Challenges in Implementing Housing First in Ireland – Dr Eoin O'Sullivan


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Challenges in Implementing Housing First in Ireland – Dr Eoin O'Sullivan
Presentation delivered at the Housing First conference organised by Athlone Institute of Technology and Midlands Simon on 30 September 2013

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Challenges in Implementing Housing First in Ireland – Dr Eoin O'Sullivan

  1. 1. Eoin O’Sullivan, School of Social Work and Social Policy, Trinity College Dublin Challenges in Implementing Housing First in Ireland
  2. 2. EUROPE 2020 STRATEGY Europe 2020 is the EU's growth strategy for the coming decade….EU to become a smart,sustainable and inclusive economy.These three mutually reinforcing priorities should help the EU and the Member States deliver high levels of employment,productivity and social cohesion….the Union has set five ambitious objectives - on employment, innovation,education,social inclusion and climate/energy - to be reached by 2020. A key initiative of the 2020 strategy is the European Platform against poverty and social exclusion, which sets out actions to reach the EU target of reducing poverty and social exclusion by at least 20 million by 2020. The Commission aims to “identify methods and means to best continue the work initiated on homelessness and housing exclusion,taking into account the outcome of the consensus conference of December 2010.” The European Consensus Conference on Homelessness, a Belgian Presidency initiative, with FEANTSA, has helped lay the foundation for a possible EU strategy on Homelessness.
  3. 3. THE EUROPEAN CONSENSUS CONFERENCE ON HOMELESSNESS On the basis of expert evidence, an independent jury drew conclusions on key questions concerning homeless policies. The Jury stated that homelessness violates the fundamental human rights and ongoing prevention in the national and regional context should be secured; that a major shift from shelters and transitional accommodation to ’housing led’approaches is needed as a sustainable solution; that homeless people should be empowered to participate in decision-making related to their issues, and to fight a usual view of homeless people as passive recipients of help; called for an integrated approach to migrants and EU citizens facing homelessness as a result of access barriers relating to legal or administrative status.
  4. 4. Roundtable meeting of Ministers with Responsibility for Homelessness, Leuven, Belgium, 2013 The meeting agreed six principles that should inform homelessness policy across Europe.These principles are: Principle 1 (Develop and Share Knowledge and Best Practice) Recognition of need to develop and share knowledge about homelessness so as to greatly improve the quality of homelessness responses at a national, regional, and local level. Principle 2 (Core Elements for Response) Acknowledge that housing-led approaches to homelessness which prioritise access to affordable,long-term stable housing solutions,are one of the most effective responses to homelessness. Also acknowledged that prevention is crucial. Principle 3 (Funding) An adequate level of funding to confront homelessness and enable continuous,high-quality provision of services, involving private investors, partnerships and collaborative approaches, if possible, should be provided. Better utilisation of EU financing instruments to combat homelessness should be encouraged. Principle 4 (Common Reference Framework) A comprehensive reference framework for homelessness can improve the capacity for data collection, comparison and analysis Principle 5 (Research,Innovation and Data Collection) A better understanding of the homelessness phenomenon would result in improved, evidence-based policies and enhanced responses to homelessness. Research and ongoing development of knowledge, and innovative approaches to the problem are required. Principle 6 (Implementation and Monitoring) The development and implementation of national homelessness plans should be monitored and advice and expertise should be made available where required.
  5. 5. Programme for Government 2011  “In line with our Comprehensive Spending Review, we will alleviate the problem of long term homelessness by introducing a ‘housing first’ approach to accommodating homeless people.  In this way we will be able to offer homeless people suitable, long term housing in the first instance and radically reduce the use of hostel accommodation and the associated costs for the Exchequer.”
  6. 6. Homelessness Policy Statement The Government’s policy on homelessness places the rapid provision of appropriate accommodation, with support as needed to ensure sustainable tenancies, as the key solution to ending homelessness. A housing-led approach is about accessing permanent housing as the primary response to all forms of homelessness. In the Irish context, housing-led is about the rapid provision of secure housing, with support as needed to ensure sustainable tenancies.
