How Housing First can improve both individual and community health

In the second blog in this series on Housing First, Alex Smith of Homeless Link discusses how offering Housing First tenancies can improve resident’s health and wellbeing whilst promoting thriving communities.

While homelessness, especially rough sleeping, gets particular attention in the harsh winter months, experiencing homelessness is traumatic and damaging to people’s health no matter the time of year.

Homelessness is a public health issue, not just a housing issue. Ill health can be both the cause and the result of homelessness and it makes sense that services take a joined-up approach to supporting people to recover and move on with their lives. Thankfully, for the people in England with the most complex support needs – those who have slept rough repeatedly or for long periods of time and experience multiple other needs including ill health – there is a solution.

Housing First is a specialist intervention that gives people a home, as well as wrap-around, open-ended support. We encourage social landlords and housing associations to consider getting involved with Housing First, to help residents with complex needs live healthy, independent lives.

Evidence of impact

Flagship research by Homeless Link shows that Housing First positively impacts residents’ lives long-term by ending homelessness, significantly improving physical and mental health and reducing offending behaviour and substance use.

Remarkably, research found that over three years, 55% of people had improved mental health, and 39% had improved physical health. Use of GPs rose from 50% on entry to Housing First to 89% after three years of support. These positive changes coincide with a sharp 20% decrease in residents’ use of A&E services after the first year of support and an 18% fall in safeguarding concerns, including risk of suicide and self-harm, over the three years.

Ron’s story

The North Yorkshire Housing First service, established in 2021, adds real life context to these findings. As part of the commissioned offer, housing and health workers - including nurses and psychologists -work together in the Housing First team, allowing the wider health and psychological needs of the client group to be addressed and supporting joined up working with a range of other services. The service has already supported 30 people to stay in their own home and significantly improve their health.

Ron has been housed under Housing First for three years. He presents with complex trauma and demonstrates a pattern of problematic alcohol use, causing him to struggle to maintain his safety, his home and a job.

Ron was often admitted to A&E and transferred to the cardiac unit but would self-discharge due to alcohol withdrawal. Ron failed to attend follow up appointments or arrived intoxicated. Ron’s Housing First team were able to explain to NHS colleagues that he would need to be placed on a detox pathway. As a result, further testing carried out identified that Ron was in heart failure. The cardiac team then liaised with the Housing First staff to arrange follow up appointments.

Ron was prescribed medication, and the team were supported to gain a comprehensive overview of Ron’s illness. Ron found it difficult to take the medication twice daily as needed, so the team liaised with his nurse to change his medication to one needed once daily, which they could better support him with.

The team also worked with Ron’s drug and alcohol support workers to secure a rehab placement that could meet his physical and mental health needs. Together, they outlined the severe impact of Ron’s alcohol use on his quality of life, to successfully apply for additional NHS funding. Ron now has a place in rehab, which he very much wanted.

Olivia’s story

Olivia, a woman in her fifties with experience of trauma and delusion, is also being supported by Scarborough Housing First. Because Olivia did not trust authorities, she missed her over 50s wellness check, cervical screening and well women check, despite receiving letters from her GP. The Housing First team worked with staff at the GP, enabling them to stop the letters, which had been making her anxious, and talk her through the reasons for each appointment.

Olivia ultimately decided to go ahead with the testing as she felt comfortable with what to expect. She is now up to date with her cervical screenings and has taken up the wellness screening offer, with no outstanding issues identified. Now Olivia feels more confident at the GPs and in control of what is happening to her.

Promoting healthy communities

Ron and Olivia’s experiences demonstrate the huge range of health issues Housing First can help resolve.

While there are over one hundred local services across the country, a lack of access to social housing remains a barrier to providing Housing First at scale. We hope to change this, and make sure intervention is available to the approximately 16,450 people who need it in England.

We would urge providers to consider partnering with Housing First, to positively impact people with complex need’s health and wellbeing. Housing First’s intensive support can also help make sure that tenancies are sustained, properties are taken care of and help communities thrive.