Across the world, cities adopting a remarkably simple homelessness policy are seeing the numbers of rough sleepers plummet. Now it’s being trialled in the UK, with impressive results
Homelessness has long been accepted as an inevitable fact of modern city life. But now a strikingly simple policy, first put forward by a psychologist in the 1990s, is making a dramatic impact in helping to all-but eradicate rough sleeping in cities around the world. The crux of the policy? Simply provide homes to people, without any preconditions. Then provide support tailored to their needs.
Since the US city of Houston adopted it a decade ago – when it had the sixth largest homeless population in the country – the number of people sleeping rough has dropped by 63 per cent. Utah in the US, and Vienna in Austria, have seen similarly transformative results. Helsinki in Finland is on track to entirely eradicate street homelessness by 2025.
These figures are particularly notable given that they are outliers among a much bleaker picture. Since the financial crash of 2008, homelessness has risen exponentially across the western world. In Britain, it has increased by 165 per cent since 2010.
While politicians in places like Hungary and the city of Tennessee in the US have responded by criminalising rough sleeping – resulting in a ballooning of their prison populations – others have taken a more radically progressive approach.
Called Housing First, the policy does exactly what it says on the tin: provides homes to people without preconditions, then wraparound support tailored to their needs. It sounds almost childishly simple, yet it is antithetical to the status quo. Most local authorities in the US and the UK operate what is known as the staircase model. Unlike Housing First, staircase expects people to be sober, engaging with support services, seeking employment, and have completed courses on managing a tenancy. Only then can one be considered housing ready.
Housing First is the brainchild of Dr Sam Tsemberis, a clinical psychologist who came up with the idea in 1992 after he saw patients he’d treated at Bellevue psychiatric hospital roaming New York City’s streets.
Since Houston first trialled it in 2012, they have moved more than 25,000 people from tents and park benches into houses. When they began, it would have taken a homeless veteran (one of the categories tracked by the government) 720 days and 76 bureaucratic steps to move from the streets into housing. Today the wait is just 32 days.
Dr Tsemberis told me that Housing First isn’t about the housing at all – it’s really about the treatment. But “you can’t really talk about the treatment unless the person is housed; otherwise, the whole conversation is only about survival”, he says. “You know – where are you going to eat? Where are you going to sleep? Once they’re housed, it becomes very, very different.”
Ana Rausch has seen firsthand the extraordinary changes catalysed by Housing First, in her role as vice president of programme operations at Coalition for the Homeless of Houston. She believes the approach they previously took – making sick people jump through hoops – was bound to fail.
“It’s very hard to think about getting a job if you’re living under a bridge or in your car. How are you going to take a shower?” says Rausch over Zoom from her offices in the city.
She shares a video showing rough sleepers walking into their homes for the first time, amazed at the comfortable furnishings and well-stocked fridges. “When I see somebody like that, it makes me feel so good that we were able to get them off the streets,” she smiles. “It’s really gratifying to see someone get to the point where they’re living in their own place.”
Sleeping rough in lockdown
During the Covid lockdowns in the UK, Boris Johnson’s government effectively – and unwittingly – rolled out a nationwide trial of Housing First. In March 2020, when the nation was legally put into lockdown and people were instructed to stay at home to try to halt the spread of Covid-19, the government adopted its Everyone In policy: an emergency scheme to accommodate rough sleepers.
Local authorities and an army of volunteers from various homeless charities mobilised. They helped 37,430 people find temporary accommodation in budget hotels, delivering hot meals and support from a secure and settled base. The results were breathtaking. In January 2021, less than a year later, the government reported that the scheme had helped 26,167 people sleeping on the streets find permanent housing. For a time, Everyone In – essentially Housing First by another name – came the closest we’ve ever been to eradicating street homelessness in the UK.
You might imagine that giving a home to everyone who needs one is an unworkably expensive solution. Research has long shown, however, that a homeless person costs the state far more than a house does. In purely financial terms, the cost of a person sleeping rough in the UK for 12 months is £20,128, according to research by Crisis. This is due to the burden they place on police, hospitals and prisons. In contrast, intervention to house a rough sleeper costs the public purse just £1,426.
