Thinking About Supportive Housing


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Presentation from Launch of Parity - 18 April 2008
Felicity Reynolds, CEO, Mercy Foundation

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Thinking About Supportive Housing

  1. 1. THINKING ABOUT SUPPORTIVE HOUSING Launch of Parity March Edition 18 April 2008 Felicity Reynolds CEO, Mercy Foundation Churchill Fellow 2007
  2. 2. Overview <ul><li>Costs associated with crisis care for people who are chronically homeless </li></ul><ul><li>Benefits of supportive housing </li></ul><ul><li>Australian context </li></ul><ul><li>Where to from here – a suggested plan </li></ul>
  3. 3. <ul><li>“ Although chronic homelessness represents a small share of the overall homeless population, chronically homeless people use up more than 50 percent of the services (for single homeless adults). The most successful model for housing people who experience chronic homelessness is permanent supportive housing using a Housing First approach”. NAEH </li></ul>
  4. 4. Chronic homelessness much more than chronic houselessness <ul><li>People who have experienced multiple episodes of homelessness over a year or people who have experienced ongoing ‘street’ homelessness for at least 6 months. </li></ul><ul><li>AND </li></ul><ul><li>Who have multiple conditions, such as a mental illness, substance abuse, brain damage, disability, physical health problems.(15 – 25% of homeless population). </li></ul><ul><li>Disconnectedness and social exclusion. </li></ul><ul><li>Often a background of trauma and abuse. </li></ul><ul><li>Trust of other people and services. </li></ul><ul><li>May develop social connections, networks and supports and become ‘entrenched’. </li></ul>
  5. 5. Cost of crisis care to this population <ul><li>Now well understood that some chronically homeless people are high users of crisis services. That is – acute mental health, EDs, IPUs, detoxes, ambulance, police, legal, shelter etc. </li></ul><ul><li>NYC study – US $41,000 </li></ul><ul><li>Sydney estimate – AUD $34,000 </li></ul><ul><li>Million dollar Murray! (The New Yorker). </li></ul><ul><li>As long as someone remains homeless, these costs are recurrent. </li></ul>
  6. 7. <ul><li>Berry (2003) noted that a study in the USA showed that it costs an additional US$3196 for each person to provide substance abuse and mental health services to homeless people, compared to clients who were housed. </li></ul><ul><li>Culhane (2004) concluded that “It costs essentially the same amount to house people as it does to leave them homeless”. </li></ul>
  7. 8. Cost/benefit studies <ul><li>Many US cities have now done cost/benefit studies and now understand that it is not only morally responsible, it is fiscally responsible to assist chronically homeless people off the streets and into permanent supportive housing (many models: private housing, public housing, safe havens, community homes etc). </li></ul><ul><li>Now, good evidence that service use reduces once people are in stable housing and have adequate support. </li></ul>
  8. 9. 10 year plans to end chronic homelessness <ul><li>As a result, more than 300 cities have implemented 10 year plans. </li></ul><ul><ul><li>Plan (envision and plan to end chronic homelessness) </li></ul></ul><ul><ul><li>Data (measure outcomes; be accountable for your services and actions) </li></ul></ul><ul><ul><li>Emergency prevention (close the front door) </li></ul></ul><ul><ul><li>Systems prevention (close the front door) </li></ul></ul><ul><ul><li>Outreach (open the back door) </li></ul></ul><ul><ul><li>Shorten homelessness (open the back door) </li></ul></ul><ul><ul><li>Rapid re-housing (open the back door) </li></ul></ul><ul><ul><li>Services (sustain) </li></ul></ul><ul><ul><li>Permanent housing (sustain) </li></ul></ul><ul><ul><li>Income (sustain) </li></ul></ul>
  9. 10. BUT, is this really what homeless people want? <ul><li>“ When we conducted the first Street Needs Assessment in April 2006, homeless people told us overwhelmingly they wanted permanent housing and the help to make this happen.” (over 90%) Toronto S2H </li></ul><ul><li>2005 – 2007: 87% of people assisted into housing by Toronto S2H had sustained their tenancies. </li></ul>
  10. 11. Follow-up survey by S2H <ul><ul><li>Are you happy with housing? </li></ul></ul><ul><ul><li>Very Happy 50% </li></ul></ul><ul><ul><li>Mostly Satisfied 37% </li></ul></ul><ul><ul><li>Somewhat Unsatisfied 8% </li></ul></ul><ul><ul><li>Very Unhappy 5% </li></ul></ul><ul><ul><li>Has housing changed your life? </li></ul></ul><ul><ul><li>Improved a lot 61% </li></ul></ul><ul><ul><li>Somewhat improved 30% </li></ul></ul><ul><ul><li>Stayed the same 7% </li></ul></ul><ul><ul><li>Gotten worse 2% </li></ul></ul>
  11. 12. <ul><ul><li>17% reported no drinking since being in housing. </li></ul></ul><ul><ul><li>Homeless 2+ years much more likely to report decrease in alcohol use ( 59% vs. 27% ). </li></ul></ul><ul><ul><li>31% reported they had quit using drugs completely since being in housing. </li></ul></ul><ul><ul><li>Those homeless 2+ years most likely to report decrease in drug use ( 78% vs. 62% ). </li></ul></ul>