  7. 7. The Extent of Housing Led Policies and Practices in Europe  Housing Led with Support the dominant model  Housing Led Strategy adopted, but not a mainstream operational reality  Supported Housing widespread, but a staircase model remains central w Housing Led Strategies not widely adopted
  8. 8. Strategies to Tackle Homelessness in Europe  National Level Integrated Strategies  Regional Level Integrated Strategies w Integrated Strategies not widely adopted
  9. 9. Challenges in Implementing Housing First in Ireland  Does Housing First work?  Does the extent and nature of homelessness in Ireland militate against HF working?  Are we spending enough on homelessness services?  Do Shelters Work?  Homelessness and ideology in Ireland
  10. 10. Recent Research on Housing First “Despite multiple health and social challenges faced by homeless individuals with mental illness,HF in both scattered- site and congregate models results in significantly greater perceived QoL as compared to individuals who do not receive HF even after a relatively short period of time.” Patterson M. et al. (2013) Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Soc Psychiatry Psychiatr Epidemiol. 2013 Aug;48(8):1245-59. “The majority of the sample was involved with the justice system,with a mean of 8.07 convictions per person in the ten years prior to recruitment.The most common category of crime was "property offences”.Following randomization,the scattered site HF condition was associated with significantly lower numbers of sentences than treatment as usual.Congregate HF was associated with a marginally significant reduction in sentences compared to treatment as usual.” Somers, et al, (2013) Housing First Reduces Re-offending among Formerly Homeless Adults with Mental Disorders: Results of a Randomized Controlled Trial. PLoS One. 2013 Sep 4;8(9)
  11. 11.  “…there is now simply too much evidence that Housing First services,with shared operating principles,are effective in a range of contexts and different countries for this critique to really be taken seriously.….Housing First consistently ends homelessness at a high rate and this means it has to be given serious consideration as a core strategy to reduce chronic homelessness across the EU.” Pleace, N. and J. Bretherton (2013)The Case for Housing First in the European Union:A Critical Evaluation of Concerns about Effectiveness, European Journal of Homelessness, 7(2).  “..the data confirmed a number of studies in the US and elsewhere that the Housing First approach facilitates high rates of housing retention and that it is possible to house homeless persons even with the most complex support needs in independent,scattered housing.This is even more remarkable as the four successful test sites evaluated in the framework of HFE show some substantial differences concerning the target group,the type of housing and the organisa- tion of services,but share most of the principles of the Housing First approach.” Busch-Geertsema,V. (2013) Housing First Europe. (Bremen: GISS).
  12. 12. The Extent and Nature of Homelessness in Ireland
  13. 13. 1985 1986 1988 1989
  14. 14. 1991 1992
  15. 15. 1993 1995 1997 1999
  16. 16. 2003 2008
  17. 17. 2008 2008
  18. 18. 2009 2010 2010
  19. 19. 0 200 400 600 800 1000 1200 1400 1600 1800 Emergency Transitional Long-Term Mixed Unknown Rough Sleeper Census 2011 – Homeless Persons by Category of Accommodation Males Females
  20. 20. 0 50 100 150 200 250 300 350 1999 2002 Oct-01 Oct-03 Mar-04 Oct-04 Mar-05 Oct-05 Oct-06 Mar-07 Oct-07 Mar-08 Oct-08 Mar-09 Numbers Sleeping Rough in Dublin, 1999-2013
  21. 21. 0 50 100 150 200 250 300 350 Census 2011 – Homeless Persons by DOB and Sex Males Females
  22. 22. 0 10000000 20000000 30000000 40000000 50000000 60000000 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Expenditure on Homeless Services by the Department of Environment, Community and Local Government, 1999-2013 (does not include the 10% from the local authorities, own resources or HSE funding)
  23. 23. Do Shelters Work?
