We have the power to end homelessness if we think creatively

It’s easy to despair. But we must not. We must hold on to the belief that homelessness can be ended and look for evidence of proven or promising approaches that could be tried or tested right now. We should be clear: overall, the evidence base for much homelessness practice is weak. Many standard
interventions used in the UK lack robust evaluation of impact, in particular cost effectiveness.

There are exceptions, however, and more high-quality causal evidence into homelessness interventions in recent years is expanding what we know. So where does the evidence lead us?

Housing First, which provides unconditional accommodation and personalised support, has a strong international evidence base where there is close fidelity to the model but is appropriate for a specific cohort with long histories of homelessness who will benefit from high support. More broadly, expanding the stock of social housing is fraught with political controversy and will take years. Right now, therefore, it is imperative that more private landlords do not withdraw good-quality housing from the rental market and that more are encouraged to let properties to tenants on low incomes or on benefits.

There is some evidence that offering landlords stronger financial incentives might work. It is worth testing whether rent guarantees, deposit bonds or up-front payments would expand supply of lower-cost private rented housing. A lower-cost approach, certainly worth trying, would be to use behavioural ‘nudges’ to encourage landlords to rent properties to people with a history of homelessness, such as personal stories or framing this as achieving a societal good.

One of the biggest evidence gaps is in understanding the relative effectiveness of types of assistance local authorities can offer different groups of people who are at risk of homelessness: evaluating housing options would lead to better decision making. Councils should also be encouraged to make full use of their power to make discretionary housing payments to people in receipt of housing benefits who are in financial difficulty; not all local authorities do so.

Such payments are made on an application basis and may be refused. But giving money directly to people in need has a strong evidence base; testing no-strings cash transfers to people experiencing different types of homelessness would be highly worthwhile. Imaginative thinking is also needed. Councils employ housing teams to support people in or at risk of homelessness and revenue departments who collect council tax. Many also have staff who collect rents from social housing and advise residents on benefit entitlements.

The London Borough of Barking and Dagenham found that by analysing the combined data it holds, it can identify residents in financial difficulty who are at risk of seeking support from its homelessness service further down the line. It tested the impact of telephoning some of the residents in council tax arrears and facing potential court action to offer support by rescheduling their payments. 

Only a minority of residents who were called agreed to set up a payment plan – around one in seven. But rates of payment among residents who received a friendly telephone call were 50 per cent higher than those not contacted: 45 per cent versus 30 per cent. Residents got more support; the council recovered more income.

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• Housing First: What can Finland teach us about tackling homelessness?
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Another evidence-based prevention model is critical time intervention to provide support for individuals during a period of transition, such as people leaving prison or young people leaving local authority care: a single case worker supervised by a mental health clinician helps with resettlement and integration over a nine-month period.

Since employment can be a route out of homelessness for people with fewer needs, there is a case for time-limited wage subsidies or more bespoke programmes such as Individual Placement and Support. This was developed in the United States for adults with severe mental illness and helps individuals who wish to find a job with in-work support provided on an open-ended basis.

We know poor access to healthcare is a common factor in homelessness. New clinical approaches have been tried to improve care for people affected by homelessness, but progress has been slow. We need to test more of these. Some may be controversial: managed alcohol programmes to stabilise drinking patterns – especially of non-beverage alcohol such as illicit grog, cooking wine or mouthwash – or drug consumption rooms to use pre-obtained drugs in a safe environment.

Young people with experience of severe adversity who are affected by homelessness might benefit from individual trauma-focused cognitive behaviour therapy; another potential treatment for post-traumatic stress disorder is a psychotherapy treatment in which the patient is asked to recall disturbing memories while focusing on an external stimulus, called Eye Movement Desensitisation and Reprocessing.

The above interventions all focus on opportunities and support or treatment for individuals impacted by homelessness. We must remember, too, the staff who work in our homelessness system, where pay is not high and career progression routes are often not well aligned. Many are exhausted, having worked hard in challenging conditions during the Covid-19 pandemic, and now facing the tragic consequences of a severe cost-of-living shock. Preventing and relieving homelessness needs this workforce to be supported and recognised.

Employers should deploy evidence-based measures such as better financial incentives, wellbeing advice and support and, when hiring, values-based recruitment practices that identify applicants strongly motivated by the challenge of addressing the societal challenge of homelessness.    

Despite the weaknesses in the evidence base, we know enough to take bold steps now that could head off a new homelessness emergency. Most of all, we must continue to generate and validate new evidence: try new interventions and, critically, evaluate them so we stop doing what doesn’t work, and scale up and replicate what does faster.

Unless we do, we are condemned to repeat the cycle of ebbs and flows of homelessness as the economic and political climate changes. We can do better.

Greg Hurst is head of communications and public affairs at the Centre for Homelessness Impact

This article is taken from The Big Issue magazine, which exists to give homeless, long-term unemployed and marginalised people the opportunity to earn an income.

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