How Finland put housing first

Earlier this year, official figures showed that rough sleeping in England had risen for the sixth successive year.

The data showed that 4,134 people slept on the street in 2016, an increase of 16% on the previous year’s figure of 3,569, and more than double the 2010 figure. Many of those enduring long-term homelessness have complex and multiple needs related to mental health or addiction. While this is a growing problem in the UK, housing exclusion is by no means confined to these shores. As we reported in April, there is growing evidence of an alarming increase in homelessness across Europe.

But one European country is bucking this trend. Since 2008, the Finnish government has been working with housing agencies to reduce long term homelessness and improve prevention services. The adopted approach, called ‘Housing First’, has had a big impact, achieving a 35% fall in long term homelessness over seven years. Finland is now the only country in the European Union where homelessness continues to fall.

Housing First: what it means

Housing First is not a uniquely Finnish approach to tackling homelessness, nor is it a new idea. The practice began in Los Angeles in the 1980s. It’s based on the principle that housing is a basic human right, and turns on its head the notion that vulnerable people are only ‘housing ready’ once they have begun to engage with support services.

As the name suggests, Housing First means providing vulnerable people with permanent, affordable housing, and then offering specialised support to ensure that they don’t return to sleeping on the streets. However, acceptance of that support is not a condition for access to housing. The approach has been adopted in various American cities, as well as parts of Australia, Canada, France and Japan. But it’s in Finland that Housing First has achieved some of its most impressive results.

Housing First: how it works

One of the key players in Finland’s Housing First strategy is the Y-Foundation, an association of local authorities, church, construction, trade union and health organisations that has been supporting homeless people for more than thirty years. Starting in 2008, the foundation converted homeless shelters in Finland’s biggest cities into rental housing. At the same time, the government set targets for local authorities to build new flats in mixed housing developments. The programme is backed by money from government grants and the proceeds from Finland’s not-for-profit gambling monopoly.

Housing First: why it works

The cost estimate for Finland’s Housing First programme is €78 million. But Juha Kaakinen, chief executive of the Y-Foundation, has no doubts about its value for money. In an interview with Inside Housing, he explained:

“It’s not only good social policy; it has a big safety and security angle, as the more homeless people there are on the streets, the more unsafe the city is. And there’s an economic argument, too: taking care of these people is a good investment.”

He estimates that taking each homeless person off the streets saves social, health and emergency services around €15,000 a year.

Housing First in the UK

Homelessness charities in Britain have been taking great interest in the success of Housing First in Finland.

“It’s a stunning result,” Matt Downie, director of policy and external affairs at Crisis, told Inside Housing.  “They used to have a bigger homelessness problem than we have.” But he was less sure whether the programme could be replicated here. “We’ve got a system that is the exact opposite of Housing First. In Finland they made a strategic choice; that allowed them to change everything.”

Even so, Housing First is already gaining ground around the UK:

Scotland
A pilot project in Glasgow by Turning Point Scotland was the first Housing First project to be implemented in the UK. Between 2011 and 2013, the project provided mainstream social housing and 24/7 floating support to 22 individuals who were homeless, aged 18 or over, and involved in substance misuse. An evaluation of the project by Heriot Watt University found that none of the tenants were evicted from their flat and the majority of participants retained their tenancies.

Wales
The Welsh Government has announced that it is considering moves towards a Housing First policy. The communities and children secretary for Wales told the Welsh Assembly in April 2017 that he would be reviewing homelessness prevention in Wales, and is exploring Housing First initiatives.

Northern Ireland
Working with the Depaul youth homelessness charity, the Northern Ireland Housing Executive funded a Housing First pilot scheme in Belfast. An evaluation of the 18-month programme reported a number of positive results, including a high rate of tenancy retention, improvements in participants’ self-care, confidence and living skills, and reductions in their dependence on drugs and alcohol. A further Housing First programme has since been established in Derry.

England
In 2015, the University of York published findings from a study of nine Housing First services in England. The authors reported high levels of success in reducing long-term and repeated homelessness, with 74% of service users successfully housed for one year or more. There were also significant improvements in the physical and mental health of Housing First tenants and high levels of satisfaction. The Centre for Social Justice has called on the UK government to set up a £110m national Housing First programme, arguing that the investment would save money and lives.

Final thoughts

There is no quick fix to the problem of homelessness, but Finland has shown that adopting new ways of thinking about the problem can virtually eradicate rough sleeping. As Juha Kaakinen observes:

“Housing First means ending homelessness instead of managing it.”



Further reading on homelessness:

Debating the cost of alcohol to society

“Society is paying the costs – alcohol-related harm is now estimated to cost society £21 billion annually.”

So said David Cameron, launching the UK government’s alcohol strategy in 2012.