  24. 24. The Great Confinements
  25. 25. Reformatory School, 1858
  26. 26. Industrial School, 1870
  27. 27. Borstal Institution, 1906
  28. 28. Magdalen Homes, 1860
  29. 29. Orphanage, 1870
  30. 30. Institute for Mental Defectives, 1920
  31. 31. Institute for the Blind, 1880
  32. 32. Institute for the Deaf, 1857
  33. 33. Lunatic Asylum, 1845
  34. 34. Lunatic Asylum, 1850
  35. 35. Workhouse, 1840
  36. 36. Mountjoy Prison, 1850
  37. 37. Iveagh Hostel for the Homeless, 1900
  38. 38. Back Lane Hostel for the Homeless, 1906
  39. 39. Morning Star Hostel for the Homeless, 1838/1930
  40. 40. Morning Star Hostel
  41. 41. The Demise of Institutions  “I cannot help feeling, from my experience, that one effect of asylums is to make permanent lunatics” (Henry Maudsley, 1871)  “..miserarable, poorly managed, underfinanced institutions, trapped by their own contradictions, poorhouses failed to meet any of the goals so confidently predicted by their sponsors” (Katz, 1986: 3).  “Its paymasters increasingly dismissed it as a well meaning experiment gone wrong, an expensive irrelevance now thankfully to be relegated to the dustbin of history” (Scull, 2011:430)
  42. 42. ‘Shelterization’ “Shelterization is a process involving a change in status, an adjustment to the shelter situation, and a degree of identification with the shelter group. In this process the attitudes and values of the men are reorganized in response to and on the basis of patterns of behaviour common to the shelter situation.The process of shelterization is organically related to attitudes and behavior patterns acquired previous to life in the shelter. Shelterization, in fact, is adaptation not only to shelters but to the total situation in which a man finds himself.The total situation includes being unemployed and dependent on public relief, living in the slum area of the city, being isolated from former social and economic contacts, having disheartening experiences with employment agencies and business concerns, and either being or approaching the age when re- employment in industry is unlikely.”
  43. 43. Lunatic Asylum 2013
  44. 44. Lunatic Asylum 2013
  45. 45. Lunatic Asylum 2013
  46. 46. Lunatic Asylum 2013
  47. 47. Workhouse, 1970
  48. 48. Magdalen Home, 2013
  49. 49. Reformatory School, 2013
  50. 50. Mountjoy Prison, 2013
  51. 51. Backlane Hostel, 2013
  52. 52. Iveagh Hostel, 2013
  53. 53. Model Lodging House, 2013
  54. 54. House of Industry, 1770
  55. 55. Homelessness and ideology in Ireland
  56. 56. 13th National Conference of Charities and Corrections, Minnesota, 1886  Drink,lack of employment,laziness,war,example,ignorance,lack of home training,dime novels,tobacco,discontent,poverty,shiftlessness,vice,love of roving,heredity,indiscriminate almsgiving or false charity,inability,dishonesty,strikes,depravity,disappointment,worth lessness,immigration,existing type of civilization,improvidence,force of habit,low wages,loss of respect,fees made by officers and magistrates,aggregation of capital in manufactures,socialistic ideas,overpopulation,lack of manhood,lack of a trade,our jail system,imbecility,defective system of education in our public schools,hospitality of jails and almhouses,uncomfortable homes,high temper,industrial causes,ex-convicts,specialization of labor,lack of wayfarers’lodges,Chinese,the devil.
  57. 57. In addition to detailed the history of the organisation, a case study of one man’s descent into homelessness and his eventual exit is provided. Poor relations with the man’s father, his experimenting with homosexuality and engagements with religions other than the Catholic Church are all implicated in his descent into homelessness. His exit from homelessness is largely achieved through rejecting homosexuality, embracing Catholicism and making contact withTrust.
  58. 58. J.L. Gillin (1929) Vagrancy and Begging, American Journal of Sociology  “The best institutions in Europe for the treatment of beggars and vagrants are to be found in Belgium and Switzerland…When I visited Merxplas (Belgium) in the spring of 1928 the inmates were employed either on the land or in the extensive shops at the institutions.At that time there were 600 employed in the workshops and 100 on the farm.There are four divisions:(1) division for old men who cannot work;(2) one for the immoral man,i.e.homosexuals and those who visit prostitutes (3) one for feeble-mined vagrants;and (4) one for young men from 16 to 21 years who have been committed for vagrancy before.All of these are detained from 3 to 7 years.”
  59. 59. Economic Cycles and Homelessness  Historical accounts of homelessness show that the surges in homelessness are generally linked to economic depressions.  Cohort Effect – “The single adult homeless population here consists primarily of a male, mostly minority cohort born between 1959 and 1964, the last years of the baby boom generation.”
