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We can end homelessness

Providing a home and then addressing everything else: the ‘Housing First’ model

EPA
EPA
A homeless man in a street in Brussels, Belgium

In Belgium, as in many other countries in the world, highly vulnerable people have been wandering the streets and public spaces in a weak physical and mental state for years.

Most of these people visit facilities that attend to their primary needs (daytime care and night shelters, health and social services, meals) more or less regularly over many years. Other services offer various types of transitional housing, usually semi-collective, for a limited period and ‘prepare’ the client to live independently, with or without social support.

Despite all these services, many homeless people are unable to kick-start a pathway to integration. And the main reason for that is simply this: They are the most excluded from housing. For them, the specific conditions of access act as a brake to their progress.

As long as you have to survive on the street, getting off alcohol or drugs, following medical treatment, and defining your goals and plans remain secondary. If a homeless person visits an emergency social service more than five years in a row, one has to pause and ask whether that very assistance isn’t actually perpetuating their homelessness. You have to pause and wonder why public policies, instead of focussing on projects for sustainable integration, appear to rather support the emergency social care system and the ‘staircase model’, where a permanent home is only a ‘reward’ earned via positive behavioural changes.

Arguably, the problem of homelessness already has an effective solution. We just have to change the paradigm. First provide a home and then address everything else: it’s the ‘Housing First’ model.

Housing First: a quick way to get people off the street

Acknowledging housing and social security as fundamental rights, Housing First takes this particular target group off the street and imposes no condition besides those for ordinary tenants (pay the rent and respect the lease). There is no need to require anything more from a homeless person. Whether the person can cook or not, uses illegal substances or hears voices is none of the landlord’s business. In other words, not respecting the lease is the only cause for it to be terminated.

The beneficiaries use the income they are entitled to (an income substitute, usually a revenue granted through Belgium’s minimum income scheme administered by Public Social Welfare Centres) to pay the rent and commit to the terms of the lease.

The underlying goal is for the once homeless individual to become a citizen who can access all their rights.

Apart from agreeing to individual support, there are no additional obligations in relation to physical or mental health problems or those related to drug addiction. Access to housing is fully deinstitutionalised and standardised.

The model promotes housing as a social integration tool, but putting a roof on top of one‘s head is not enough. More needs to be done to deliver appropriate intensive multidisciplinary support services that focus on the priorities of the formerly homeless person – for as long as necessary. Housing First support is primarily concerned with stabilising the person: helping them to regain control of their life and mobilise their personal resources.

The underlying goal is for the once homeless individual to become a citizen who can access all their rights, including getting help from the traditional system of social assistance: someone who can contact their general practitioner when needed – or call on their own social network, for example.

The Belgian Housing First experiment

Three factors made it possible to implement this innovative method in Belgium: First, the political will to test an ambitious social experiment. Second, a significant financial support and, third, a partnership for sponsoring projects in the field.

Belgium’s Federal Public Service for Social Integration drew up a plan against poverty in 2012, which translated the political will into operational goals. The necessary funds came from the National Lottery, whose mission is to support social projects. Belgium’s governance culture of participation and dialogue with regard to fighting poverty made it possible for federal authorities to find partners who want to fight homelessness by voluntarily sharing their expertise. This is how ‘Housing First Belgium (HFB)’ came to life.  

From 2013 to 2016, multidisciplinary teams (nurse, psychologist, social worker, practitioner, expert in harm reduction, peer worker) supported more than 150 highly vulnerable homeless people to access housing and start a recovery process. Until now, in Belgium, no fewer than 400 homeless people were able to leave the street for good. Support teams intensively accompanied their clients in all aspects of their lives in rights-based and client-centred approach.

A high success rate

Importantly, the effectiveness of this social innovation (Housing First) was tested in comparison with a ‘control group’ representing the current public policy (staircase model). The results were striking.

After two years, 93 per cent of the formerly homeless people who had received accommodation and support from HFB were still in their own homes. This shows that they did not need to be ‘prepared’ to live in apartments: They pay their rent and have taken possession of their homes. Even active drug use, which can make living in your own home difficult, has not prevented the target group from remaining housed.

When it comes to fighting homelessness, local authorities make a lot of political decisions under pressure, and often feel neglected and left alone with their local realities.

In comparison, two years into the experiment, only 48 per cent of the homeless people in the traditional support system (the ‘control group’) had managed to access housing. The remainder were still homeless, either ‘unhoused’ (in hospitals or penitentiaries with no prospects for getting housing when they are released) or ‘poorly housed(in unhealthy or inadequate housing and subject to eviction).

Yet, Housing First is not for everyone everywhere. Appropriate, multidisciplinary and intensive support must remain a response to the greatest and most complex needs. Nevertheless, the fact that the group least able to access housing has demonstrated that it can go directly from the street to living independently in apartments forces us to reconsider current practices. We might make use of this housing-led paradigm to successfully fight homelessness.

A Cooperation Agreement on homelessness and the lack of housing, signed by Belgium’s federal government and the federal entities, promotes evidence-based policy. The experiment conducted in Belgium indicates clearly that Housing First is the most effective, efficient, sustainable and fair public policy for accommodating highly vulnerable homeless people in Belgium.

From the local to the European level

When it comes to fighting homelessness, local authorities make a lot of political decisions under pressure, and often feel neglected and left alone with their local realities. They have no global vision of this extremely mobile and complex phenomenon. Therefore, sectoral policies must be replaced by a multi-level approach.

A good example of multi-level governance is the recent methodology used by the Urban Agenda for the European Union which brings representatives of cities, regions, member states and European organisations together to discuss common challenges and find local solutions. The thematic partnership on urban poverty even made homelessness one of its priorities, as it is one of the most extreme and visible forms of poverty and social exclusion in (semi)urban contexts.

Local authorities are often on the front line caring for this group. The link between the local level and the European level may not always be obvious for field workers. But the partnership studying the issue believes that the European Union has a role to play in pushing members to achieve a clear and realistic goal: ending homelessness by 2030. This requires reforming social integration strategies by incorporating specific measures to end homelessness, including coordinated housing policies.

Although we have the tools, methods and evidence to be able to ensure this fundamental right for everyone, we continue to have to deal with fragmented competences, policies and administrative procedures. In 2007, the Leipzig Charter on Sustainable European Cities recognised this. Eleven years on, public authorities must finally begin to elaborate integrated public policies for combating homelessness ­– both vertically and horizontally.

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