"We need leadership that empowers change now. The evidence is clear; integrated interventions where all stakeholders have a place at the table and hold each other accountable is critical to the cultural change in leadership we require."
Unless Scotland embraces a radical, new, collaborative culture throughout our public services, both budgets and provision will buckle under the strain. That was the message, some ten years ago from Dr Campbell Christie and his commission on the future delivery of public services.
However, despite a series of Scottish government initiatives and significant growth in public spending since devolution, on most key measures little has changed and the inequalities that exist in our society continue to contribute to increasing demands on our public services.
The development of a collaborative culture is critical, and Housing First delivered through a consortium of genuine collaboration is one small but important contribution to answering Christie’s challenge.
Housing First is an evidence-based approach which successfully supports people with multiple complex needs (MCNs) and histories of repeat homelessness, to live in their own homes. It has been widely adopted across the US, is central to the national homelessness strategies in Canada, Denmark, Finland and France, and is growing in popularity in countries including Italy, Sweden, Spain and in other parts of the UK.
The overall philosophy of Housing First is to provide a stable, independent home and intensive personalised support. Housing should be seen as a human right by all social care and support services. There should be no conditions around ‘housing readiness’ before providing someone with a home.
In my experience, mainstream services are often not equipped to support individuals with overlapping multiple complex needs, are siloed in their own areas of work, and are impacted by a fear of the genuine drive towards integration or held back by the vested interest of individuals. The Hard Edges Scotland report published in 2019 pointed out that referrals to addiction and mental health services of clients experiencing severe and multiple disadvantage (SMD), many of them homeless, arise because services and housing options “have no command over these resources, nor the necessary authority to coordinate timely multi-sectorial interventions for people with complex needs”.
The Pathfinder Programme
In Scotland, the Pathfinder programme is a genuine attempt to address these structural barriers.
Jointly administered by the Scottish Government and Social Bite across five pilot areas in Aberdeen and Aberdeenshire, Dundee, Edinburgh, Glasgow and Stirling from 2018 to 2021, Pathfinder supported international evidence that Housing First works for those most marginalised with enduring MCNs.
In Aberdeen and Aberdeenshire, where I chaired the Housing First board, our local programme specifically targeted those people with MCNs who had a history of cyclical homelessness, chaotic mental health and substance misuse, often entwined with repeat offending and custodial periods.
With those characteristics in mind, we knew that collaboration would be essential and – working with local authorities – sought to establish a Local Outcome Improve Plan charter early on. We also wanted to make sure that both of the Health and Social Care Partnerships (HSCPs) in the areas we worked in were at the table in order to ensure service access and availability were equitable.
The success of the programme in Aberdeen and Aberdeenshire speaks for itself.
In December 2019, the Community Planning Board for Aberdeen approved the charter which is expected to improve health and wellbeing outcomes for 50% of programme participants in the Housing First Pathfinder Program by December 2021.
We gave participants a home; not temporary ‘steppingstone’ accommodation but a tenancy they could sustain. We achieved 92-93% tenancy sustainment (where anything >80% is considered as a successful change measurement internationally).
We provided intensive support to the participants to work through their own issues to reduce their level of chaos, ultimately supporting the individual to maintain their own wellbeing and tenancy.
Over a two-year period we did not experience a single eviction within a group of people for whom eviction had previously been a common experience. This gives testimony to the integration and hard work of partner agencies and shines a light on what can be achieved when the commitment is shared, owned and clearly open to national scrutiny.
The landscape of local authority homelessness services, Housing First programmes and HSCPs will have, without doubt, been negatively impacted by the national response to Covid-19. The need for reform is urgent but the resources to achieve it is low. And so I ask: if a moment of crisis isn’t the time to look again the ecosystem of support, when will be?
We need leadership that empowers change now. The evidence is clear; integrated interventions where all stakeholders have a place at the table and hold each other accountable is critical to the cultural change in leadership we require.
The Homelessness in Scotland report published in July showed that measures introduced during the pandemic to prevent homelessness had a limited impact on reducing the number of people with mental health problems experiencing homelessness.
While the total number of households assessed as homeless or at risk of it fell by eight per cent compared to 2013-14, the figure for those with mental health problems saw a shocking 90% increase. The figures also show that mental health is now one of the biggest causes of homelessness, attributed in almost a quarter of cases.
In 2013-14, 3,899 people, or 13% of all those assessed as homeless across Scotland were noted to have a mental health problem. In 2019-20, that figure had risen to 8,404, representing 27%.
The delivery of Housing First programmes across Scotland, reflected in local authority Rapid Rehousing Transition Plans and delivered by local authorities or commissioned services, needs to be reflective of the integrated model that Pathfinder set out to create.
The Hard Edges report clearly explains that any move towards offering short-term or ‘light touch’ floating support to those with MCNs after they have moved into their own tenancies, will see a return to cyclical homelessness. Any reversion to historical commissioning patterns, or without the necessary collaboration with mental health and other health and social care services, risks the same.
If Housing First is to achieve the best outcomes for those living with MCNs, we need to work collaboratively and for the long-term. Any alternative is a step backward.
Mike Burns is the CEO of Penumbra, one of Scotland's largest mental health charities. Mike is the former CEO of Aberdeen Cyrenians, former chair of the Aberdeen and Aberdeenshire Housing First board and a former member of the national Housing First board.
Over the coming weeks, we will be sharing a range of guest blogs as part of #ChristiePlus10, reflecting on the ten years since the publication of the Christie Commission.