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 eradicating 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 U.S. 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 U.S., 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 U.S. 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 provides homes to people without preconditions, then wraparound support tailored to people’s needs.

It sounds almost childishly simple, yet it is antithetical to the status quo. Most local authorities in the U.S. and the U.K. operate what is known as the staircase model.

Unlike Housing First, the staircase model 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 have a shower?” says Rausch over Zoom from her offices in the city.

Sleeping Rough In Lockdown 

During the Covid lockdowns in the U.K., 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 the U.K. had ever seen to eradicating street homelessness.

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 U.K. 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 non-profit 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.

That same year a three-year Housing First pilot was launched in the U.K, 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.

This has been 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.

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