I would like to thank my dissertation tutor Liz Fern for her support and guidance. I would also like to thank the University for accepting me on to the Social Work course and to all the tutors for preparing me with the lifelong skills which have enabled me to continue my journey to becoming a Social Worker.
I would like to thank my fellow students whom I could now call most friends for life, your knowledge and passion has been inspiring and I wish you all the best of luck in your future endeavours.
I would like to thank my family for all the love, support and encouragement I have received since I started my return to education 5 years ago, this journey would not have been possible without you all.
But my biggest thank you is for my little best mate, my daughter Darcie, you are my inspiration, I strive to achieve to provide you with all the world can offer. Thank you for being on this journey with me, you have watched your mummy sit in front of a computer for 5 long years, I will be forever thankful for your love, patience and support, I love you the mostest, Darcie Cox.
Table of contents
Abstract. 4
Chapter One - Introduction. 5
1.1 Background information. 6
1.2 Research focus. 7
1.3 Objectives of research. 8
Chapter Two – Methodology. 9
2.1 Research design and data collection. 10
Chapter Three - Literature review.. 11
3.1 Understanding the concept of homelessness. 12
3.2 Statistics of homelessness in the UK.. 13
3.3 Factors of homelessness. 15
3.4 Typologies of homelessness in the UK.. 16
3.5 Homelessness policies in the UK.. 18
3.6 Interventions for Homelessness. 21
3.6.1 Treatment First 21
3.6.2 Housing First 22
3.7 Services/programs to address homelessness. 22
3.7.1 Linear housing models. 22
3.7.2 Non-linear model 25
3.7.3 The Housing First model 26
3.8 UK’s approach to homelessness. 27
3.9 Housing First case studies. 29
3.9.1 Housing First Glasgow, Scotland. 29
3.9.2 Housing First Toronto, Canada. 33
3.10 The Impact of auserity on houisng provisions in the UK.. 35
3.11 Conclusion of literature review.. 36
Chapter Four: Conclusion. 37
4.1 Summary of findings. 38
4.2 Implications of research on UK housing services. 39
Abstract
Homelessness is a key social issue in the UK which has seen a large portion of the poor and vulnerable population living on the streets. Scholars, researchers, and policymakers have come up with various interventions to address the problem. The commonly applied homelessness interventions are the Treatment First and the Housing First approaches. In the UK, the government together with the social service networks have implemented the Treatment First initiatives over the years which have proven to be fruitful. However, many users of the programs have found themselves living back on the streets after being unable to achieve housing readiness or to maintain a housing tenancy. The Housing First strategy has, thus, been recommended by various literature. It relies on the ideology that every individual has the right to housing, and that providing shelter first would be more effective towards tackling personal problems such as substance misuse and mental health issues creating a more successful and stable reintegration into society. The approach was first introduced in the U.S and since then has been implemented by various countries including Canada, Italy, and Scotland. This study reviews different kinds of literature which discuss the Housing First and Treatment first intervention and their effectiveness in addressing long-term homelessness.
Keywords: Homelessness, Homeless, Housing First, Policies, Housing strategies.
Chapter one: Introduction
1.1 Background information
The existing social relationships and social policy structure can influence life in a critical manner. The effects of marginalisation, social inequality, and isolation are visible in everyday experience. One of the most noted forms of marginalisation is homelessness which consists of the most challenging social problems which can be problematic in addressing (Benjaminsen and Dyb 2010, p.33). Within the last fifteen years, the number of people living on the streets has continued to rise with the phenomenon accompanied by relationship breakdowns, poor mental health, substance abuse, redundancy, and domestic abuse (Brousse 2009). Many countries across the world have adopted diverse methods and approaches to address the issue of homelessness; each of them has always relied on theoretical contexts and understanding of the causes of homelessness (Department of work and pensions 2010, p. 2). As a result, a variety of social policies as well as support services has emerged.
