Recovery Orientation and Realistic Expectations

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Presentation by Volker Busch-Geertsema, GISS Bremen, Germany, at the 2013 FEANTSA Research Conference, Alice Salomon Hochschule Berlin, 20th September 2013

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Recovery Orientation and Realistic Expectations

  1. 1. 1 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Recovery Orientation and Realistic Expectations Dr. Volker Busch-Geertsema GISS, Association for Innovative Social Research and Social Planning, Bremen, Germany Coordinator of the European Observatory on Homelessness Coordinator of « Housing First Europe » until August 2013 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Housing First!  Evidence shows that the overall majority of homeless people want to live in regular housing.  There is plenty of evidence that even homeless people with complex problems (mental health problems and addiction) are able to sustain a regular tenancy if appropriate support and individual choice is provided.  High housing retention rates in Housing First projects have been documented in a rapidly growing bulk of evidence, in the US, in Canada, in various European countries and elsewhere.
  2. 2. 2 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 “Where do you want to live in the future?” Answers of clients registered by NGO services for homeless  people Germany 2010 no request for housing, already living in a regular flat 12.4% “sta onary" ins tu on for homeless people 10.1% shared housing / group home 1.6% furnished room 1.6% alterna ve form of accommoda on 0.5% other 0.8% own dwelling for one person 63.8% own dwelling for two persons 6.4% own dwelling for a family 3.0% own self‐contained dwelling = 73.2%   Basis: 8,134 homeless persons, BAG W 20111 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Amster- dam Copen- hagen Glasgow Lisbon Buda- pest Total number of service users housed 165 80 16 74 90 Unclear cases (death, left to more institutional accommodation, left with no information if housed or not etc.) 23 16 2 6 na Basis for calculation of housing retention 142 64 14 68 na Positive outcome (still housed) 138 (97.2%) 60 (93.8%) 13 (92.9%) 54 (79.4%) 29 (< 50%)  Still housed with support from HF programme 122 (85.9%) 57 (89.1%) 13 (92.9%) 45 (66.2%) 0  Housed without support from HF programme 16 (11.3%) 3 (4.7%) 0 9 (13.8%) 29 (< 50%) Negative outcome (lost housing by imprisonment, eviction, “voluntary” leave into homelessness etc.) 4 (2.8%) 4 (6.3%) 1 (7.1%) 14 (20.6%) na Housing retention rates in Housing First Europe test sites Source: Local final reports, own calculations. See Busch-Geertsema (2013)2 www.housingfirsteurope.eu
  3. 3. 3 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Regular housing as a platform for further integration  Housing basis for “ontological security” (constancy, daily routines, privacy and identity construction; Padget 2007)3.  Padget on the results of a HF study in New York: “Yet, just as a house (or apartment) does not make a home, a home does not make a life. Other core elements of ... recovery such as hope for the future, having a job, enjoying the company and support of others, and being involved in society (...) have only been partially attained by this study’s participants. Having a ‘home’ may not guarantee recovery in the future, but it does afford a stable platform for re- creating a less stigmatized, normalized life in the present.”4  Results of Housing First “underwhelming” in these fields?5 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 High expectations. Too high?  In Sweden a Housing First tenant was elected as “tenant of the year“.  Some rehousing projects present ex-homeless clients who study at university, have found a job, have married and moved to a detached house.  Are these the right examples to promote the Housing First approach?
  4. 4. 4 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Evaluation Results  Results on recovery from mental illness and addiction are indeed mixed in many HF projects, though Housing First Europe provided evidence on improvements even for heroin and severe alcohol addicts (for some, but not for all)  Many homeless single people re-housed in scattered housing face (initially) loneliness and social isolation  If they remain in contact with the former peer group (which is the rule if they are rehoused in congregate housing), and are struggling with addiction, problems with managing the reduction of their substance use tend to be reported.  If they try to cut contacts with their former homeless peers – as many rehoused homeless people do – it is not easy for them to create a new social network. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Evaluation Results  The majority of service users remain poor and most remain excluded from regular labour market though some projects achieve surprisingly good results regarding community integration and finding something meaningful to do.  Sam Tsemberis (2010): “„Housing First (programs) may end homelessness but do not cure psychiatric disability, addiction or poverty. These programs (...) help individuals graduate from the trauma of homelessness into the normal everyday misery of extreme poverty, stigma and unemployment.”6  Given the complex support needs of the main target group of Housing First, further integration might take more time and structural constraints play a role as well.
