What we Know about What Works
Nicholas Pleace
Overview
• Different forms of homelessness
– Different forms of need
• Innovation in service design
– Prevention
– Housing First and Housing-Led
• The importance of an integrated strategy
– Coherence and coordination
– Costs
Different Forms of Homelessness
• The common stereotype of a homeless
person exists throughout Europe
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High and complex needs
Severe mental health problems
Drug and alcohol use
Poor physical health
Nuisance and criminal behaviour
Economically inactive
Male, early middle age
Different Forms of Homelessness
• But our understanding of who this group of
people are has changed
• Support and treatment needs may exist
before and arise during homelessness
• Clear American evidence that many longterm and repeatedly homeless people with
high needs, become homeless with low, or
no, support/treatment needs
• Some European data suggest a similar
pattern
Different Forms of Homelessness
• Women do not experience homelessness in the
same ways as men
• Women use relatives, friends and acquaintances
to keep a roof over their head
• Male domestic/gender based violence is a major
cause
• Exhaust informal support before seeking help
• Often living without no legal or physical security, or
privacy, or amenities
• Evidence suggesting high support needs
Different Forms of Homelessness
• Family homelessness
• Highly gendered, relatively young
• Bulk of family homelessness is women lone
parents with dependent children
• Poverty, poor life chances
• Violence and relationship breakdown are
major causes
• Only a few have high or complex needs
Different Forms of Homelessness
• Young people (16-24)
• Strongly associated with disrupted
childhoods
• Experience of child protection/social work
systems
• Economic and social marginalisation
• Needs can be high and complex
Service Innovation
• Prevention
• Reflecting distinct needs of different groups of homeless
people
• Low intensity support services
– Housing advice and information
• Support to prevent eviction
– Financial
– Legal
– Practical
Service Innovation
• Prevention
• Support services
– For people with higher needs
– Case management, service brokerage
– Direct practical support
• Housing access schemes
– Not ‘prevention’ technically, but rapid re-housing
• Social lettings schemes, rent deposit/bond schemes,
assistance with rent
Service Innovation
• Housing-Led services
– Ordinary housing
– Combined with floating (mobile/peripatetic) support
– Low to medium support
• Housing First
– Of which more in the next presentation
– Related approaches, particularly Critical Time
Intervention
Service innovation
• Common aspects to all these service models
• Based on recognising diversity of need
• Providing a bespoke/tailored response
• Supporting strengths, recognising and
respecting the views of homeless people
• Flexible, non-judgemental
• Essentially reflecting best practice in health
and social care systems
Service innovation
• Clear evidence that services that focus on
making an individual ‘housing ready’ in an
institutional setting are less effective
• Mass of data from EU/OECD studies on
Housing First, CTI
• Person centred, flexible, tolerant services
are more effective in preventing/ending
homelessness and more cost effective
Integrated Strategies
• Thinking about homelessness across
Europe has tended to be at the level of
individual services or service models
• Truly strategic thinking is less common
and tends to be at the level of individual
cities or regions
• There are integrated national strategies,
e.g. Finland
Integrated Strategies
• An effective strategy is a comprehensive
strategy
• Recognising different forms of homelessness
• Different sets of needs to be met
– Directly (South and East)
– Interagency coordination (North West)
• And which is coordinated with health, social
care and criminal justice systems
Homeless Families
• Some support needs will be present, but high
support needs are unusual
• Facilitate access to suitable, affordable,
adequate housing
• Preventative services
• Rapid re-housing when homelessness has
occurred
• Access to training, education, employment
Young people
• Support needs can be high
• Both preventative and homelessness
services will need to provide support and
treatment
• An element of ‘parenting’ in a broad sense
• Access to training, education, employment
• Emphasis on social integration
Lone Women
• May not use existing homelessness services
• Alternatives that allow women to retain or
secure an independent home
– Prevention and rapid re-housing
• Support will need to be intensive in some
cases
• Recognition of the role of domestic violence
in causation of homelessness is important
Lone Men
• Prevention is crucial
• Evidence that men deteriorate when
homelessness is not resolved
• Costs increase, potentially dramatically, when
homelessness is not rapidly resolved
• Good evidence on how to end recurrent/long
term homelessness
– Housing First
– CTI
Migrants
• Complex area
• Needs may be high for some
– Asylum seekers and refugees
• But many economic migrants are young
• Crucial balance is between humanitarian
responses and maintenance of border
controls
– Political risks
Integrated Strategy
• Prevention
• Emergency accommodation
• Housing-Led, Housing First, CTI
• High intensity services for most complex
needs
Housing
• Must pay attention to housing supply
• Does not matter how comprehensive
– how effective
– how well tested
– how integrated, a strategy is…
• If there is nowhere adequate, affordable and
secure to house families and individuals
• A strategy, indeed an individual service, will
always be limited in effectiveness if housing
supply is not in place.
Do nothing…
€373,864
€302,756
€108,495
€52,994
€33,337
DRUG/ALCOHOL
SERVICES
MENTAL HEALTH
NHS
CRIMINAL JUSTICE
HOMELESS SERVICES
An Effective Integrated Homelessness Strategy
• Will at least partially pay for itself
• There may even be savings which can be
redeployed elsewhere
• UK spent £600 million in 2016 on temporary
accommodation for statutory homeless people in
London alone
• Upwards of an additional £1 billion on other
homelessness services/homelessness related
spending (health, criminal justice) in 2016
• Because systems to prevent and resolve
homelessness rapidly were not in place
Thanks for Listening
• Nicholas Pleace
– Deputy Director, Centre for Housing Policy
– European Observatory on Homelessness
– Women’s Homelessness in Europe Network