In the United Kingdom, the guiding principles adopted by social workers and agencies in the provision of housing needs for the homeless include equity of access, health support, community care, and inclusiveness and to challenge social injustices as underpinned in social work values and ethics. The recovery approach has become a relevant cornerstone of the vision of social change. The approach in homelessness context reflects the belief that social workers and support workers can help individuals improve their lifestyles, recover their self-esteem, and experience a sense of participation and belonging within society (Benjaminsen and Dyb 2010). Accompanied by the difficulty of securing employment and limited access to housing indicates a persistent barrier to social and mental health experienced by many people in the UK (Department of Health and Children 2006). Amidst the challenges, however, the UK Government, social workers and housing organisations have continued to work together to ensure that service users get access to housing which is appropriate to their needs.
1.2 Research focus
Many researchers have attempted to understanding of homelessness phenomenon since it has been proven that although the majority of homeless individuals remain without shelter for a short period of time, many return to the streets more often (Busch-Geertsema et al. 2010). This has therefore raised the question of what policies and service provision can guarantee a successful return to a normative life after homelessness. Having worked within the housing sector under a traditional dominant approach which involves a step by step exit accompanied by strict regulations and measures. From my experience and interactions with the service users, I have observed that the process can be an insufficient pathway and can be structurally oppressive. For this reason, I wanted to examine from my own professional experience of the housing sector alternative strategies for effective re-integration of homeless people into society. Therefore, for this study, I have chosen to investigate the “Housing First” approach as according to Padgett, Henwood and Tsemberis (2016) this has become of interest to many policymakers and scholars as it prioritizes the principle of the ‘right to housing’ first rather than the traditional linear step by step ‘housing readiness’ approach. Although it is a new concept, there is evidence to suggest that the ‘housing first’ approach is successful in addressing homelessness, therefore, this study will be reporting on the effectiveness of ‘Housing First’ in addressing the issue of homelessness in the UK.
Researching the effectiveness of the Housing First model in the UK could be important for various reasons. First, the country’s homelessness statistics indicate that a large number of people are still sleeping rough on the streets which means that the current approach adopted by homelessness services is not effective enough. Secondly, the model has been found to be effective in other countries, particularly in the US and Italy; by understanding the implementation process, the UK could adopt the approach to solve its current inadequate housing situation. Decision making among the homeless needs to be just as informed; this study provides an understanding of the service users’ perception of housing models adopted to enhance the benefits to both the UK government and the residents.
1.3 Objectives of research
To address the aim of the study, the key objectives formulated include:
A. To investigate the factors that lead to homelessness in the UK
B. To understand the current model adopted by the UK to address homelessness
C. To understand the relationship between homelessness, socio-economic deprivation, and health
D. To assess the effectiveness of Housing First Model in integrating homeless people back to the society by social services.
Chapter Two: Methodology
2.1 Research design and data collection
This study deployed a deductive research approach as it involves the examination and review of theoretical concepts through the use of different processes. Kovacs and Spens (2005) considered a deductive approach as the most suitable study method for social related subjects such as housing and homelessness. For this study, the deductive method was used to assess the applicability and impact of housing first approach to addressing homelessness in the UK. To obtain insight into the research question, this study examined the existing literature on homelessness in the UK and how the Housing First model can be implemented by housing organisations in collaboration with support services to address the issue of homelessness. The research design used to gather information was a qualitative method which involves the reviewing of existing literature on a particular research topic. By consulting various journals and articles available online, this study was able to address the key issues concerning homelessness.
During data collection, the study identified various resources from key electronic databases. These included Eric, PsycARTICLES, PsycINFO, Google Scholar, and Elsevier. While conducting the search, the keywords that were keyed in the databases included: (a) homelessness OR chronic homelessness OR sporadic homelessness AND (b) social welfare OR social policy AND (c) housing first model OR staircase and elevator models of housing. The study found more than 450 articles in the first search forcing the research to consider inclusion and exclusion criteria that would help screen out the resources. First, the resources were restricted to the UK, Europe and the United States. The articles were also to be current with the oldest being 15 years. All the journals were also supposed to be peer-reviewed, and all address the concept of homelessness and housing first model. Eventually, the research selected thirty-five sources for further analysis.
