Housing First, a widely promoted approach to ending homelessness, is based on the idea that people who are homeless cannot properly focus on sorting out their often complex lives unless they have a roof over their heads.
There has been a gradual world-wide acceptance of Housing First philosophy. Earlier, supports for the homeless, particularly those chronically homeless and living outdoors, leaned towards a “housing ready” grooming — helping them clean up their act and appearance so as to be acceptable to prospective landlords and maintain a successful tenancy.
“Housing ready” is a client centred approach starting with the premise that where people are staying is their home, regardless of whether it’s a luxury apartment, sidewalk or encampment. There is also a pragmatic element, driven by low vacancy rates and high rents. Simply getting access to support services, which have long waiting lists, is a big focus of support work.
“Housing First” is also client centred, building on the idea that people who are homeless want housing. Indeed, when asked, most people who are homeless do want housing. ‘Housing first’ also provides supports, focusing on the goal of getting housing. Once housed, follow up social and health supports are available for those who decide to focus on other issues in their lives, for example; treatment, training or employment.
Although there has been great success with Housing First, there are circumstances when there are no homes available, or when homeless individuals avoid or refuse housing for any of a number of different reasons.
So persuasive are the benefits of Housing First that it might be believed to be the only way of getting the chronically homeless off the streets.
However, a Dublin, Ireland hospital has been testing out the idea that there is an alternative that can be employed where housing is unavailable or Housing First isn’t an effective approach.
It seems that a team-based health intervention, with outreach to patients who are homeless can — before they are housed — both significantly improve both mental and physical health, help them overcome challenges in their lives and ease them towards permanent housing.
For more on an “inclusion health” experiment for the homeless at St. James’s Hospital, read in The Guardian: Inclusion health: an Irish answer to the homelessness crisis
