by Terry Richards


Mercer Story

Nicholas Pleace and Joanne Bretherton “Will Paradigm Drift Stop Housing First
from Ending Homelessness? Categorising and Critically Assessing the Housing
First Movement from a Social Policy Perspective” Paper given at Social Policy
in an Unequal World: Joint Annual Conference of the East Asian Social Policy
Research Network (EASP) and the United Kingdom Social Policy Association (SPA)
University of York, United Kingdom, July 16th-18th 2012


Proof Independent Private ‘supported housing’ approach will End Veteran Homelessness, Not Building Veterans Homes!!! – Part 1 of a Series

Writer’s Note: Surveys have revealed that 80% of Veterans do not want to live in Veterans Homes whether on or off VA or other Government Property because they don’t have their total privacy, and because they are subjected to substance abuse testing, curfews, not being able to have overnight guests, and other Rules that are part of this kind of housing. Most of these Veterans say they would rather be homeless than live in this kind of housing…

LOS ANGELES, CA – The information provided in this story and the continuing series of stories will prove that the “Independent Private ‘supported housing’ approach (‘Housing First’) through HUD-VASH (VA Supported Housing) for about 80% of Homeless Veterans in Los Angeles and housingfirst10tipsforsuccessNationwide will end homelessness among Veterans, Not the building of Veterans Homes!!!

Will Paradigm Drift To Veterans Homes Stop Housing First Approach from Ending Veteran Homelessness? housingfirstdoingmorewithlessbldgs

Housing First is at the centre of policy responses to chronic homelessness in Finland, France, Ireland, the Netherlands and the USA. Services following a ‘Housing First’ approach have also appeared in Austria, Australia, Denmark, France, Hungary, the Netherlands, Japan, Portugal and the UK. Recent  hudvashcommittmentsignresearch has noted growing diversity in ‘Housing First’ services and that many services have ‘drifted’ significantly from the service design established by the Tsemberis ‘Pathways’ service. The Housing First movement is now at risk of losing focus, with discussion and implementation of what are nominally ‘Housing First’ approaches now encompassing a range of diverse ideas and hudvashpicuteofhouseservice models. This paper argues that there is a need to construct a clear and accurate taxonomy of Housing First services. Creating this taxonomy is a first step in refocusing attention on the effectiveness of the original Pathways model in producing sustained exits from homelessness for vulnerable people and may also serve as a means to look critically at the housingfirstVeterans-First-logoeffectiveness of emergent forms of ‘Housing First’ service.

The housing sustainment rates reported by the Pathways (PHF) ‘Housing First’ ‘supported housing’ approach, with 88% of formerly chronically homeless people still in housing at five years being reported by one study and 74% still in housing at four years by another, were close to double the rate of housing sustainment achieved by LRT (linear residential treatment model) sometimes called the ‘staircase model’ in Europe) Although the term ‘Housing First’ had already been used elsewhere, the homelessness service with which ‘Housing First’ is synonymous was established by Pathways in New York in 1992.

HUD Secretary Shaun Donovan: “The Obama Administration is on the right path, working together across agencies to target Federal resources to produce a measurable reduction in Veteran homelessness. Key to this success has been VA and HUD’s implementation of the Housing First approach endorsed by the Administration’s strategic plan to prevent and end homelessness. As our nation’s economic recovery takes hold, we will make certain that our homeless veterans find stable housing so they can get on their path to recovery.”

Although the term ‘Housing First’ had already been used elsewhere, the homelessness service with which ‘Housing First’ is synonymous was established by Pathways in New York in 1992. Pathways Housing First (PHF) is based on the ‘supported housing’ approach which was originally developed for former psychiatric patients being discharged from long stay hospitals. PHF is targeted on people experiencing, or at risk of, sustained homelessness who have a severe mental illness and also works with people with severe mental illness who present with problematic drug and/or alcohol use.

As is extensively documented elsewhere, PHF was developed in reaction to the continuum or linear residential treatment model (LRT) (sometimes called the ‘staircase model’ in Europe). The LRT approach was treatment-led and aimed to resettle homeless people with severe mental illness and/or problematic drug and alcohol use by using a series of ‘steps’, beginning with highly supportive, highly regulated communal accommodation, progressing into more home-like 3 environments and ending with independent housing. These services required conformity with treatment and abstinence from drugs and alcohol. They sought to treat severe mental illness and end problematic drug and alcohol use before, eventually, addressing housing need. The LRT model was widely criticised, both because these services often used a relatively harsh regime that required both abstinence and treatment compliance and because LRT services were frequently abandoned by homeless people. LRT services often lost a majority of their service users before the process of treatment and resettlement was complete.  

