Housing First in focus: Glasgow

From 31 tenancies in 2018 to 318 total tenancies today, Housing First has scaled up in Glasgow, providing homes with flexible support for people whose homelessness is complex and often tied up with issues including mental health and addiction.

The city’s Health and Social Care Partnership (HSCP) works successfully with Housing Associations to provide Housing First homes, with a current target of 600 tenancies.

A sample of 20 tenants shows that prior to their tenancies they made a combined 220 homelessness applications, some dating as far back as 1994 – Housing First clearly works to keep people facing overlapping disadvantage in tenancies.

Eleanor Lee, Principal Officer for Housing First at Glasgow City Health and Social Care Partnership, says the city has learned on the job and refined its processes over the last six years in the face of unprecedented pressures. Here, she sets out how the system operates to ensure people’s wellbeing needs are met.

My team consists of a team leader, senior addiction practitioner, eight assessment officers and a resource worker supporting governance.

The first step is a referral to Housing First – anyone can refer you and you can self-refer. A crucial new addition at this stage is an in-depth pre-screening of candidates, looking at their historical data on our systems.

The idea is to assess risk, look at how systems have responded to a person’s needs and trauma, what needs to happen this time to keep a person in a tenancy. A care manager has input from the start of the process. The assessment is also available across the HSPC systems, meaning applicants don’t have to repeat their story again and again.

We then link up with a Registered Social Landlord who has accepted the tenant to discuss matching their needs to a tenancy and raising any potential issues.

Successful applicants sometimes have to wait for upgrades to a void and it can be a challenge keeping them stable in temporary accommodation while they wait. But some of our tenancies have been out of this world. Low-level, great condition houses. It’s not all perfect but there’s really been an effort here to make the best offer.

A care plan is then put in place. When someone is moving into a new type of tenancy, wraparound support and building a relationship with a support worker is critical.

In Glasgow we recognise that a good relationship with a Housing Officer is important too, and they will meet the tenant before the tenancy. The tenant is more likely to flag problems if they have a rapport – say the water’s off, they might not tell their care manager or support worker.

Landlords often add in a bit extra – a starter pack, or fire-resistant bedding if a fire risk has been identified – instead of refusing housing which would have happened in the past. The aim is to prevent issues arising in the first place.

Once the tenant has moved in, six and 12-week reviews are carried out with them, in the property, to ensure they’re safe and well before we sign-off on the tenancy. They may be vulnerable to exploitation or self-harm, like cuckooing and hoarding. There is a part missing though. When your life has been chaos for 20 years you might not know how to run your home, how to keep it clean and tidy. People should have the opportunity to learn these skills before their tenancy starts.

During the tenancy, a cycle of care managers will be on board to get responses within the HSPC to things that aren’t going right – this is where a whole systems approach comes in.

There is an issue around mental health services; our shared understanding of the issues is unclear. Sometimes we’ll see a tenant struggling mentally even after a community practice nurse has said they’re fine. We’ll try to look back in whether through the adult support protection route, the care manager, a service review – whatever needs to be done.

Quite often when we start assessment people have burnt their boats with their family, and after coming into Housing First they re-establish connections.

One tenant was in the Bellgrove Hotel hostel in Glasgow for 14 years. His marriage broke down, he was separated from his wife and kids, he lost his job, was drinking heavily and had anger management issues. He now needs no support and has re-engaged with his family. He told us: “I’m not angry at life now – I’m happy with life”. Others have moved on in recovery, they’re going to university, taking courses.

The final stage is the overview. We have a weekly live caseload with updates on cases from the support organisations, and a fortnightly case management meeting to highlight concerns about tenants.

We work with the wider homelessness system in Glasgow, liaise with RSLs and provide six-monthly Scottish Government monitoring report with qualitative information about tenants, looking at their journeys rather than seeing people as numbers. Reporting includes within the GCCHSPC and to the Integrated Joint Board. There is a huge amount of governance and reporting but you need to understand how things are going.

During Covid there were no lets and we’ve not properly recovered. There’s big pressure on homelessness from leave to remain cases, from indigenous presentations, and a downturn in availability of housing. Referrals are more than double the 318 tenancies.

But looking at the statistics, of the 61 people in tenancies in 2021/22, 45 are still there, which is remarkable. You can see how the system of assessment is improving, support is improving and having an impact. It’s amazing to see.