Housing First success

Housing First success - 19/10/2021

Housing First is a person-centred, evidence-based approach to supporting homeless people who have high needs and histories of entrenched or repeat homelessness, and especially rough sleeping, to live in their own homes. It has been widely adopted across the US and Europe and increasingly in the UK, including in Sheffield.

We spoke to Katie Hawxwell and Daniel Jay from Sheffield City Council’s Housing First team about somebody accessing the support in Sheffield. Daniel takes up the story…

“In December 2020, ‘Paul’ wasn’t in great shape. He’d been living in a hotel accessing the coronavirus support available to people sleeping rough, but was on his final warning and about to get evicted. That would have seen him return to the streets, where he’d been on and off for the best part of 20 years. He was drinking heavily, on a methadone script but using on top of that, and not looking after himself at all.

Paul’s health was really poor. He’s diabetic but hadn’t been taking insulin, had been Hep C positive for about 10 years, but never engaged in treatment, so with his excessive drinking his liver was in bad shape. He’d been in and out of prison and custody, usually related to drinking and being aggressive, and his mental health was really struggling too, with a dual diagnosis of paranoid schizophrenia and anxiety and depression.”

Housing First prioritises access to housing as quickly as possible. Eligibility for housing is not contingent on any conditions other than willingness to maintain a tenancy, and the individual is given their own secure tenancy.

“Paul signed up to Housing First in December, and moved to his own flat on the outskirts of Sheffield, close to his brother who is his only remaining family member. I became his primary support worker meaning I was responsible for coordinating various appointments and prescriptions for Paul, that he wasn’t able to manage himself. Paul started to engage with the Hep C and diabetes nurses, and the change in him once he started back on treatment was immediate. Within 11 weeks, he was clear of Hep C! 

The biggest change has been in Paul’s mindset however. He’s started to reduce his drinking and take more interest in his health, appearance, and looking after his flat. He’s prioritising shopping for food, and topping up his gas and electric. For Paul, that’s huge progress, made on his own terms, and in a relatively short space of time.”

Staff are responsible for proactively engaging their clients and for making the service fit the individual rather than trying to make the individual fit the service. Caseloads are small which allows staff to be persistent and proactive – doing ‘whatever it takes’ and not giving up or closing the case when engagement is low.  Support is provided for as long as each client requires it and the team continues to engage and support the individual if they lose their home or leave their home temporarily.

Team Manager, Katie, explains more about their work: “Housing First services feature a central person who has oversight of a person’s support needs, helping to keep them on track with appointments and treatment as required. This enables the support to be delivered in a coordinated way to fit around the needs of the person, rather than trying to make them fit into a service that may not address their needs sufficiently.

It’s all about re-drawing success. Many people accessing the service don’t have the basic life skills that many of us take for granted, for whatever reason. Budgeting and self care are simply not on their radar, so for someone to turn their life around in the way that Paul has is something to be celebrated!”

Providers commit to long-term offers of support with no end date: recovery takes time and varies according to individual needs, characteristics and experiences. The service is designed for flexibility of support with procedures in place for high/low intensity support provision and for cases that are ‘dormant’.

Support is provided for the individual to transition away from Housing First if this is a positive choice for them and the support provides links with relevant services across sectors that help to meet the full range of an individual’s needs. There are clear pathways into, and out of, the Housing First service.

Katie continues, “We have 31 people accessing the service at the moment, but we anticipate growing the provision to around 50 people, made up of many of the most entrenched rough sleepers in Sheffield. Keeping caseloads small is important in order to maintain the customer focus and work intensively with each client. 

Key to our success as a team has been the inclusion of a mental health nurse for 20 hours a week. We’re not mental health professionals ourselves, yet pretty much everyone accessing the support experiences poor mental health. Having that professional backup available to us is so important.

Fundamentally, Housing First is about choice. It’s about providing people with the security of a tenancy, and then building relationships to encourage them to start accessing support to address their needs, whatever they may be. All of the planning is person-centred and they are given the lead to shape the support they receive. Often, people will be with us for two years before we start to work on what their next steps may be. We’re looking forward to seeing just how much progress Paul makes in that time!”


Alison Wise, for Help us Help

October 2021