Research shows Australia’s Housing First approach produces better housing retention rates compared to other programs, but impact on health is less clear

Authors: Daniel Kuehnle^1,2, Guy Johnson³, Yi-Ping Tseng⁴

1. University of Duisburg-Essen & CINCH, Essen, Germany
2. Institute for the Study of Labor (IZA), Bonn, Germany
3. RMIT University, Melbourne, Australia
4. Melbourne Institute of Applied Economic and Social Research, Melbourne, Australia

Summary:

In recent years policy makers around the world have progressively embraced an approach known as Housing First to end long-term homelessness. The Housing First approach emphasizes rapid placement of clients into independent housing while at the same eschewing requirements that clients demonstrate sobriety or success in treatment programs prior to being offered housing. Research into Housing First programs show that it produces significantly better housing retention rates compared to those obtained from traditional programs, although the results from other outcomes measured such as health, social connection and employment, are more patchy.

In 2009 an inner-city service in Melbourne, Victoria began a pilot of a new intensive support program called Journey to Social Inclusion. The program embraced many key Housing First principles but also differentiated itself by providing program participants with three years of intensive support. The aim of the program was to provide participants with the skills and resources they needed to successfully transition out of homelessness into mainstream life

We evaluated the three-year program over six-years using a randomised controlled trial. Unlike most experimental and quasi experimental studies of interventions like the program, our observation period of 6 years was considerably longer and this was important in terms of understanding the longer term impact of intensive support programs. The results, recently publishing in the Journal of Urban Economics, are illuminating, if not a little sobering. Three years after the trial began, we documented substantially higher rates of housing and better employment outcomes for the treated group, but no significant changes across the three measures we used to assess participants health. The measures included the Depression Anxiety Stress Scales, a widely used, valid and reliable tool to measure the severity of mental health problems in adults; we used the SF-36 inventory to measure self-assessed health, which was measured on a five-point scale ranging from 1 (very good) to 5 (bad); and we collected self-reported information on health service use to calculate health service costs. Three years after the program ended, we observed no significant differences between the treatment and control group with respect to any outcomes, including housing retention and health.

Although our results show that the long-term homeless can maintain their housing with the right mix of support, it is equally clear that once chronic homelessness sets in, it is challenging and costly to resolve. Indeed, the participants had been at the margins of society for many years and that the compounding effects of long-term social exclusion are hard to overcome. For many participants, poor physical and mental health, constant exclusion from the labour market, prolonged exposure to poor living conditions, and social stigma mean that the likelihood of experiencing rapid and significant improvements in economic, health, and social outcomes are low, despite improvements in housing and access to therapeutic means. Policy makers can underestimate how challenging and complex this process can be, with the result that many interventions are insufficiently resourced to provide meaningful and much needed support during the settlement process. Although housing is not a sufficient condition to improve other outcomes, it appears to be a necessary and complementary condition to help improve these other outcomes as well.