Chapter Three: Literature review
In this section, the study will address the research objectives by first defining the key concept of ‘homelessness’ from both the international and the UK perspective. The chapter then reviews the statistics and factors of homelessness in the country, followed by the impact of austerity on the existing homelessness. In the later sections, the chapter reviews different types of homelessness and the legislative framework pertaining homelessness in the UK. The chapter further investigates two key interventions to homelessness i.e. housing first and treatment first models and the current intervention adopted by the UK. It concludes by illustrative two case studies, Canada and Scotland, which have successfully implemented housing first model.
3.1 Understanding the concept of homelessness
Studies on homelessness have revealed a variety of definitions and explanations of the concept. Some researchers relate homelessness to lack of a permeant residence, whilst others continue to interpret it by linking lack of housing with socio-economic factors including relationship breakdown, unemployment, addiction, and mental health (FEANTSA 2008). The term “homelessness” is a widely defined concept within literature with various countries and organisations having their own interpretations. The UK government defines ‘homelessness’ as being in the state of ‘sleeping rough.’ This definition does, however, encompass a ‘statutorily homeless’ section to include households that meet a particular criteria of legislative priority needs due to the fact that are at risk of losing their current accommodation. This priority needs group as stated by the government involves households having dependent children or vulnerable people with physical or mental disability as well as pregnant women. The Housing Act 1996 extends this category to include: persons aged 16 and below; 18 to 20 year olds who are still under the care of the local authority and who are deemed vulnerable due to time spent in care or custody (Gov.uk, 2018). Alternatively, Section 330 of the Public Health Service Act of the United States, for instance, defines homeless people as “individuals who lack housing, including those whose primary residences are supervised public facilities (shelters) that offer temporary living accommodation” (Busch-Geertsema et al. 2010, p. 10). This definition considers a homeless person to lack housing experience or social status, thus, making it narrow in scope.
Homelessness is also defined by the Bureau of Primary Health Care as “the lack of permanent housing in which individuals are forced to live on the streets, stay in a mission, shelter, or single room facilities, vehicles, or abandoned buildings or in a non-permanent situation” (FEANTSA 2012 p. 3). The Habitat international considers housing not only as a basic human right but also as an adequate foundation from which other human needs such as the development of social relationships and engagement in community activities is promoted (Tosi, 2005).
On the other hand, there are studies that attempt to explain homelessness beyond the scope of rooflessness and consider the phenomenon a result of vulnerability and social instability experienced in the post-Fordism society. The approach introduces a key dimension of heterogeneity of homelessness by considering social exclusion as a determinant of lack of shelter. Thus, homelessness is considered an extreme component of marginalisation accompanied by high levels of poverty (FEANTSA 2012 p. 5). The literature reviewed has assigned the concept homelessness as a complex phenomenon that relates to housing dimensions, duration of homelessness, and routes away from the situation.
3.2 Statistics of homelessness in the UK
In the United Kingdom, the Department for Communities and Local Government (DCLG) has the role of publishing three different sets of homelessness data: statutory homelessness, relief and prevention, and rough sleeping data. Gov.uk report of 2017 revealed that between July and 30th September 2017, there were 29,340 applications for housing assistance (Gov.uk 2018). Out of this number, 15,290 households indicated that they were owed the main homeless duty. In London, there was a rise in those who demanded homelessness duty from 4,390 in 2015 to 4,940 (Ibid). Data on relief and prevention efforts by the local authorities are also in the statistical records of homelessness. Relief
refers to the situation in which the authorities have found difficulty preventing cases of homelessness but are helping individuals to secure accommodation even if it is not its legal obligation to do so. Prevention, on the other hand, involves helping people the local authorities and councils to avoid homelessness by considering measures that would aid in securing alternative homes or forms of accommodation. In 2017, an estimated 212,680 homelessness cases were either prevented from or offered relief in England. Out of these, 198,000 were preventions while the remaining number were relief (Ibid). The number of temporary accommodation cases was also noted to rise in England from 35,850 in 2011 to 54,280 in 2017.
