My ears pricked up when I first saw the invitation to tender for a research project exploring moving on from Housing First support. My initial reaction was - wouldn’t talking about ‘move on’ give completely the wrong impression and risk undoing all the hard work to explain and justify the key principle that flexible support will be provided ‘for as long as it is needed’? In a homelessness sector that is increasingly driven by time limits and judged by its ability to ‘move people on’, this felt like dangerous territory.
But, while ending someone’s support is not a goal of Housing First, there will be times when the person in question chooses to end their support, and of course this choice must be respected. At the same time, with the combined regional authority pilots and some of the Fulfilling Lives projects now contingency planning for funding sunsets, transitions out of Housing First are a hot topic.
Working together with Anita Birchall and Nicholas Pleace, our study found that the term ‘endings’ covers a wide variety of situations, with death being the main cause, followed by moves to long-term care facilities and people no longer wanting the support.
Death being the most common ending may initially be seen as a negative, but I was deeply moved by poignant descriptions of people being supported to end of life by their worker, people who were given the dignity of dying in their own homes. Many people who access Housing First have developed significant health issues due to years of social exclusion. While research has shown Housing First is an effective health intervention, for some, the damage of the past is too great.
Another finding from the research was that we encountered strikingly few cases in which Housing First support ended because people no longer needed it. In the few cases this did happen, individuals tended to be younger. As one respondent said:
“The longer the trauma, the harder it is for it to get to a stage where you won’t need support.... With younger people, there may be more opportunity for change”.
Often such ‘graduations’ or ‘move-ons’ were associated with people achieving social goals, such as forming new relationships, moving to a new area, re-connecting with children or progressing to become a peer mentor.
But the low number of graduations from support are an indication of the complex needs of the people who access Housing First, rather than a lack of effectiveness. For people who have experienced significant trauma, recovery is not linear, with support needs fluctuating. While, for some, due to the choice element at the heart of Housing First, recovery may not even be their goal. Additionally, many services reported that withdrawing support too quickly can trigger a crisis.
Most beneficiaries of Housing First value an elastic service offer which flexes up and down depending on their needs. But our study found that many projects have not formally defined what it means for support to end or transition in these circumstances. As one response makes clear, this proves an issue in terms of expanding the service:
“If we’re not going to close cases, we can’t keep on taking on referrals; otherwise, we’re going to go well over the caseload limit.”
Some services have developed policies such as having staff who float to help deal with rising and falling demand. Others utilise peer support workers or multi-agency panels to lever in support from wider systems.
The focus of Housing First services should be on helping people to build their confidence and their social capital on their own terms and at their own pace. But it’s clear that, as a sector, we need to talk more about how we plan for and deliver an elastic service, with supported transitions and endings where that works best for individuals. As one survey respondent said:
"There is a difference between saying ‘you might not need us in the future’ and saying ‘we might not be here for you in the future.”