Written evidence submitted by Phoenix Futures [HOL 161]
Introduction to Phoenix Futures
Phoenix Futures is a national specialist substance misuse treatment charity delivering a range of drug and alcohol treatment services in community, prison and residential settings. We are the only specialist housing association providing models of accommodation specifically for people with substance misuse issues.
Whilst the link between substance misuse and homelessness is well established we welcome the opportunity to submit to the enquiry -
• Evidence that draws a distinction between alcohol and drug users within the homeless population, and, the need for special consideration for housing solutions for drug using homeless people
• The need to bridge the gap between housing and substance misuse treatment provision that sees 27% of opiate users access treatment without appropriate stable housing that could aid their recovery
• Our experience of developing specific housing solutions for people in addiction with specific focus on drug users
• A case study that demonstrates the positive impact of a specialist recovery housing pathways for drug users
1. Homelessness and drug use
At Phoenix we are acutely aware of the need to focus on homelessness solutions for people experiencing problematic substance misuse.
The fear of stigmatising homeless people with the unhelpful stigma around drug use, and therefore creating an image of homeless people as ‘undeserving’, can prevent us all from facing facts:
• 41% of homeless population are drug users or in treatment (Homeless Link)
• 27% of opiate clients present to treatment with an urgent housing problem (No Fixed Abode) or with another form of housing need (PHE)
• 68% of opiate users presenting for treatment with a housing problem reported as having housing need 6 months after entering treatment. (PHE)
2.0 Recovery-orientated Housing
The need for ‘recovery-orientated’ housing in order to aid recovery of people with substance misuse problems is recognised by both academics and expert government advisors:
“The multiplicity of need created by homelessness and addiction means that tailored approaches are required that reduce harm and build recovery capital” (Granfield and Cloud)
“There is emerging evidence that having a job and interventions such as: help with personal finances; debt counselling; rent deposit schemes; and recovery-orientated housing; improve a range of intermediate recovery outcomes.” (ACMD)
It is important however to make a distinction between alcohol and drug use when looking at the homeless population. The chaotic nature of drug users and the increased likelihood of drug users to have a criminal history makes it harder for them to find appropriate accommodation that will aid their recovery.
“Opiate clients had the highest rates of urgent housing problems (12%) and alcohol only clients the least (3%), reflecting the generally more chaotic nature of individuals presenting to treatment for opiates compared to those presenting with alcohol only.” (PHE)
Not only is a lower rate of homelessness amongst those people entering treatment for an alcohol addiction than for a drug addiction (27% versus 41%), furthermore fewer people seeking support for drug addiction have their housing issues resolved in the first 6 months of treatment compared to those with an alcohol problem. (PHE)
3.0 Housing First and drug users
Housing First is increasingly being promoted as a low cost housing solution for people with complex needs including substance misuse. There is some evidence from the UK (Bretherton) that as a harm reduction technique Housing First is effective in that it provides stability and would seem to aid the reduction of alcohol misuse. There is however little evidence that Housing First is an effective housing solution for illicit drug users, whilst other sources of research (Kirst) challenging any effectiveness in substance misuse outcomes:
“There is strong evidence that Housing First interventions are effective in improving housing stability and quality of life among homeless people with mental illness and addictions. However, there is very little evidence on the effectiveness of Housing First in improving substance use-related outcomes in this population.” (Kirst)
Housing First as a harm reduction tool and alternative to street homelessness is welcome. As a means of basic stability for long term treatment-resistant alcohol users to help manage their drinking it appears to be a beneficial approach. However, Housing First presented as an alternative to Residential treatment for alcohol users who wish to seek treatment, or, as any form of illicit drug treatment would appear to be ineffective.
5.0 What our experience tells us
Addressing the gap between housing and substance misuse treatment, particularly for drug users, has the potential to improve outcomes for both homelessness and the substance misuse treatment sector, not just for the 27% of drug users accessing treatment in 2014/15 with housing problems, but for the many more hidden homeless in treatment and in recovery.
We need to bring the housing and substance misuse sectors together to focus services around the needs of the individuals. We need a range of specialist housing provision from residential treatment through to recovery orientated independent living (Appendix 1) that complements the housing pathways already available in each region.
Specialist recovery housing can add more capacity to local housing provision, and increase the effectiveness of specialist substance misuse treatment, creating clearer pathways to independence. This is especially important for drug users who experience the most difficulty in securing safe appropriate accommodation.
6.0 Case Study
Andy is 38 years old, he first entered prison at the age of 18 and for most of the next 15 years was stuck in a cycle of drug use and crime that damaged his family relationships, employment and left him homeless. Finding treatment and housing through Phoenix Futures was crucial in breaking that cycle.
