Policy shift or program drift? Implementing Housing First in Australia
Housing First approaches are based on the concept that a homeless individual’s first and primary need is to obtain stable housing, and that other issues that may impact the household can and should be addressed once permanent housing is obtained. It involves housing people in the wider community with clients receiving support when they require it from multidisciplinary Assertive Community Teams (ACT). It can be contrasted with the ‘continuum care’ model, which makes progress to permanent housing conditional upon committing to address issues such as addictions and managing mental health, and is often provided through congregate living arrangements.
The Housing First model first came to prominence in America, but now programs have commenced in Australia. Evaluation evidence from the United States suggests that rates of retention in housing are much higher in the Housing First model compared to continuum care models, thus substantially reducing the incidence of homelessness. However, outcomes in terms social inclusion and recovery from substance abuse have been less impressive, and the cost savings associated with the model (in terms of reduced hospitalization acute treatment and involvement with criminal justice) do not meet the cost of providing supportive housing.
The authors argue that the Housing First model has much to recommend it for Australia, but care should be exercised in applying the model in Australia, which faces a different policy environment to the United States. For example, because many of the principles underpinning Housing First (client empowerment, voluntary nature of accessing services) are already present in mainstream services, we might not expect the dramatic improvements witnessed in the United States. Furthermore, there has been substantial ‘policy drift’ over the course of time which has meant that Housing First models in Australia have already been altered from the formulation in the US, entailing the need for independent evaluation in an Australian context.