DCLG also provides homelessness statistics of rough sleeping. These counts and estimates represent the total number of individuals sleeping rough in the areas of local authorities. Considering this data, there were estimated 4,751 cases in England in the 2017 autumn which was an increase by 15% from the previous year’s records of 4,134 cases (Ministry of Housing, Communities and Local Government 2018, p. 3). Out of this number, 1,137 rough sleepers were from London; this was 24% of the total number of England; this was an increase by 10% compared to the 2016 figure of 964 (Ministry of Housing, Communities and Local Government 2018, p. 4). In 2017, the London rough sleepers’ population accounted for a total of 24% of England’s rough sleepers’ population; this was low compared to the 26% and 25% in 2015 and 2016 respectively. In Scotland, the number of homelessness identified by the department was 28,346 households in 2017 (Ministry of Housing, Communities and Local Government 2018, p. 4). The rising cases of homelessness are associated with various factors including household disputes, forced to leave accommodation, landlord or lender pressure, harassment, and discharge from prison or hospital.
3.3 Factors of homelessness
The notion held about homelessness has changed over time due to the various factors causing the phenomenon. Since the 1970s, homelessness has always been understood as a distinct process from the wide social context. Many researchers always focus on the characteristics and needs of the homeless people and try to explain the phenomenon through an individualistic context. However, the rising number of homeless people in the 1980s resulted in the highlights of the weaknesses of this approach to address the problem. As noted by Archard (1979) (in Busch-Geertsema, Edgar, O’Sullivan, and Pleace 2010, p. 10), the contemporary studies on the homeless instead of homelessness. They concentrate on the individual rather than the social and political dimensions of the issues. Most significantly, the existing relationship between the homeless, the social and economic structures, and the reaction of the society is lacking in the current research.
At first, the concept of homelessness had been interpreted by scholars through an “individualistic” perspective which considers the personalities of homeless people to be defective, weak and characterised by high life crisis levels. The individualistic approach also associates homelessness with increased personal-social problems including alcoholism, mental disorders, and criminality combined with low social support from the community (Anderson 2010, p.49). Other researchers, however, focused on a more “structural” understanding of the phenomenon. This approach burgeoned in the 1990s and considered major social issues such as unemployment to be the cause of the phenomenon (Morse 1992). Since the start of the 21st century, the discussion on the notion and definition of homelessness regarding the two factors has been extensive. Researchers and scholars consider the structural reasons for homelessness a key factor, finding the linkage between the increasing phenomenon and social ills such as poverty and unemployment.
“Structural” factors are observed by scholars to offer a broad understanding of homelessness. For example, Marsh and Kennet (1999) (in Mylona, p.12) introduced the term “new homelessness” which rapidly became popular. It specifically refers to the type of homelessness caused by an end to employment, erosion of social welfare, and the marketisation of the state of welfare. This form of homelessness has been observed in Greece during the 2008 economic crisis in which people who had been in the past employed with high degree in education and skills (Boyd, 2012). Majority of the “new homeless” includes older people who lost their jobs right before they retired and have the difficulty of getting new employment.
The causes of homelessness had been summarised by Martha Burt (2002) (in Mylona 2016, p.16) who gave an interpretation of the combined structural and individualistic dimension. She stated that the two factors have been acknowledged widely to cause homelessness. The structural factors are always accompanied by societal changes and trends affecting a wider population including loss of employment or changes in the housing markets. The individual factors affect particular individuals which encompass addiction, illnesses and destitution. Regardless of the varying emphasis created on the structural and individual causes of homelessness, considering the structural causes individually is not adequate in explaining why some households that found themselves exposed to poverty, unemployment, and cutbacks became homeless while others did not. As such, researchers consider homelessness to result from a complex interaction between structural and individual events which eventually causes “new orthodoxy” in exploring and measuring the contributing factors of homelessness (Busch-Geertsema et al. 2010, p. 19). The new orthodox approach combines the two factors of homelessness.
3.4 Typologies of homelessness in the UK
The socio-economic contexts and housing policies in the UK and Europe, in general, are actually different from those in the United States. The European Federation of National Organisation Working with the Homeless (FEANTSA) came up with a detailed typology of homelessness which was named ETHOS. It explains the homelessness in the UK as it encompasses the understanding of homelessness based on housing and individual conditions. This typology is divided into 4 categories: roofless, houseless, insecurity, and inadequacy.
