The trauma of long-term homelessness, poverty and social exclusion means a small but significant cohort of people see their needs consistently unmet by traditional homelessness services. These individuals typically have significantly worse physical and mental health compared to both the general public and other people experiencing homelessness. This is exacerbated by the cycles of rough sleeping, temporary accommodation, prison stays and hospital admissions that often mark their lives.
Over the last decade, Housing First has had a growing presence, helping to break cycles of homelessness and acting as a transformative, even lifesaving intervention for this population.
Even though homelessness is only one of multiple support needs faced by people accessing Housing First, the conversation surrounding it, still firmly sits within the homelessness sector. Through our new research, More Than a Roof, Homeless Link wanted to explore holistic Housing First outcomes to better understand impacts across health, social care, criminal justice and beyond, and what this means for how we think about the intervention.
The findings are based on a range of sources including a survey of Housing First providers representing 934 residents, and peer research carried out with people with lived experience of Housing First. The survey investigates outcomes over a three-year period, looking at the length of time needed to achieve positive change.
So what did we find out? In line with existing international evidence, the overarching finding is that Housing First works – not just in helping individuals to sustain their tenancies, but also to improve physical and mental health, reduce offending behaviour, and limit emergency services use.
After three years, 39% of Housing First residents had improved physical health, and 55% improved mental health. This coincides with a decrease in A&E use from an average of 59% of residents in the first six months, down to 38% by their third year of engagement, and a drop from 38% of residents being admitted to hospital to 18% after three years. Alongside this, there is a shift from emergency healthcare usage to engaging with preventative healthcare, whether that’s GPs (engagement increased from 50% to 89%), mental health support (from 23% to 32%), or drug and alcohol services (48% to 60%).
“Last time I was in the hospital was like, four years ago. So that’s quite a long time now I haven’t been in hospital.”
“I was a heroin addict before I moved in here. I’ve been clean, 3 or 4 years with me methadone. It’s the support I’ve had that’s kept me away from that.”
These improvements to health and engagement with appropriate health services have significant consequences. Safeguarding concerns including risk of suicide and self-harm dropped from 50% of all Housing First residents to 32% over three years. We know that sadly attempted suicide and self-harm is a leading cause of A&E, ambulance, and hospital admissions among people experiencing homelessness.i
Our research also revealed extremely positive evidence on the interaction between Housing First and offending behaviour. At the point of entry into Housing First on average 84% of residents were engaged in antisocial or offending behaviour, but by the end of the third year this had dropped to 45%. Consequently, there is a massive reduction in engagement with the criminal justice system, from 71% to 39%.
If I got locked up, because my life was already at the bottom of the heap. Well, now I’ve came so far that if I was to get locked up again, I’d have to come and start from the bottom again. And nobody got time for that.
Housing First is about more than reducing impact on public services, it is about helping people with histories of complex trauma and instability to build a sense of agency and self-worth. Our research shows that only 9% of residents said they had hobbies or interests at the point of entry compared to 37% after three years of engagement, while the number of people reporting positive social networks more than doubled. The recovery effect of Housing First support goes well beyond the physical – with residents showing emotional recovery, increased resilience and an improved quality of life.
But Housing First is not without challenges. The research finds that while its success is predicated on long-term, open-ended support, short-term funding windows mean many projects are unable to guarantee support more than a year or two in advance. Similarly, existing funding often comes with unrealistic expectations around staffing, caseloads, outcomes and throughput that fail to consider the intensity of support that this cohort can require. National constraints on affordable and social housing supply also threatens the success of Housing First in England.
Alongside our research, a recent DLUHC published evaluation looking at the Housing First pilots’ 12-month outcomes evidenced statistically significant improvements across a wide range of similar outcome measures. Together they show that Housing First works, not just as a homelessness intervention, but also as a significant support to health and social care, and criminal justice services.
In that context, other government departments such as Department for Health and Social Care and Ministry of Justice should be stepping up to play their part in the rollout of a national Housing First programme so that it is available for each of the estimated 16,450 people with the most intense support needs across England.