 The advocates of PHF argued that LRT services required service users to comply with psychiatric treatment and show sobriety because it was assumed they will ‘value’ independent housing that they have ‘earned’. By contrast, PHF was described as grounded in the following operating principles: Housing is a basic human right. There should be: o respect, warmth and compassion for service users; o a commitment to working with service users for as long as they need; scattered site housing using independent apartments (i.e. homeless people should not be housed within dedicated buildings but within ordinary housing); separation of housing from mental health, and drug and alcohol services (i.e. housing provision is not conditional on compliance with psychiatric treatment or sobriety); consumer choice and self-determination (i.e. delivering mental health and drug and alcohol services with an emphasis on service user choice and control; basing treatment plans around service users’ own goals); a recovery orientation (conveying a positive message that recovery is possible for service users); a harm reduction approach (i.e. supporting the minimisation of problematic drug/alcohol use but not insisting on total abstinence).

Homeless people using PHF have a severe mental illness, this is the group for whom the service is designed and, in addition, the funding for PHF partly relies on Federal welfare benefits for which only people with severe mental illness are eligible PHF places formerly chronically homeless people in furnished 4 apartments provided via the private rented sector. Housing must be of reasonable quality and service users must sign a lease agreement, usually with PHF (i.e. the tenancy is held by PHF and the service user is sub-letting). This approach reduces any private landlord concerns about letting to formerly homeless people as the tenancy agreement is between PHF and the landlord, but while it arguably somewhat reduces the housing rights of service users, it also creates flexibility, because PHF can relatively easily move service users between housing if there is a problem, without needing to evict them. There is no requirement for compliance with psychiatric treatment or for abstinence from drugs or alcohol in order to access and retain housing. Access to housing is however not entirely unconditional, as service users must agree to a weekly visit from a PHF support worker and also to paying 30% of their monthly income towards rent, alongside agreeing with the requirements of their lease.

The PHF interdisciplinary team combines Assertive Community Treatment (ACT) and Intensive Case Management (ICM) services. The ACT element concentrating on people with the severest forms of mental illness, while the ICM team supports those service users with relatively lower levels of need. The interdisciplinary team can include a psychiatrist, a peer specialist (i.e. a former service user providing support), a health worker, a family specialist (centred on enhancing social support), a drug and alcohol worker, a supported employment specialist, as well as a housing specialist. Quasi-experimental and control studies have shown that PHF in New York had much better resettlement and housing sustainment outcomes than LRT services.

The housing sustainment rates reported by PHF, with 88% of formerly chronically homeless people still in housing at five years being reported by one study and 74% still in housing at four years by another, were close to double the rate of housing sustainment achieved by LRT services. There is also evidence of cost effectiveness. PHF costs less than staircase models because no specialist accommodation has to be built. PHF service users also make less use of emergency shelters, less use of emergency medical services, and are less likely to get arrested than when they were homeless, all of which produce savings for the US Taxpayer.

Writer’s Note:  In my entire life I have never seen so much grandstanding, debating, bickering, whining, greed, drama, improper political maneuvers, back-stabbing, excuses, stalling-tactics, red-tape, lack of staying informed and lack of knowledge and research in endeavoring to understand the “mind-set” of homeless Veterans, and just plain old bull-crap by Veterans Advocates, especially Bob Rosebrock and his Old Veterans Guard and Veterans Revolution Group, Members of Congress, The Democratic and Republican Parties, and Los Angeles City and County Members of Government, et al, over endeavoring to solve the homeless Veterans plight in Los Angeles, when the ‘Housing First” Paradigm solution has already been ascertained and tested, already part of The Obama Administrations’ the VA’s strategy because it’s the most successful Worldwide of any other Paradigms… So all of the above mal-behavior needs to cease and desist and for them and Congress and everyone else to foucs on the Solution, which is for Congress to Legislate and Appropriate Funds for 70,000 HUD-VASH Section 8 Housing Vouchers for all of the estimated 70,000 homeless Veterans or for as many as there actually are that want Independent Private Housing using the ‘housing first’ – ‘supported housing’ approach as opposed to Veterans Homes… 

Just click onto the link to read Part 2 of this story: 


Mercer Story
Nicholas Pleace Centre for Housing Policy, University of York

European Observatory on Homelessness (Corresponding author)

Joanne Bretherton Centre for Housing Policy, University of York 2