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Ain’t Got No Home In This World Anymore. I feel like I’ve been here before. “38 % of people sleeping rough in London have drug support needs” [chain: 2010]. 88% had used a drug other than alcohol in the last year 55% had used heroin in the past year [CRISIS/NAC 2002]. THE FIGHT.
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“38% of people sleeping rough in London have drug support needs” [chain: 2010] 88% had used a drug other than alcohol in the last year 55% had used heroin in the past year [CRISIS/NAC 2002]
THE FIGHT Round 1 Vs JELLINEK MASLOW Is ‘rock bottom’ a prerequisite for change or will the unmet basic needs hinder self actualisation.
A Rock and A Hard Place • Cut out of benefit system and often no form of identification • Can’t gain access to housing until claim sorted • Places in housing dependent on being in treatment or being abstinent • Difficulty of gaining access to structured treatment while homeless • Or as a person I knew back then put it: • “Nowhere to live till I get clean; no way to get clean till I get somewhere to live”
Eyes Wide Open • Model of housing which: • worked with people while they were still actively using • Actively acknowledges use – doesn’t turn blind eye t o it • Doesn’t directly or indirectly exclude for use • On site needle exchange • Open joint working with drugs agencies • Early adopters: • Single Homeless Project, St Mungos, Thamesreach • Brighton and Hove Housing Trust, Foundation Housing • Wallich Clifford Community, MMHG • Key Outcomes: • No resident drug deaths on site • Good use of Nx • High vaccination rates • Improvements in health, retention and referral
I’m Not Moving • We only got so far: • Lots of areas still have no ‘eyes wide open’ housing • Too many areas still ‘turn blind eyes.’ • There’s still been a lack of firm Government endorsement. • Momentum has stalled. • Eyes wide open housing not perfect: • Just as with opiate substitution therapy some people got ‘stuck’ • Housed and stable in accommodation but • still using and injecting • and/or engaged in OST • but not making further substantial changes • A dilemma for providers of ‘eyes wide open’ housing • Maybe a resurgence in interest in recovery could be a solution?
Drug strategy says “Homeless people are also more likely to require assistance to access and sustain specialist drug treatment and to help them to live independently.” … We have also announced an innovative voluntary-sector led incentive scheme to improve the help available for single homeless people to access the private rented sector, thereby aiding their recovery. … the development of a Payment by Results…for housing-related support services, for people dependent on drugs and/or alcohol.” Payment by Results: what result?
THE FIGHT Round 2 Vs Howard Gyngell Recovery: is it synonymous with abstinence or not.A no-holds barred ‘slug’-fest.
If recovery is taken to equate with abstinence… Then a PBR housing model which only pays for an abstinent outcome will effectively time limit or put an end to supported housing working with dependent users without a pre-requisite that they sustain abstinence. That such a model will see the most vulnerable and those with most entrenched use either denied housing in the first instance or housing ending if they don’t achieve change within a set time frame. That housing models will reflect an abstinence orientation, and will develop policies accordingly which will mean the policy and practice are ill-matched for ongoing use.
Where are we going to live? Proposed housing benefit cap: George Osbourne imposed caps on housing benefit of £400 a week for a four-bedroom property and £250 a week for a two-bedroom home. The government estimates that 14,000 households will be affected, largely in London. [Guardian: July 2010] • Increased strain on services • Less selection of housing • Interruption of treatment interventions • Further removal from potential recovery assets
Lean on me – I won’t fall over. • Supporting People: overall cut of 2.7% with significant local variance • but • local implementation has seen huge local changes: • some authorities increasing spending • 41% of authorities cutting SP budgets by a greater extent than that lost by central Government • cuts as high as 45% • How to implement such cuts? • John Coventry – St Austell , Cornwall : 40% cuts • Focuses on alcohol usage • Cease to work with the most challenging and most difficult • Reduce the number worked with • Ban use on site • Reduce cover/call out/out of hours • Night shelter only
You Pay My Rent • Changes to Single Affordable Rent (SAR) • To be extended to cover under 35s from January 2012 • SAR allows rental for a single room in shared accommodation. • Potential huge impact on people who are dependent on drugs and not in abstinent recovery • Shared housing can and does have a potentially hugely beneficial effect where people have stopped using, desire to stay stopped, and will benefit from the support of others to achieve this. • Much like drug-free second stage housing… BUT • Shared housing for ongoing users, ESPECIALLY with a reduced level of support is less likely to be therapeutic or beneficial • And has a low level of appeal to private landlords
Better to light a single candle than to curse the darkness PBR tied to recovery SAR extension Policy commitment from Govt Austerity Possibility of additional money: PBR SP Cuts Localism Benefit Caps Ideological shifts ROIS Local visible recovery champions Work Programme Criminalisation of squatters HB Cap