Repeatedly in care when he was younger Andy started smoking cannabis and using aerosols throughout his teenage years and then progressed onto ecstasy and then amphetamines. Whilst he was involved in petty criminal activity as he was growing up and experimenting with crime and drugs, it was when he started experiment with heroin as well as illicit prescription medications in his mid-20’s that his problems really started.
Andy was a qualified plasterer by this time but within 6 months off using class A’s he had lost his job.
“I got myself into a rut, ended up not working and then got involved with more serious crime and offending to support my habit, any means to get money to pay for my addiction.”
It was a lifestyle that made finding a place to stay very difficult.
“I was in and out of children’s homes when I was younger so didn’t have a great relationship with family, but dad would let me stay with him now and again.”
Periods of time were spent in prison but on release abstinence didn’t last long and he soon ended up back in the vicious cycle of drugs and crime.
His first attempt at residential rehab was in 2009. He completed a 6 month programme followed by 3 months supported housing and whilst this gave him some stability it didn’t work out as he still wasn’t fully committed to his recovery. Andy ended up back in prison again and when came out of prison on license conditions he decided to ‘play the game’, but he still wasn’t ready to commit to making real change. By 2012 however he was homeless again with no one to turn to:
“I was living on a couch, sofa surfing…this was story of my life, it was the worst place I’ve ever been in my life. My dad had just died, I had burnt all my bridges…..No family, no accommodation, no job, no money and fully immersed in a life of crime and addiction.”
His situation finally hit home and he realised he needed to sort himself out. He started by accessing support from a number of different sources but decided he wanted to get himself back into rehab. He was referred into a Phoenix residential service in Sheffield.
He completed treatment and progressed onto Phoenix’s specialist supported housing where he is now. His life is very different now. The foundation of accommodation has enabled him to start up his own plastering business, he’s now self-employed. Relationships are a lot better with all his family “we actually get on really well” and he has a stable relationship with his partner. Andy has been abstinent now for almost 4 years, the longest he’s been drug and crime free.
He is succeeding in his recovery, and as Andy explains, housing is a crucial element of his success:
“The housing element of treatment was one of the most important aspects of my recovery, the security of having a roof over my head enabled me to focus on other aspects of my recovery and focus on other things that I wanted to achieve”
Appendix 1 - Phoenix Recovery Housing Provision
Residential services
Phoenix have a range of residential treatment options to suit an individual’s needs. We are able to provide a therapeutic detox before offering 3 month and 6 month placements in comfortable residential services. Each resident with support from staff and peers is able to acquire the tools needed to live a substance free life.
Phoenix provides specialist services that meet the needs of different groups, for example women referred to Grace House have high incidents of domestic and sexual abuse experience of the criminal justice system and prostitution.
Supported Housing
The next step on our Recovery Housing Pathway is Supported Housing. Supported Housing provides opportunities for residents to develop life skills while in a supportive environment. Residents must learn how to maintain a tenancy and live by the rules of the house, learning to cope with the pressures of life without resorting to drugs or alcohol. Residents are encouraged to fill their week with meaningful activities including attending college, volunteering and working towards gaining employment. There are qualified staff to provide specialist support during core hours and an on-call provision during weekend if residents needs extra support.
Recovery Housing
Recovery Housing provides a self-supported environment with access to mutual aid in the community. Residents are encouraged to gain their NVQ in Peer Mentoring and work towards meaningful employment. Support can be accessed on-call enabling residents to develop greater independence, maintaining a tenancy and live with others. Residents are encouraged to find meaningful employment and prepare to move on into independent accommodation.
Independent Living
Through our independent living residents who have the skills to maintain their recovery more independently can benefit from a landlord that understands their recovery journey and issues they may face in everyday life. Residents have the opportunity to provide mentoring to others in recovery in the community and whilst they do not have to move on from Independent Living accommodation they make the choice when appropriate.
All of these housing models are provided by staff trained in substance misuse and housing.
References
ACMD - Recovery from drug and alcohol dependence: an overview of the evidence (2012) available at https://www.gov.uk/government/publications/acmd-recovery-from-drug-and-alcohol-dependence-an-overview-of-the-evidence-2012
Bretherton J. and Nicholas P. (2015) Housing First in England – An Evaluation of Nine Services University of York
Available at http://www.homeless.org.uk/facts/our-research/housing-first-in-england-evaluation-of-nine-services
Granfield, R. & Cloud, W. (1999). Coming Clean: Overcoming Addiction Without Treatment. New York: New York University Press
Homeless Link - Health Needs Audit Analysis available at http://www.homeless.org.uk/facts/homelessness-in-numbers/health-needs-audit-explore-data
Kirst 2015 - The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug and Alcohol Dependence: 2015, 146, p. 24–29
PHE - Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2014 to 31 March 2015 available at https://www.ndtms.net/Publications/downloads/Adult%20Substance%20Misuse/adult-statistics-from-the-national-drug-treatment-monitoring-system-2014-2015.pdf