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

Eoin O’Sullivan,
School of Social Work and Social Policy, Trinity College Dublin
Challenges in Implementing Housing
First in Ireland

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.

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.

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.

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.”

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.

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

Strategies to Tackle Homelessness in Europe
 National Level Integrated
Strategies
 Regional Level Integrated
Strategies
w Integrated Strategies not widely
adopted

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

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)

 “…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).

The Extent and Nature of
Homelessness in Ireland

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

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

0
50
100
150
200
250
300
350
Census 2011 –
Homeless Persons by DOB and Sex
Males
Females

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)

Institute for Mental Defectives, 1920

Iveagh Hostel for the Homeless, 1900

Back Lane Hostel for the Homeless, 1906

Morning Star Hostel for the Homeless, 1838/1930

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)

‘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.”

Homelessness and ideology in
Ireland

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.

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.

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.”

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.”

‘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)

‘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.

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.

 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.

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.

 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.

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)

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

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