Homelessness has hit the headlines again. There has been a steep growth in the number of homeless children in Britain – at least 135,000, according to the charity Shelter, the highest in 12 years, will be homeless and living in temporary accommodation this Christmas. There are record numbers of rough sleepers in some cities, including London. And a horrifying and escalating number of deaths of people who are homeless.
Predictably, pre-election debates regarding the (mis)representation of homelessness statistics and accusations regarding who is to blame for the current situation abound.
All forms of homelessness have a profoundly negative impact, but the one that courts most media and public attention is rough sleeping due to its greater visibility and the extreme dangers faced by those living on the streets. A vast amount of money, time and personal commitment has been invested in ending street homelessness.
Some progress has recently been made in reducing the number of rough sleepers at the national level, due at least in part to targeted government investment in areas with high levels of rough sleeping. The 2019 Homelessness Monitor reported a 2% drop over the past year across England, for example. But this does not detract from the fact that at the beginning of 2019, the total remained 165% higher than in 2010.
Part of the solution does of course lie in prevention, that is, in making people less vulnerable to homelessness and rough sleeping in particular.
A manifesto to end homelessness recently developed by a coalition of UK charities calls for the government to do more in terms of prevention, including strengthening the welfare system and improving access to affordable housing. More also clearly needs to be done to resolve the plight of those who find themselves living on the streets.
I recently took part in a project reviewing international evidence regarding “what works” in ending rough sleeping. We found that the current evidence base is a bit patchy, but there are nevertheless strong grounds to promote some responses over others. Yet our review showed that the UK, like most other western societies, continues to invest in responses that are ineffective for a substantial number of those they purport to help.
We know that interventions such as Housing First, which offers rapid access to settled housing and long-term flexible support on a relatively unconditional basis, works for the vast majority of those it targets. So does the provision of person-centred support, which gives rough sleepers more say in which services they use than traditional approaches.
But these interventions are still provided on a relatively small and localised scale in England and Wales (although Housing First is being scaled up in three city regions of England and is being rolled out in an ambitious programme across Scotland).
Evidence also confirms that “assertive outreach”, which very proactively and persistently encourages and supports rough sleepers to “come inside” and engage with support services, is effective. This was a critical ingredient within large-scale initiatives that reduced rough sleeper numbers substantially in England and Scotland in the late 1990s and early 2000s.
Collaboration across sectors, including health, housing, and policing is also very influential in bringing an end to episodes of street homelessness.
Depressingly, some of the approaches adopted most widely internationally, including a number of mainstream responses in the UK, are reported to be ineffective.
Many hostels and shelters, which are the “bread and butter” response to rough sleeping in most western societies, are cases in point. These are intended to provide emergency or temporary accommodation, but a lack of move-on housing means that they often end up providing long-term but unsustainable solutions. Hostel residents are less likely to experience improvements with things like health than are homeless people provided with Housing First.
In addition, many homeless people find hostels and shelters highly intimidating and unpleasant environments. Some choose not to use them due to fears for their safety or because doing so compromises their recovery from addiction or mental ill health.
Levels of support associated with a number of common interventions have been revealed to be inadequate or entirely absent. In some parts of England, particular concerns have been raised about the denial of key services such as emergency accommodation to rough sleepers with no “local connection” to the town or city where they are contacted by street outreach workers if they refuse to return back to their “home” area. The over-intrusiveness and lack of user choice regarding the support provided in a number of other programmes were also deemed problematic.
So if existing evidence (imperfect as it may be) provides a good indication of what does and doesn’t work in ending rough sleeping, why aren’t services that we know to be effective used much more widely?
There are a number of reasons for this – not least a lack of affordable and suitable settled accommodation for people to move into. Restrictions on rough sleepers’ eligibility for help, meanwhile, such as having no recourse to public funds (affecting many migrants) or “local connection” (in the case of some UK nationals who may have moved from their “home” area), are highly problematic. And short-term funding and bureaucratic barriers hinder the commissioning and delivery of flexible cross-departmental support.
Also critically important is the lack of political will in government. This impedes the implementation of responses that work. Achieving a significant shift in responses to rough sleeping in any context requires considerable political will, not least because of the potentially high upfront investment and associated upheaval of prevailing “ways of doing things”.
The dominant political parties in the UK have very different legacies as regards levels of interest in and policy contributions to the causes, prevention and amelioration of homelessness. Whichever party holds power after the election, we must hope that policy responses are strongly informed by evidence, and that investment of public resource is directed toward what is known to be effective: rapid access to affordable housing together with person-centred support that is available for as long as it is needed.
Sarah Johnsen receives research funding from a range of sources, including central government, research councils, and charitable bodies. The international evidence review drawn upon in this article was funded by Crisis.