  5. 5. 5 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Relative integration and ambitious goals  Housing First cannot change structural conditions of labour markets and welfare systems. Here – as well as in housing policies – fundamental changes are necessary!  Under given conditions “relative integration” legitimate goal for some when re-housing severely marginalised people.7  “Practitioners and policy makers should keep their goals clearly in mind. More specifically, they should remember that [rehousing homeless people]* is not identical with ending poverty, curing mental illness, promoting economic self-sufficiency, or making needy people healthy, wealthy and wise.” (Shinn and Baumohl, 1998)8 *quote focused on prevention of homelessness EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Relative integration and ambitious goals  However, HF support staff should always be ambitious and aim at the highest level of integration possible, following the individual goals and preferences of HF service users.  Not always easy:  Change in balance of power  It’s the tenant who has the key  Support offers have to be useful and attractive  Service users preferences about their lives and recovery may vary considerably and have to be taken seriously  Respect, warmth and compassion for all clients!  Ability to build trustful relationships is needed, “personal factor” should not be underestimated when selecting support workers
  6. 6. 6 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Housing First. What’s Second?  Given that we agree that HF approaches and housing led strategies are the right way to reducing homelessness or even ending it for most people (and accepting that some of our presenters are challenging this assumption), what is needed after integration into regular housing is secured?  What are successful ways to overcome loneliness and social isolation? But also: How to reduce financial barriers to building and maintaining social networks?  How can community integration be promoted? But also: How do communities need to change for being integrative?  How could integration into employment be improved? But also: What is to be done to make labour markets less excluding? And are there non-discriminating and attractive ways to provide something meaningful to do (other than employment)? EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Housing First. What’s Second?  What is needed to offer people with problematic substance use harm reduction and – if wanted – ways out of addiction? But also: Which changes are needed in drug policies and addiction services?  These are some of the questions and ideas behind the theme of our Research Conference: “Housing First. What’s Second?”.  Not all of these questions will be tackled by presentations in the seminars, other important themes will be discussed.  However, there should be time and plenty of opportunities to discuss these questions during this conference.  All the best for lively debates and new insights!
  7. 7. 7 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Contact Dr. Volker Busch‐Geertsema Gesellschaft für innovative Sozialforschung und Sozialplanung e.V.  (GISS,  Association for Innovative Social Research and Social Planning)  Kohlhökerstraße 22 28203 Bremen, Germany Fon:+49‐421 – 33 47 08‐2 Fax: +49‐421 – 339 88 35 Mail: vbg@giss‐ev.de Internet: www.giss‐ev.de Housing First Europe evaluation: www.housingfirsteurope.eu EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Notes and References 1) BAG W, Bundesarbeitsgemeinschaft Wohnungslosenhilfe e.V. (ed.; 2011) Statistikbericht 2010. Auswertungstabellen [Statistical Report. Tables] (2011): http://www.bagw.de/agstado/5.phtml 2) Busch-Geertsema, V. (2013) Housing First Europe. Final Report: http://www.socialstyrelsen.dk/housingfirsteurope/copy4_of_FinalReportHousingFirstEurope.pdf 3) Padget, D.K. (2007) There’s no place like (a) home: Ontological security among persons with serious mental illness in the United States, Social Science & Medicine 64 (2007),1925–1936 4) Ibid., p. 1934 5) Atherton, I. and McNaughton-Nicholls, C. (2008) Housing First as a Means of Addressing Multiple Needs and Homelessness. European Journal of Homelessness, 2, pp. 289-303; Johnsen, S. and Teixeira, L (2010) Staircases, Elevators and Cycles of Change: Housing First and Other Housing Models for People with Complex Support Needs (London: Crisis). Johnsen, S. and Teixeira, L. (2012) ‘Doing it Already’?: Stakeholders Perceptions of ‘Housing First’ in the UK. International Journal of Housing Policy (2012, 12 (2)); McNaughton-Nicholls, C. and Atherton, I. (2011) Housing First: Considering Components for Successful Resettlement of Homeless People with Multiple Needs. Housing Studies, 26:5, pp. 767-77; Pleace, N. (2011) ‘The Ambiguities, Limits and Risks of Housing First from a European Perspective’ European Journal of Homelessness 5, 2, pp. 113-127; 7; Waegemakers Schiff, J. and Rook, J. (2012) Housing First: Where is the evidence (Toronto: Homeless Hub), see http://www.homelesshub.ca;)
  8. 8. 8 EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Notes and References 6) Tsemberis, S. (2010) Housing First: Ending Homelessness, Promoting Recovery and Reducing Costs, in: Gould Ellen, I. and O’Flaherty, B. (eds.) How to House the Homeless (New York: Russell Sage Foundation), p. 52 7) Busch-Geertsema, V. (2005) Does Re-Housing Lead to Reintegration? Follow-Up Studies of Re- Housed Homeless People, INNOVATION - The European Journal of Social Science Research, 18(2) pp.205-226 8) Shinn, M. and Baumohl, J. (1999) Rethinking the Prevention of Homelessness, in: Fosburg, L. & Dennis, D.L. (eds.) Practical Lessons: The 1998 National Symposium on Homelessness Research (U.S. Department of Housing and Urban Development and U.S. Department of Health and Human Services)

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