The prime minister was echoing the widely held view that alcohol is a financial burden on taxpayers. The British Medical Association has put the costs of alcohol harm in Northern Ireland and Wales at £680m and £1bn respectively, while the Scottish Government believes the annual cost of excessive alcohol consumption to be £3.6bn (equivalent to £900 for every adult in Scotland).

An alternative view

But now the popular view of alcohol as a drain on taxpayers has been challenged. A new report from the Institute of Economic Affairs (IEA) claims that the net cost of alcohol to the state is minus £6.5 billion.

The report found that the direct costs of alcohol use to the government in England – including NHS, police, criminal justice and welfare costs – amount to just under £4 billion each year, whilst revenues from alcohol taxes amount to over £10 billion. And it claims that even if the government halved all forms of alcohol duty, it would still receive more money in tax than it spends dealing with alcohol-related problems.

Commenting on the findings, the report’s author, Christopher Snowden said it was time to stop regarding drinkers as a burden on taxpayers:

“Forty per cent of the EU’s entire alcohol tax bill is paid by drinkers in Britain and, as this new research shows, teetotallers in England are being subsidised by drinkers to the tune of at least six and a half billion pounds a year.”

The report received a hostile reception from Alcohol Concern. Deputy chief executive Emily Robinson told the Daily Telegraph:

“Non-drinkers suffer the consequences of alcohol related problems every day; whether that’s from drink driving accidents, being the victim of crime or anti-social behaviour, family breakdown, waiting in Accident and Emergency departments for their turn, even through to the costs of street cleaning town centres after a Friday night.

She went on to argue that policies, such as minimum unit pricing (MUP), were needed to tackle the harm caused by alcohol.

A setback for minimum unit pricing?

The IEA report appeared on the same day that the European Court of Justice (ECJ) advocate general advised that the Scottish Government’s policy on MUP breached EU competition and free trade laws.

The proposal to introduce minimum retail pricing for alcohol appeared in the Scottish Government’s 2009 alcohol framework, and in 2012 the Alcohol (Minimum Pricing) (Scotland) Act 2 paved the way for the introduction of a minimum price of 50p per unit. The policy was challenged by the drinks industry, which believes that there are more effective ways of tackling harmful drinking.

While the advocate general’s advice may influence the ECJ’s final decision, The Scottish Government is standing by its policy. “While we must await the final outcome of this legal process,” said Scotland’s First Minister, Nicola Sturgeon, “the Scottish Government remains certain that minimum unit pricing is the right measure for Scotland to reduce the harm that cheap, high-strength alcohol causes our communities.”

The devolved administrations in Wales and Northern Ireland have set out plans to introduce their own MUP legislation. In England, the 2012 alcohol strategy included a commitment to introduce an MUP for alcohol. However, in 2013 the coalition government decided not to proceed with this, and instead to impose a ban on the sale of alcohol below cost price.

Last year, a report from Sheffield University suggested that below cost price policy would have small effects on consumption and health harm, while an MUP set at  a level between 40p and 50p per unit, was estimated to have an approximately 40-50 times greater effect. The research appears to support evidence from Canada, the first country in the world to introduce MUP, indicating that MUP could bring significant health benefits.

With the IEA report introducing a provocative new perspective, and the final judgement on MUP awaited, it’s unlikely that ‘last orders’ will be called any time soon in the debate on alcohol’s impact on society.


 

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Further reading*

Alcohol pricing and purchasing among heavy drinkers in Edinburgh and Glasgow: current trends and implications for pricing policies

Understanding the alcohol harm paradox in order to focus the development of interventions

Understanding the development of Minimum Unit Pricing of alcohol in Scotland: a qualitative study of the policy process

Alcohol’s harm to others

The cost of binge drinking in the UK

*Some resources may only be available to members of the Idox Information Service

Public Health Information Network for Scotland (PHINS) – 14th Seminar

Image of outside of the Glasgow Royal Concert Hall.

Image by Neil Turner under Creative Commons License, via Flickr

By Steven McGinty

On the 10th October I attended an annual event organised by the Scottish Public Health Observatory (ScotPHO) in the Royal Concert Hall in Glasgow. The event focused on health inequalities and the factors driving them. It brought together individuals from a variety of areas, including academia, public health organisations, local and central government, and the voluntary sector to review current evidence, highlight upcoming research and debate key issues with fellow professionals. Continue reading

The World Cup 2014 is great for many things but public health isn’t one of them

football and beer sign

Used under a Creative Commons license from Flickr (source)

by Steven McGinty

This month, the world’s attention has been unequivocally focused on Brazil, with the start of the 2014 World Cup. For many, the arrival of the #WorldCup has been four years in the waiting. However, for some, the potential negative consequences of the World Cup are of great concern.

Two of the main organisations to make their viewpoints known are Alcohol Concern and the BMJ. They both highlight that the increased consumption of alcohol will be damaging to public health, with increases both in alcohol related violence and emergency admissions. The medical evidence on irresponsible drinking seems clear enough, but the question is, what can be done to prevent this? Continue reading