Nurturing Housing in Drug and Alcohol Addiction
Over the last year or so, our research with people who have lived and living experience of addiction has shown variation in the way the system approaches homelessness prevention, and the accommodation needs of people in addiction, treatment and/or recovery. While the right to adequate housing is a fundamental right and essential to overall health, the approach to homelessness prevention is housing led, showing the limitation of health engagement in creating suitable housing and accommodation pathways. These risks deepening cycles of homelessness, worsening addiction and furthering trauma rather than providing the stability needed to rebuild lives.
Through years of experience in the housing and homelessness sector, I've been witness to the heartbreaking decision many people seeking recovery face, refusing accommodation placements that are unsuitable. There has been growing progress of initiatives to address complex homelessness, like Housing First, they have their very necessary place in the system prioritising housing and everything else thereafter – a great option for those still caught in addiction. To maximise the impact of both the Drugs Mission and Homeless Prevention policy it is essential that we connect to ensure Scotland can meet the unique needs of individuals who seek recovery to provide stable accommodation that is essential for their ongoing recovery, social support and long-term success
The insights we have gathered confirmed what many already knew and reveal the complexity of the current housing and homeless system that drives short-term accommodation over sustainable, supportive environments that support people to thrive in their recovery journey. The housing and homelessness system may lack the necessary accommodation to meet specific needs of individuals in addiction, treatment or recovery. A healthcare led approach would emphasise the power of safe, stable, supportive and secure housing to promote long-term recovery and reduce the risk of further occurrences of homelessness or harm.
With this vision in mind, we have now looked towards existing Scottish and UK wide practises to show precedent in bringing together essential healthcare services with housing to promote recovery and support people in their aspirations to recover. Integrated health and social care for people experiencing homelessness, see NICE guideline NG214, have embedded housing assessment recommendations which also supports the efforts of the Orange Guidelines in considering accommodation needs as part of integrated addiction support.
As Scotland furthers its homeless prevention efforts, evidenced based guidelines could support new emergent duties as part of ‘Ask and Act’. Alongside Scottish housing legislation and guidance, there is an opportunity to explore a health-led, integrated approach to the allocation of accommodation and homelessness prevention that balances suitable accommodation, recovery and support.
Why Scotland Needs Healthcare Led Housing Pathways
A Healthcare led approach would guide housing and homelessness assessments toward a more holistic understanding of each person’s journey, including factors like addiction, mental health and trauma. Further, with a Healthcare led approach, we can better position ourselves to recognise the needs and strengths of individuals, paving the way for recovery-centred housing solutions. MAT Standards in Scotland create opportunities to fully integrate the recommendations from NC214 to improve integrated health and housing needs assessments within their framework - most suitably MAT Standards 3 (Assertive Outreach and Anticipatory Care) for homeless prevention and community-based support, and MAT Standard 8 (Independent Advocacy, Housing & Social Support).
By utilising evidence-based approaches we can embed into local systems this good practise to embed the MAT standards whilst simultaneously supporting the sustainability of suitable accommodation and homeless prevention opportunities within the existing housing system.
The Role of Housing Providers in Homelessness Prevention
Housing providers have a significant role in preventing homelessness and supporting recovery. Our insights show that a shift toward a Healthcare led approach, could drive significant positive change, including improvement of health outcomes for our most complex of individuals and communities, budgetary efficiencies to providers and to the sector, ensuring best value and laying the path for increasing integrated care offers.
Housing assessments that include health can help identify underlying issues, such as substance use, mental health, or trauma, which often go unaddressed in more traditional housing assessments, often leading to providers to pursue eviction – which compounds the issues faced by those caught in addiction even further – while also being more costly financially to the provider.
Engaging with housing providers such as Places for People Scotland (Craigmillar) and Sanctuary Scotland have highlighted good practice within Housing evidencing that so much more can be done to support individuals to sustain their tenancies as opposed to evicting them. Sanctuary Scotland Community Connectors alone have supported over 35 at risk individuals to keep their tenancies, preventing costly eviction, while preventing exposure to the effects of homelessness and helping the individual connect back, or remain connected, into their communities.
By taking a Healthcare led approach, housing providers can act as proactive partners relieving some of the pressure on the healthcare system and creating cost savings that can be reinvested into further preventative services.
Assessing the Need for Recovery-focused Housing
Recovery-focused housing offers an opportunity to build on homeless prevention activities, supporting the growth and development of local solutions to manage care needs. Recovery led housing centres the recovery journey itself, offering environments that nurture growth, stability, and wellbeing for those emerging from problematic addiction seeking long term recovery. It combines a supportive community with resources for a broader range of needs met to build resilience and confidence.
Scotland's unique context, with high rates of addiction in areas of deprivation, requires specific support that can adapt across a range of housing provision, recognition of the role of not just short-term homeless or supported accommodation, but social housing in supporting drug and alcohol harms could support a whole system response to the National Drugs Mission. Developing recovery-focused housing in Scotland could provide a powerful tool for homeless prevention, community stability and individual transformation and recovery.
Moving Forward with, Healthcare Led, Supportive Housing Solutions
Bringing together two significant policy areas is complex and challenging. By working alongside housing or accommodation providers and advocating for health needs assessments based on the NICE guidelines, we can lay the groundwork for systems that prioritise both housing security and health, creating better outcomes for individuals who are in both addiction and recovery.
Our journey is ongoing, we need to share the commitment to building a Scotland where everyone has access to a home that supports their health, dignity, hopes and aspirations and a holistic multi-disciplinary approach that creates housing pathways that truly support recovery, improves quality of life and ultimately plays its part in reducing Scotland’s high level of drug related harm and death.