  12. 13. <ul><li>Reduced use of crisis and emergency services </li></ul><ul><li>Clinics - 28% </li></ul><ul><li>ER - 40% </li></ul><ul><li>Hospital - 25% </li></ul><ul><li>911 (emergency call) - 35% </li></ul><ul><li>Ambulance - 38% </li></ul><ul><li>Fire - 71% </li></ul><ul><li>Police detox (“Drunk Tank”) - 75% </li></ul><ul><li>Getting arrested - 56% </li></ul><ul><li>Jail - 68% </li></ul><ul><li>Court - 58% </li></ul><ul><li>Probation - 38% </li></ul>
  13. 14. An example of a supportive housing model <ul><li>House/Unit + </li></ul><ul><li>Person/People + </li></ul><ul><li>Support (little or lots) = </li></ul><ul><li>Supportive Housing </li></ul><ul><li>(and no, I don’t think we need to pilot it). </li></ul>
  14. 15. Key components of ‘Housing First’ <ul><li>People do not have to be assessed as ‘Housing Ready’. </li></ul><ul><li>Housing is provided as quickly as possible. </li></ul><ul><li>People are provided with adequate and appropriate support services in their home. </li></ul><ul><li>People with alcohol or other drug addictions can access housing. </li></ul><ul><li>People do not need to be ‘compliant’ with mental health treatment – separate the behaviour from the diagnoses </li></ul><ul><li>Separate the management of the housing from the support. </li></ul>
  15. 16. Other useful models <ul><li>‘ Safe havens’ – a useful model for some. </li></ul><ul><li>Harm minimisation accommodation services work very well with this group (Seaton House Annex a good example). </li></ul><ul><li>‘ Ready, Willing and Able (The Doe Fund) in NYC is a good example of an abstinence based, work skills residential program. </li></ul><ul><li>Transitional housing for older women. </li></ul>
  16. 17. Australian context <ul><li>Australia - multiple levels of government with overlapping as well as differing responsibilities. </li></ul><ul><li>USA and Canada – Local government has significant responsibility for policing, homeless shelters, public housing, local health services and emergency services. </li></ul><ul><li>This means a local plan can incorporate multiple service responses and cost savings can be made within one organisation. </li></ul>
  17. 18. <ul><li>Federal – national policy, funding to the states for housing and hostels, primary health care (eg. Medicare/GPs) etc. </li></ul><ul><li>State – state policy, policing, courts, emergency services, housing, hostel funding, tertiary health care, acute mental health services etc. </li></ul><ul><li>Local – public space, some community services (varies across LGAs), local planning and housing strategies. </li></ul>
  18. 20. What does this mean? <ul><li>Some departments or councils might have to spend more money and never see any of the savings. </li></ul><ul><li>Savings may be made in health or policing but will this actually result in fewer clinicians or the need for fewer police? Probably not. </li></ul><ul><li>Housing and support services might make all the expenditure but never see any of the savings. </li></ul><ul><li>ANSWER: Whole of government approach – social inclusion (good examples SA, Tasmania). </li></ul>
  19. 21. Where to from here…….. <ul><li>The Federal Government should develop a new National Homelessness Strategy, which has as its key aim, a plan to end chronic homelessness (very good start with the Green and White papers!). </li></ul><ul><li>Any new National Homelessness Strategy must be closely linked or fully incorporate a National Affordable Housing Strategy. </li></ul><ul><li>Any new National Homelessness Strategy needs to include actions that will prevent homelessness as well as address homelessness. </li></ul><ul><li>Any new National Homelessness Strategy should include incentives for State Government’s to develop and implement homelessness and affordable housing strategies. </li></ul>
  20. 22. <ul><li>State Governments should develop new Homelessness Strategies, with the key aim to end chronic homelessness. They should also include affordable housing strategies as well as mechanisms for preventing homelessness. </li></ul><ul><li>State homelessness strategies should include incentives for city council’s to develop and implement homelessness and affordable housing strategies. </li></ul><ul><li>‘ Housing First’, with appropriate levels of support for people who require that support, should be implemented as an evidence based effective model of long term assistance for chronically homeless people. </li></ul>
  21. 23. <ul><li>Any savings made from these new approaches will need to be evaluated and assessed as a whole of government(s) and savings to all members of the Australian community– and not evaluated department by department or silo by silo. </li></ul>
  22. 24. Contact details <ul><li>(and to obtain a copy of my Churchill report) </li></ul><ul><li>Felicity Reynolds </li></ul><ul><li>CEO, Mercy Foundation </li></ul><ul><li>[email_address] </li></ul><ul><li>02 9699 8726 </li></ul>