Finding homes for all the people that need them is a major stumbling block to Housing First. In many cities with large homeless populations, a lack of affordable housing is a key driver of homelessness in the first place.
But hope lies in the novel approach pioneered by the Y-Foundation, the Helsinki nonprofit that has been working hand-in-hand with the Finnish government to eradicate homelessness. Using money from public and private grants, they have been buying up properties with the aim of housing the homeless, and are now the country’s fourth largest landlord. The rents they collect from their formerly homeless tenants – more than €100m (£86.8m) annually from 26,000 tenants in 18,000 properties – runs at a profit. Any surplus is reinvested in the foundation, meaning the model is entirely self-sustaining.
The Finnish approach goes global
These extraordinary results have led a stream of politicians from across the western world to visit Finland. Inspired by their success, the Housing First model is now being rolled out in cities throughout the US and Western Europe. Greater Manchester’s Mayor Andy Burnham was one of those who made the trip.
“When I decided to make ending rough sleeping my top priority, I lost count of the number of people who said: you’ve got to go to Finland,” he blogged back in 2019. “Last week I finally made my first visit and I am so glad I did. In these modern times which seem to become more harsh and polarised with every week, it was wonderful to find that a different world can still exist.”
That same year he launched a three-year Housing First pilot, with funding from central government. Emily Cole, programme lead at Greater Manchester Housing First, reports that the city has now helped 445 people into their own homes, and boasts an 81 per cent tenancy sustainment rate – a typical figure for Housing First programmes. It’s achieved by offering the recently housed whatever assistance they may need to move forward with their lives, be it mental health or substance abuse support, assistance with job training or financial literacy.
In June, the Greater Manchester scheme secured an additional £6.3m in government funding to support the initiative for a further two years, and Birmingham and Liverpool have launched their own Housing First pilots.
Despite their success Cole is quick to point out that Housing First is not a panacea. “It isn’t the answer for everybody, and I think it does need to be part of a plethora of options for people,” she says. Some people do not want to take on the responsibility of managing a household, and others are simply incapable of it.
Cole’s biggest challenge now is to convince central government to adopt the policy nationwide. “The only reason we’re doing these pilots at all is because our treasury wanted more evidence in this country,” she says.
She believes the evidence is clear: it works.
A home at last
Lisa Mindshull has had periods of homelessness ever since she ran away from home, aged 15, to escape her abusive father. Most recently, she’s been sleeping rough in Manchester. “For 11 months, I was sleeping at a derelict church every night,” she says.
When Housing First took her on, she was sceptical; she had heard all their promises before, but this time it was different. She’s finally settled in a place she can call home; she has friendly neighbours, a growing number of friends, and she has Cheryl, who has been more like a best friend to her than a support worker.
“They put me in control,” she says. “I felt this time they were listening to me. They’ve given me my self-esteem back; gave me my strength back. And I’ve got a purpose, something to live for. It’s the best thing I’ve ever done.”
Gary Cundle has spent 30 of his 49 years on and off Manchester’s streets. Cundle doesn’t think much of charities and hostels; even though they’ve been helpful to him over the years, they’ve never solved his problems.
“Housing First helped me in a big way. [My support worker] comes to check on me every week to make sure I’m paying my bills or if there’s anything wrong,” Cundle says. He won’t go into much detail about how he ended up homeless but says he’s abused all manner of drugs over the years: “I’ve been on everything: crack, heroin, cannabis.”
Before Cundle got on the pilot scheme, he bounced between the city’s hostels and the streets. Now he has his own place in Salford and a clear care plan, which provides him with the support he needs with his mental health and drug dependency. “Without Housing First, I wouldn’t have known how to go about that,” he admits.
Main image: FG Trade/iStock
Illustrations: Nathalie Lees
Profiles: Greater Manchester Housing First