Housing First as an effective response to chronic homeless people with addiction behaviours

The Project É UMA CASA, Lisboa Housing First, was implemented in 2013 to respond to a significant number of illegal drugs and alcohol users, in a chronic homeless situation, excluded from every health and social services. It has emerged as an alternative to existing treatment programs, which were not effective for these cases – a group of "poor prognosis" patients that were neglected in the usual medical interventions and very resistant to psychosocial rehabilitation projects. The project was thought to immediately respond to the most complex and vulnerable situations. The main goal of this study was to evaluate the impact of the intervention method on the target-population – a) Does individualized housing help to control psychoactive substance use?; b) Does the inversion of the intervention paradigm, giving priority access to housing, influence the (re)integration into the community?; c) May Housing First complement harm reduction strategies concerning drug addictions, promoting, at the same time, the empowerment of the target-population?; d) Do those who integrate Housing First have better access to social and health services? The data was gathered through: 1) Observation Grid – to register aspects related to: Household Organization; Documentation; Health Care; Mental Health Care; Addictions Care; Networks Development; 2) Individual semi-structured interviews; 3) Group meetings.

36 people, with co-morbidity, who were living on the streets for 15 years (on average), were integrated into individualized scattered houses from the common rental market. Evidence suggests that access to individualized housing facilitates the inclusion of the target population into the community; Harm reduction approaches seem to enhance beneficiaries’ motivation to decrease the consumption of psychoactive substances, as well as other unhealthy behaviors; Housing First programs appear to enhance beneficiaries’ access to health and social services, as well as continuity of care needed, with greater investment by health services; Housing First programs appear to enhance beneficiaries’ wiling to initiate therapeutic projects; The project presents a success rate of 89% - percentage of beneficiaries who didn’t return to homeless situation. As conclusion, a qualitative analysis suggests that Housing First programs seem to promote a greater community integration, improving beneficiaries’ general living conditions.