The time period of homelessness has also been considered in identifying different types of homelessness. In the UK, the length of homelessness has received great attention due to the fact that time variable shows the needs and heterogeneity of the phenomenon. Busch-Geertsems, Edgar, O’Sullivan and Pleace (2010) found that various homeless people lack shelter only for a short period of time while many of them get out of the situation easily. Mylona (2016, p.7) explained that homelessness is not a chronic condition, but a dynamic state that people can enter and exit repeatedly over time. Hence, considering the timing aspect of the phenomenon, researchers group homeless people in 3 categories: transitional, sporadic, and chronic.
Transitional homelessness refers to the situation in which homeless people use emergency accommodation over a short period of time i.e. temporary homelessness. According to Kuhn and Metraux (2008) (in Mylona 2016), this category represents 80% of the total people in temporary homelessness. The group is also characterised by shorter stays as well as few social issues such as addiction and mental health. People matching this description find themselves in a shelter because of unemployment, natural disasters, or separation. Evidence suggests that this group always exit the state of homelessness by self-struggle, but due to their low income they still suffer from housing exclusion.
Also known as cyclical, sporadic homelessness refers to those who find themselves lacking shelter after having been housed in an emergency shelter, and who then repeatedly go back to the shelter. They constitute 10% of the shelter population and always vary in age (Kirsch and Wellesley, 2009 p. 3). The group is also characterised by concurrent issues of mental health and addictions as well chronic unemployment rate. Culhane (2008) suggested that in some cases, this group of people do not reach the chronic state due to long time they spend in institutions such as hospitals, prisons, and treatment programs.
According to FEANTSA (2008, p. 1), chronic homelessness involves people who live in the emergency shelters for a long period of time. They also account for 10% of the shelter population and consume half of the day in the shelter. The majority of chronically homeless people are always older and stay in the shelters longer than those in the transitional and cyclic groups. They are also associated with mental issues, disability, addictions, and mental health issues.
3.5 Homelessness policies in the UK
In the UK, various integrated strategies have been developed to provide long and medium-term frameworks to aid in the development and implementation of policies that aim at “gradually” reducing homelessness. According to FEANTSA (2012), such strategies are different from “managing” strategies that do not offer a long-term framework to end the phenomenon. The UK relies on 10 elements that are found in the homelessness policies to aid in an integrated approach. These include:
An evidence-based approach to get a clear understanding of the homelessness problem
A comprehensive approach which ensures that policies on resettlement of the homeless people and adoption emergency services
Multi-dimensional approach—the policies must consider multi-dimensional facets of tackling the problem
Right-based approach— social workers must adopt policies that recognize and promote access to basic needs including stable, decent housing, food, and clothing
Participatory approach—there is a need for all participants to address homelessness including the local community, the government, social workers, treatment intervention programs, healthcare providers, financial institutions.
Statutory approach—involves recognition of legislation in underpinning the strategies of homelessness
Sustainable approach—there is need to consider political commitment, public support, and adequate funding
Need-based approach—the interventions must be based on the principle that there is need to address the existing needs of victims
Pragmatic approach—the policies must have realistic and clear, achievable objectives
The efficiency of the strategies depends on the multi-dimensional approach to solving homelessness in which different stakeholders, actors, and administrations have clear roles in regard to their field of interventions. It is also necessary that all level of political structure is included in the successful strategies implemented to ensure that there is high sufficient interaction among all levels of governance. FEANTSA (2012) highlighted that adequate funding is needed for long-term intervention towards homelessness. The social policies of countries like Spain, Portugal, and Greece have always been affected by the economic crisis which acts as a barrier to addressing homelessness.
