Analysis of ‘Housing First’ pilots reveals vast majority of individuals successfully retained their tenancies

An evaluation of the ‘Housing First’ pilots has confirmed a substantial improvement in the housing retention rate among participants with multiple and complex needs, and suggested that the programme has delivered value for money.

Participants additionally showed improved health and social outcomes, reducing their reliance on emergency services and other crisis interventions.

Housing First is an intervention which supports homeless people with multiple and complex needs, which most commonly relate to co-occurring mental health issues and alcohol and/or drug use, to access and maintain independent housing.

The full report, Evaluation of the Housing First Pilots - Final synthesis report, notes that the intervention differs from traditional ‘staircase’ or ‘treatment first’ approaches in that it places people directly in independent long-term settled housing, with personalised, flexible, and non-time-limited support.

There are no preconditions around ‘housing readiness’ or participation in treatment, rather secure housing is considered to offer a stable platform from which other issues might be addressed.

Pilot programmes were set up in the three combined authority areas of Greater Manchester, Liverpool City Region and West Midlands.

Clients of the Housing First initiative described experiencing multiple adverse life events before taking part in the scheme. Common key characteristics identified include:

• Homelessness – one third had been sleeping rough in the month before being accepted onto Housing First. 96% reported experiencing rough sleeping previously.
• Employment history and education - one in five (18%) had never worked and a further 72% had not worked in the past year. Half left school before the age of 16, with a further 36% leaving at 16.
• Health and well-being - 61% reported having a longstanding illness or disability, and 21% reported having a learning disability. The vast majority of clients self-reported having depression (80%) or anxiety (79%).
• Drug and alcohol use - 71% of individuals reported taking drugs in the previous three months, including heroin or opiates (34%) and crack cocaine (41%). Some 33% described being currently dependent on drugs.
• Involvement with the criminal justice system – three-quarters of respondents reported that they had been a victim of crime in the last six months, most commonly having their belongings stolen (35%), being threatened (31%), and being verbally abused (29%).

Substanial numbers of clients also had trauma, PTSD, personality disorders, psychosis, or schizophrenia. Half experienced mental health issues before 16, and 41% were prescribed medication. Only 57% had a GP, and 34% had spent time in prison. More than 40% had antisocial behaviour actions taken recently against them.

The clients were then asked to complete follow up surveys in order to track the progress of those who received housing under Housing First.

After six months in the progamme, 84% of clients were living in long-term, largely social rented, accommodation. This rose to 92% after a year.

“This represented a significant shift in their living circumstances compared to prior to being part of Housing First,” the report said.

It added that the housing secured for clients largely suited their needs, with most reporting high degrees of satisfaction with various aspects of where they were living.

Very high proportions were said to be satisfied with the autonomy they had in their accommodation, but clients were slightly less likely to be satisfied with the amount of choice they originally had about where they were housed.

A year after entering Housing First, clients were significantly more likely than before to feel safe and less likely to have been a victim of crime.

At 12 months, 49% of clients felt safe all of the time, with a further 22% feeling safe most of the time, marking a significant improvement on the comparative figures of 11% and 18% at baseline.

Significantly more participants reported eating and sleeping well 12 months into the programme, with 36% eating well ‘all of the time’ and 10% sleeping well ‘all of the time’ compared to 10% and 3% respectively at the time of the baseline surveys.

Equally, 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 with 7% rating their health as ‘very good’ and 27% as ‘good’ compared to 4% and 17% a year earlier.

Fewer of those surveyed reported suffering from anxiety (71% compared to 81% on entering Housing First) and depression (68% compared to 80%).

There was also an improvement in access to health services, with a significant increase in the percentage of clients registered with a GP rising from 60% to 92%.

At the end of December 2022, 884 individuals remained on the programme from a total of 1,061 that had been accepted onto the programme by that timepoint.

The most common reason for exit was loss of contact (103 individuals) followed by the death of the participant while on the programme (90 individuals).

The report analysed the costs of support provided by the three Housing First Pilots in England and the value of benefits delivered.

The costs of delivering the pilots averaged £7,700 per person supported per year to the end of 2022.

The report said that while the full benefits of the pilots would take many years to be seen, they were expected to amount to £15,880 per person per year, through improvements in personal well-being and reductions in the public service costs of homelessness.

More than half of the value of these annual benefits were estimated to have been realised 12 months after participants had entered the programme, the report said.

The benefit:cost ratio was therefore estimated at 2.1 (based on expected benefits) and 1.1 (based on estimated benefits after only 12 months).

“This suggests that the Pilots have delivered good value for money,” the report said.

Harry Rodd