A Government report, of which GM Housing First played a major part, has highlighted the undoubted benefits of the Housing First model as it was released by the Department of Levelling Up, Housing and Communities (DLUHC).
The report, entitled “Evaluation of the Housing First Pilots Report on clients” outcomes 12 months after entering Housing First” looked at the three regional pilots (Greater Manchester, Liverpool City Region and West Midlands) and followed a group of people from across the pilots. This report is part of a series from the evaluation of the Housing First (HF) Pilots.
The findings are based on survey data collected directly from HF clients as they entered one of the regional programmes and then six months and 12 months later.
The analysis of six-month change is based on 159 clients who completed the baseline and six-month follow-up surveys, with the 12-month change analysis based on 167 clients who completed the baseline and 12-month follow-up surveys.
The report stated that: “The vast majority of HF clients were in long-term accommodation a year after entering HF and reported significantly better outcomes across a range of measures, with sub-group analysis suggesting that, in the main, HF support had wide benefits across the different types of clients coming into the programme.”
GMHF Programme Lead Emily Cole said: “The report adds to the growing evidence base that the Housing First model works and can make a significant contribution to fighting homelessness and rough sleeping – especially now as numbers are on the rise again.
“Housing First supports people who have experienced significant trauma which is why it is a long-term intervention with longer term research required around wider benefits that the approach realises. Even though only capturing outcomes after 12 months of support the data proves that the model has a significant impact on physical and mental health and allows people to reconnect with friends and family and access services to help them rebuild their lives.
“With a general election in the offing, we would urge politicians to look seriously at the research and embed the model across the country as there is hard evidence that the model works.”
Here is a breakdown of the report’s analysis:
Housing
A year after entering Housing First (HF), the majority of clients were living in long-term, largely social rented, accommodation.
84% were living in long-term accommodation at the point of the six-month interview and this rose to 92% after a year.
A year after entering HF, very high proportions were satisfied with the autonomy they had in their accommodation (e.g., 94% were satisfied with the control they had about who could come round).
However illustrating the challenge of housing supply, they were slightly less likely to be satisfied with the amount of choice they originally had about the place (77% were very satisfied).
Social connectedness
A year after entering HF, there had been a significant reduction in the proportion of clients reporting feeling lonely. When they entered HF, a third (35%) of clients reported ‘often or always’ being lonely, a percentage which had halved to 16% 12 months later.
Similarly, the percentages saying they ‘never’ felt lonely doubled from 16% to 27% over the period.
While three quarters (75%) of clients reported feeling at home where they lived, only half (48%) reported interaction with people locally. However, perhaps linked to support within HF, clients were significantly more likely at the 12-month point, compared to when they entered HF, to have people to turn to for support.
Coming into HF, 70% of clients felt they had someone to listen to them, a figure which rose to 81% after a year.
Safety
A year after entering HF, clients were significantly more likely than before to feel safe and less likely to have been a victim of crime. At 12 months, half (49%) of clients felt safe all of the time, with a further fifth (22%) feeling safe most of the time. This is a significant improvement on the comparative figures of 11% and 18% before entering HF.
Prior to entering HF, the majority of clients had been a victim of crime over the previous six months, with only three in ten (30%) saying that they had not been.
Six months on, two thirds (65%) reported not having been a victim of crime in the preceding six months. While things after a year remain significantly better than prior to HF, there is tentative evidence of clients being more likely to be victims of crime at the 12-month follow-up stage than reported after six months, with 55% reported not having been a victim of crime.
Wellbeing and health
A year after entering HF, there had been a significant positive shift in relation to clients’ wellbeing and health, particularly mental health, compared to their circumstances prior to entering HF.
Significantly greater proportions of clients reported eating and sleeping well. At baseline, using a five-point scale, 10% of clients reported eating well ‘all of the time’ and 3% slept well ‘all of the time’.
A year later, these percentages rose to 36% and 10%. Conversely, the percentage reporting ‘never’ eating well fell from 22% to 2%, with the comparable figures for sleep being 42% and 25%.
Clients were also significantly more likely to perceive their overall health as good after a year. Using a five-point scale, at baseline, 4% rated their health as ‘very good’ and 17% as ‘good’. A year later, the percentages were 7% and 27%.
In addition, significantly fewer reported suffering from anxiety (71% compared to 81% on entering HF) and depression (68% compared to 80%). There had also been an improvement in access to health services, with a significant increase in the percentage of clients registered with a GP from 60% to 92%.
Drug and alcohol use
A year after entering HF, there had been no statistically significant reduction in self-reported drug, overall drug use, or alcohol dependency. At baseline, 27% of clients said that they were dependent on drugs, a percentage which was 25% a year later.
The proportion of HF clients who reported being currently dependent on alcohol when they entered HF was substantially smaller (17%), and had not changed significantly (13%) a year later. However, there is some evidence of a reduction in the usage of particular drugs (e.g., a fall in the percentage using crack cocaine in the previous three months from 37% before entering HF to 20% after a year) and in the frequency of drinking alcohol.
However, substantial numbers of clients had taken action in relation to their substance dependency. Half of clients (51%) had received treatment for drug dependency since entering HF, and 17% had done so for alcohol dependency.
Contact with the criminal justice system
A year after entering HF, clients were significantly less likely than previously to report having been involved in antisocial behaviour (notices, orders, injunctions) or criminal behaviour. In the six months prior to entering HF, a third (34%) of clients reported having been involved in antisocial behaviour, a figure which dropped to 15% at the 12-month follow-up.
Likewise, while 29% of clients had been cautioned, arrested, or convicted of a crime in the year prior to HF, at the 12-month point, only 12% had done so in the previous six months.
Income, employment, training, and future plans
There is little evidence of clients having become closer to the labour market at the 12-month point after entering HF. Only 4% of clients were in paid work and only a further 3% were looking for work or expecting to be in work in the next six months.
This is in line with the HF theory of change, which would not predict an impact of HF on employment at this early stage, given the severity of disadvantage that clients have typically experienced. However, there is some suggestion that HF may have ensured that clients were claiming the disability benefits to which they were entitled.
At the 12-month follow-up, 56% of clients were in receipt of disability benefits, compared to 33% before they entered HF. When asked a series of statements about future plans a year after entering HF, substantial proportions of clients had positive plans. Using a four-point scale, six in 10 (60%) clients said that it was ‘completely true’ that they had the desire to succeed, and half (52%) said it was ‘completely true’ that they had life goals.
Outcomes for different subgroups of the client population
A year after entering HF, significant improvements in clients’ outcomes were evident across the whole of the client population. Analysis comparing changes in outcomes among different types of clients (split by gender, age, where they were living prior to HF, age they were first homeless, health, mental health, learning disability and substance dependency) showed a relatively consistent pattern of change.
The most notable differences related to:
Gender: women’s accommodation and health outcomes were less likely to improve than men’s;
Age: younger people’s health and alcohol dependency outcomes were more likely to improve than older people’s;
Age at which someone first became homeless: those first experiencing homelessness at a younger age had worse outcomes in relation to drug dependency;
Mental health conditions: those with conditions had better outcomes in relation to drug dependency than those without;
Cognitive impairment/disability: those with impairments had worse outcomes in relation to alcohol dependency.
Concluding comments
The vast majority of HF clients were in long-term accommodation a year after entering HF and reported significantly better outcomes across a range of measures, with sub-group analysis suggesting that, in the main, HF support had wide benefits across the different types of clients coming into the programme.
A follow-on report will look across the various elements of the evaluation to provide a rounded picture of how HF has worked in the three pilot areas and help to explain and interpret the pattern of change in outcomes reported here.