  60. 60. ‘System Talk’ and Housing First  “Housing First is certainly a mode of socialization; it also relies on a medical and individualizing explanation for homelessness. But it is also a punitive strategy, only here the punishment sits just over the horizon, rather than directly in the baton of a cop rapping the feet of a sleeping street person. This is the “dual strategy of punitive responses to non-service compliant homeless people… Housing First and punitiveness are two sides of the same coin.” Mitchell, D. (2013)  “Housing First, having struggled for credibility in its early years was eventually adopted as a flagship programme by GeorgeW. Bush (perhaps the most enthusiastic neoliberal of the US presidents).The explanation for this apparent paradox is that Housing First turns out to be not only a reasonably effective programme but also financially advantageous - a cheaper alternative to„housing ready‟ approaches in dealing with homelessness. In this instance „economising the social‟ allowed Bush to trumpet his administration‟s adoption of Housing First as part of his„compassion agenda‟.” Doherty, J. (2013)
  61. 61. ‘Sick Talk’ and Housing First  “Treatment First providers were consumed with the pursuit of housing, whereas Housing First providers were able to focus more on clinical concerns since consumers have already obtained permanent housing. ForTreatment First providers, the pressures of having consumers comply with the conditions necessary to secure housing placements led case managers to focus more on ways to maneuver through the system rather than addressing consumers‟ specific clinical needs.The pressure of the continuum model even encouraged someTreatment First providers to overlook or not address mental health or substance use problems since making them explicit could jeopardize a consumer‟s chances of moving on into more permanent housing placements.”  Henwood, B.F., Stanhope,V. and Padgett, D.K. (2011)The Role of Housing:A Comparison of Front-Line ProviderViews on Housing First andTraditional Programs, Adm Policy Ment Health 38(2), pp.77-85.
  62. 62. Operating Housing First in Ireland  The key logistical blockage towards the achievement of a„Housing Led‟ policy approach is the supply of appropriate and adequate housing. In the short-term, only a very limited new supply of local authority managed dwellings or not-for profit managed dwellings will be available due to constraints in new building.  Therefore, leasing for the PRS is the key means of acquiring the dwellings required. Existing mechanisms to lease dwellings from private landlords, while successful at one level, are not of sufficient scale in the major urban areas to move homeless people into private rented accommodation with supports as required.
  63. 63.  Each lead local authority or strategic cluster of lead authorities should establish a Social Rental Agency managed by a profit or not-for-profit organisation.These agencies, will have an exclusive mandate to provide housing for secure occupancy for homeless people currently occupying emergency and transitional housing services and the principles that inform the Pathways Housing First model should apply.  Social Rental Agencies are vehicles, which will lease existing rental dwellings from Private Landlords. Such agencies operate in a number of European member states including Belgium and Finland.  TheseAgencies should embody the key principles established over the past number of years and integrate them into a coherent framework that will source rental accommodation, settle those currently occupying emergency and transitional accommodation and provide ongoing support as necessary for ensuring successful maintenance of these tenancies.
  64. 64. Key Principles  Such Agencies should lease rented properties from private landlords on a long- term basis.  The dwellings should be scattered through the relevant local authority areas and no more than 5 per cent can be leased in any single complex or estate.  Landlords should receive a rent equivalent to rent allowance rate for the particular location and the Rent will be paid directly to the Landlord by the RentalAgency.  Private Landlords wshould have no further responsibility for the tenancy as the selection of the tenant and the maintenance of the dwelling will be the responsibility of the RentalAgency.  The provisions of the ResidentialTenancies Act,2004 as amended, should apply to these tenancies.
  65. 65.  Existing residents of emergency and transitional housing with be prioritised for accommodation through the RentalAgency, and given a number of housing options, with the support of their key worker.  TheTenants will source their rent from the rent allowance scheme and the rent will be paid directly to theAgency.TheTenants contribution will be mandatorily deducted as part of the tenancy agreement.  TheAgency will provideAssertive CommunityTreatment teams of mobile support workers, with a minimum ratio of one staff member to three formerly homeless residents.  Funding theAgencies and its allied services will be sourced from the cost-offset achieved from the closure of existing emergency and transitional accommodation.  To achieve synergies and appropriate expertise, the governance functions of theAgencies will be embedded within the existing governance structure of the HousingAgency.
  66. 66. Conclusion  the shelter system will likely defy attempts at reform. Subpopulations may be displaced, once again, from one miserable institution to another…inhumane conditions in shelters may make shelter reform compelling, but because shelter conditions do not cause homelessness, reformers should not make the mistake of assuming that by fixing shelters, they are going to remedy the problem (Culhane, 1996: 68)