Various legislations have been adopted by the UK countries to address the issue of homelessness. These include:
The Housing Act 1996
The primary legislation that has been adopted in the UK to control the risks of homelessness is Part 7 of the Housing Act. In section 189 of the Act, the government highlights the categories of homeless individuals, known as “priority need” who are supposed to be offered accommodation (Ministery of housing, communities and local government, 2018). These include: people who are homeless as a resulting of emergencies like flood or hurricane; individuals having dependent children, but are unable to afford housing for all of them; those with vulnerabilities such as mental illness, handicap, or physical disability; pregnant mothers; 16-17-year-old’s care leavers who are vulnerable or 18-20 year old’s or former prisoners or former armed forces members; and those vulnerable from fleeing violence (Ibid). Through the Act, the government is able to prioritise those in need of home provision depending on their vulnerabilities. (Housing Act 1996)
Homelessness Act 2002
This legislation offers the amendments to the Housing Act of 1996 and gives the local housing authorities the role of protecting the homeless and providing homes to those in need. The main aim of the Act was to ensure that an integrated approach was used to tackle and prevent homelessness, and in particular, ensure every district authority had an effective homelessness strategy. The Act strengthened the assistance that could be offered to the vulnerable or threated “priority needs” as highlighted in the 1996 Act. In England, the government implements the Act together with the Homelessness (Priority Need for Accommodation Order of 2002) whose article 2 highlights the provision for the “priority need”. (Homelessness Act 2002)
Homelessness Reduction Act 2017
This Act is to be enacted in the UK in April this year. It modifies and extends the protection and prevention of homelessness in various ways. First, the Act aims at improving advice and information regarding homelessness and its prevention. Under the Act, all individuals in the housing authority district should access free advice and information regarding prevention of homelessness; securing accommodation by the homeless; the role of authorities and the right of the homeless people; how the homeless can access help; and available help from the social services or local authorities. The Act will also extend the period at which the homeless are threatened. The current legislation considers applicants threatened only if they are likely to become homeless within 28 years. However, the new Act will extend this period to 56 days; this will encourage the social services and housing authorities to proactively and quickly act towards addressing homelessness.
The Act will also encourage the public bodies in the UK to work collaboratively to relieve the homeless through the refer duty. Under the Act, UK public bodies will have the duty to refer homelessness cases to the housing authorities. The duty permits the entities to offer an impetus for arranging referrals and developing accommodation pathways which provide support to prevent homelessness. Furthermore, under the Act, the local authorities will perform assessments together with the homeless applicants and develop a personalised housing plan. The assessment will include the reasons for homelessness or threats; the type o housing the applicant needs; and whether the applicant requires support to get and keep accommodation. (Homelessness Reduction Act 2017)
3.6 Interventions for Homelessness
Over the years, various models of homelessness intervention approaches have been proposed. Amidst the models having the same goal of transitioning into society, different theoretical frameworks have been used to implement the strategies. The current models that are commonly used to address homelessness include Treatment First and Housing First.
3.6.1 Treatment First
The Treatment First (TF) model asserts that it is healthier for individuals to progress through different stages to get prepared for “housing readiness.” These stages include sobriety period, development of key life skills, and psychiatric treatments necessary to achieve life independence (Greenwood et al. 2005, p. 33). The model considers permanent housing an end goal that must be achieved through the accomplishment of particular tasks instead of considering it as a first priority. The TF model provides short-term accommodation to the clients while they progress through different stages of housing readiness. The clients are expected to prove that they are able to live autonomously through the stages. TF model often employs a case management or intensive case management interventions transform the lives of the homeless. In this intervention, the managers uphold strict rules which must be adhered to by the clients while moving services along a continuum. According to Henwood and Padgett (2011), the approach is, however, most effective with female clients than male clients and is often associated with consumer disengagement due to the strict program rules put in place.
3.6.2 Housing First
The Housing First (HF) model was developed in 1992 through the Pathway of Housing program to meet the needs of the chronically homeless. According to Tsemberis et al. (2004), the tenets of the model are that the main priority for homelessness is housing, and as such the services should not be contingent on psychiatric treatment or sobriety. The main ideologies of the model include self-control, autonomy, and consumer satisfaction. Thus, its main aim is to offer to house solely by providing rent to the consumers and meeting them on regular basis (Padgett, Henwood and Tsemberis, 2011). The model is also congruent with the structural component of homelessness. Although services such as mental health and addiction programs may be offered, the attendance of the consumers is not mandatory. HF model is often implemented through Assertive Community Teams intervention. This intervention focuses on mental illness, integration an interdisciplinary team which may include nurses, social
