation facility. She’s tried to access rehab before but was told she wasn’t “in the right frame of mind” when living in a hostel due to the drug use and violence going on around her. Barrie says services in Dundee “are starting to be more honest and admitting that homeless hostels aren’t a good environment for people to address their substance use. If you’ve got 20 people, the majority of which use alcohol or drugs and house them all together it’s not going to end well for a lot of people.” Hostels also have a strict no drugs policy which isn’t necessarily conducive to reducing harm. Paterson from Transform says Housing First is different, “we’re more open about it and say: if this is happening let us support you to do it safely.”
But Paterson also maintains Housing First is about more than just harm reduction. She says the small caseloads allow staff to help people build on their skills and “reduce social isolation.” Prestidge from Homeless Link says a big part of this is “actively encouraging people to identify their goals and where they see themselves in the future.”
Lisa and Angie have identified Angie tends to drink most when alone, so they’re working to get her out in the community more and make friends. They attend a women’s group together on a Thursday, while Angie also wants to get back into swimming. Meanwhile, Lyndsey is supporting a client who dreams of being a stand up comedian, so she’s booked him a slot at a comedy night early next year and is planning to help him with his material. And Daz hopes to get a dog when he moves in to his new flat because “dogs give that unconditional love. It will be nice to look after something instead of people looking after me.”
Barrie says Housing First is “a model of compassion and honesty” through “treating people with respect and not trying to force them into being something they’re not.’’ At its heart, it accepts some people have had tough lives and need support to live with dignity. As Paterson says, “We’ll be with you regardless. We don’t mind if you’ve got drunk or used drugs and if you get evicted we’ll find you a new tenancy. Our support isn’t conditional on anything. There’s no failure here.”
If you or someone you love needs help or support, reach out. You can chat to a trained advisor at addaction.org.uk.