Nearly all cities struggle with providing good quality and affordable homes for all their citizens. In some it’s become an existential challenge, fundamentally linked to the ability to continue to succeed or even survive. Our cities often have pockets of incredibly luxurious and expensive housing, beyond the reach of even those working in relatively well paid and secure jobs. It is sadly all to frequent that you can observe fellow citizens living in doorways, parks and underpasses in close proximity to these homes for the wealthy. In all measures other than geography they live lives very distant from the urban idyll. The issue of people ending up sleeping on the streets of our cities is to be found world-wide, from Osaka to Sao Paulo, from Auckland to Stockholm. The underlying reasons that lead people to living on the streets are often multi-faceted and can be linked to particular local or regional factors. Health issues, both physical and mental are more common than in the general population. Research from the UK indicates the significant role played by alcohol and drugs. There is a strong correlation in terms of individuals who have experienced some form of significant trauma. We also cannot ignore the impact of national and municipal policies. Across the globe, policies intended to reduce government expenditure have made many millions more vulnerable to becoming homeless. 

It is true that considerable resources are directed in trying to deal with this problem. I have worked alongside at least three initiatives in England or London where the objective was to end rough sleeping. National government, city level, local authority, police, health bodies and the voluntary sector all seek to reduce the number of people on the streets or mitigate related issues. A short walk through any area of central London soon shows that despite some genuinely excellent work that is happening, there is a lot more to do.

Now one positive aspect of a problem experienced by so many cities is that there are opportunities to look at what other areas have done. International comparisons in this area are fraught and challenging due to differing definitions, politics and the pure complexity of counting those without a roof over their head. The Homeless World Cup Foundation made a helpful attempt to provide a global overview, but this does appear an area ripe for some serious academic activity. However, in terms of initiatives there are some interesting projects worth examination.

Last month a headline from Irish internet publication, The Journal, carried the headline Fix it like Finland. This highlighted the success of Finland’s approach, which as the article states now means that Helsinki doesn’t have a single rough sleeper on its streets. Here is an example where the laudable ambition of eradicating rough sleeping has been achieved. So, what was this approach that succeeded where, so few others have? Step forward Housing First. The philosophy behind Housing First is simple. Rather than go through various stages such as; moving into a hostel, seeking to address health, substance use or other issues, the priority is placed on moving an individual into their own accommodation as soon as possible. Its origins are to be found in Los Angeles and New York around 1990. Its influence has spread across the world and has been adopted by politicians of all hues. Quite something when you consider its underpinning philosophy is of housing being a human right, and that its approach of removing hurdles to individuals and bringing services to them provides it own political and resourcing challenges. One of the reasons Housing First has spread is that it has a positive evidence base, although there are also a number of critiques. So, there we are, a successful, deliverable approach to a widespread and age-old problem. Except, that in some areas it doesn’t seem to have worked. The Irish story referenced above actually compares the experience of Helsinki against the much less favourable outcomes in Dublin. The fact that not all interventions work in every location should not be a surprise or automatically detract from the validity of any given approach. Initiatives likes this exist in their own local ecology. Levels of financial and political resource will vary. Support from the community (which itself can influence political support) varies. The level of substance use or mental health problems is not uniform. Nor the quality and quantity of services to respond to these challenges. Availability of suitable housing stock is difficult, or impossible, to secure in many cities.

So, we need to ensure that we continue to improve services to help address the needs of both rough sleepers and the broader communities in which they exist. In London we are fortunate to have a Find and Treat Service which goes out to street populations and helps tackle TB, HIV, Hepatitis B and C. Pathway, a charity, is doing great work to try and provide better outcomes across a range of health issues for those living on the streets. We need to do much more to help and support rough sleepers to engage successfully with mental health and substance use services. There are real challenges in terms of human rights of individuals and communities in terms of how assertive and challenging our outreach services can, and should, be as well as what services and support we provide for our most vulnerable citizens. These are ongoing debates. But, we should not loose sight of what has been achieved and how, in Finland and elsewhere, through the Housing First approach. Let’s not leave anyone forgotten on the desolate outskirts of our cities.

D.Mackintosh photoDavid MacKintosh is the Head of Community Safety for the City of London, and has also been the Policy Adviser/Director to the London Drug and Alcohol Policy Forum (LDAPF) since 2001.  The LDAPF works to support policy delivery and promote good practice across the drugs, alcohol and community safety agendas.  He has been involved in a number of innovative campaigns around issues including drug driving, substance misuse in the workplace and improving awareness around drug safety in clubs and pubs. The LDAPF is funded by the City of London as part of its commitment to improving the life of all those who live and work in London.  For the last eight years he has also been seconded to the Greater London Authority to provide advice around substance use issues and health inequalities. 

Prior to this post David worked for the United Kingdom Anti-Drug Co-ordination Unit (part of the Cabinet Office) for two years, primarily on young people and treatment policy issues.  This followed on from some 8 years in the Department for Education and Skills where he worked in a number of areas including international relations and higher education policy. He spent ten years as chair of an East London based service provider and is currently a trustee of Adfam (families, drugs and alcohol) and the New Nicotine Alliance (which aims to improve public health by raising awareness of risk-reduced products).