SCOTLAND can eradicate homelessness, according to the man who first developed a radical and much-celebrated housing solution that aims to get people off the streets and re-integrated into communities in homes of their own.
But it can only do so, claims Sam Tsemberis – the psychologist who founded the world’s first Housing First programme in New York – if there is sufficient political will, along with commitment to provide additional social housing, support services and funding to match.
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Tsemberis, founder and director of US-based Pathways to Housing, helped develop the ground-breaking approach, which worked with street homeless people who often had issues with mental illness and addiction, in New York in 1992.
The idea was born while he worked as part of a small team running a street-based “psychiatric emergency room” which saw 30-40 of the city’s most vulnerable every day. He witnessed how the revolving door of homelessness was failing people and decided a new approach – based on what homeless people themselves wanted – was needed.
He spoke exclusively to the Sunday National ahead of a Scottish conference on Housing First later this month, hosted in Edinburgh by the Glasgow Homeless Network. The organisation is co-ordinating Scotland’s plans to roll-out the Housing First Pathway project in Glasgow, Edinburgh, Dundee, Aberdeen and Stirling over the next two years.
The Housing First Pathway project aims to provide homes in social housing – along with tailored support packages – to 830 homeless people in that period, before aiming to scale up thereafter.
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The approach, first used by Tsemberis and his team and successfully replicated in cities around the world, is deceptively simple. The current system insists homeless people with complex needs undergo treatment for issues such as addiction and mental health difficulties before being judged “tenancy ready” and allowed to move on from hostels.
Housing First allocates a permanent flat immediately and puts the support in place around people.
In Scotland campaigners hope that it could be a game-changer, and say action has never been more important. Figures show homelessness rose slightly last year for the first time in almost a decade, with 34,972 homeless applications made between April 1, 2017, and March 31, 2018.
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Though the Scottish Government says it has delivered 56,000 homes for social rent since 2007, leading homeless charities point to a lack of housing, with some people – particularly in Glasgow – turned away by local authorities due to lack of availability of emergency accommodation. Others around Scotland spend months and years in temporary accommodation, including unsuitable and substandard B&Bs and hostels. The Housing First model, along with a policy of rapid re-housing, aims to challenge that and some argue it’s been a long time coming.
Tsemberis was involved in an earlier Scottish Housing First pilot set-up by charity Turning Point in Glasgow in 2010 and said he was delighted to see the approach finally take off in Scotland after “a very, very long pause”.
He added: “We have to celebrate the moment, because it’s a fantastic moment. This is a door opening.”
Funding of £10 million across Scotland is provided by the Scottish Government, Social Bite and Merchants House Glasgow, with local authorities looking for additional funding to continue work after the Pathway project is complete at the end of March 2021.
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He added: “The scaling part is going to require a different level of commitment in terms of government input, both in terms of the number of units they are going to allocate on the social housing side, and then on the support side.”
KEY to the belief that homelessness can be solved, he claimed, is the understanding of its roots in neoliberal policy rather than individual failings.
He said: “In the early days of homelessness there was a lot of questions about how we got here. In the US this happened when [President Ronald] Reagan basically cut the budget for building affordable housing in the early 1980s. Thatcher was hand-in-hand with Reagan.
“[At the time] we were distracted by the pain and the tragedy of seeing people on the street, often with mental illness. It was all about the individual, how did this person end up here? Because you can’t see policy – it’s creating disasters but it’s invisible.”
In response Tsemberis and his small team – a psychiatrist, a nurse and a social worker – drove around New York in a beat-up van, taking referrals to help those struggling to survive on the streets, hospitalising and even sectioning people when necessary.
“It was very intense,” he said. “We were using our clinical judgement and we would have a lot of disagreement even between the team. Often people were also medically sick – they were spitting up blood or there was pus oozing out from their shoe.”
As the years rolled on a pattern emerged that was impossible to ignore, with about half of the people he had hospitalised re-emerging on the streets.
“It was in the face of repeated failures that I realised that something else was needed, a different type of intervention,” he said.
“We decided to take a completely different approach, which was to work collaboratively with the people we were trying to help. And that’s how we got to Housing First.
“What they wanted was not a hospital, or a clinic, not a sandwich or another trip to the shelter. What they wanted desperately was a safe, secure place to live, like everybody else.”
Pathways to Housing rented 50 apartments across the city in that first year, and set people up with the support they needed including frequent home visits and help with everything from sorting out benefits to reconnecting with family and addressing long-standing health conditions.
And something extraordinary happened. They had hoped to match average housing retention rates – based on treatment then housing programmes – of 40%. At the end of the year 84% were still living in the apartments.
“We had been wrong,” Tsemberis said. “Wrong not only about the way we were treating people here but wrong about what people were capable of in terms of recovery and integration.”
Since then programmes have been developed around the rest of the US, in Canada, New Zealand, and Northern European countries including the UK, often with input from Tsemberis.
BACK in Scotland, the Housing First Pathway started officially in April, following a nine-month bedding in phase, and though numbers are still small they are growing, with targets to house 132 people in Edinburgh and 165 supported homes in Glasgow – as well as tens in the other cities – by the end of next April. Individual support packages, involving home visits and telephone contact, will be provided by Salvation Army case workers, who will help them connect with all the other services they need.
The Glasgow Homeless Network believes the political will is there – and the Scottish Government insist that ending street homelessness is a priority. Evidence indicates that in time there will be a public sector costs saving and the Glasgow Homeless Network argues it should free up resources rather than being a burden.
It also claims this will require parts of the current system to be decommissioned. Yet concerns have already been raised about how this can work in a country where accommodation is already in short supply.
Last week it was announced that Glasgow would lose almost 100 emergency and supported accommodation beds by October due to budget cuts, more than the number of Housing First flats – funded completely separately – due to come onstream in the period. Some insist both are needed, at least for now.
So what advice would Tsemberis give Scottish authorities at this juncture? For one, he says, there needs to be emergency accommodation on offer alongside Housing First – not everyone will fit the criteria of the programme.
Success is also dependent on more social housing and finding ways to forge a more equal society in which housing is a right, not a commodity. “What you notice when you look at levels of homelessness is the greater the income disparity, the greater the number who are homeless,” he said.
“Housing First has taught us one thing. It’s demonstrated we can house the people who have all kinds of issues, years of homelessness, poverty and mental health problems and disconnection from family.
“If we can house those individuals we can also house anyone – there is no excuse.’’
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