Analysis of the Housing Needs of People with Substance Misuse Problems in Knowsley

Analysis of the housing needs of people with substance misuse problems in Knowsley

Executive Summary

January 2010

Background to this study

This study was commissioned from Peter Fletcher Associates and HGO Consultancy by the Safer Knowsley PartnershipSubstance Misuse Thematic Board, with four key objectives in mind:

• To obtain an estimate of scale of housing need for substance misusers
• To understand the housing pathways currently taken by people living in Knowsley who have substance misuse problems
• To understand which housing and support services are currently used by substance users, and how these services might be enhanced to better meet current needs
• To assess how problems identified can be addressed, through new services or different ways of working

It is expected that the findings of the study will inform three sets of plans:

• Move-On plans being developed by the Council and their partners within the housing and homelessness sector for increasing the rate of people moving on from supported housing to independence, and ensuring that as many as possible are able to sustain their housing once they have moved on to independence
• The development of the Choice-Based Lettings scheme
• The preparation of a new specification for drug-related services in Knowsley, which will ensure that there is a consistent approach to helping people to resolve other difficulties such as housing problems

The study builds on an earlier piece of work undertaken by HGO Consultancy to research the housing and support needs of offenders in Knowsley, and key learning points from that study will be referred to where relevant.

How the study was carried out

The study was carried out in four parts:

1. Collectingand analysing data about housing and support needs, using a survey to find out about people who currently have both a housing problem and a drug and/or alcohol problem, and analysing existing data about needs from other sources
2. Consulting organisations which are in touch with people who have both housing problems and substance misuse problems
3. Consulting with people who have both housing problems and substance misuse problems
4. Mapping current provision

Data collected in the research has also been used to populate the tables required for the local edition of the North West Needs Assessment Model.

The context for this study

It is well known that stable housing is essential for people with substance misuse issues to be able to engage with treatment and work towards recovery. Yet individuals with substance misuse problems can face many barriers when trying to obtain settled accommodation, including a lack of co-ordination between relevant housing providers and support agencies. Large numbers of people across the country say that a lack of stable housing is the main barrier to them achieving their treatment goals, and high proportion of homeless people have drug and/or alcohol problems.

There are several important reasons for this research to be carried out, as well as to help to shape the policies mentioned earlier. The Government’s new Drugs Strategy (2008) highlighted the need to improve social re-integration of drug users going through treatment, by helping them to find appropriate housing, work, and other support. The new Rough Sleeping Strategy (2008) and the Places of Change policy initiative recognise that homeless people need help and support to address the issues – including substance misuse – that have led to homelessness and which may be keeping them out of a settled way of life.

Finally, it is important to note that the North West region has been helping to lead the Routes to Recovery initiative and the Recovery Model. A key focus of this approach is the need for interventions which help the person towards abstinence-based recovery. Addressing housing issues is seen as a key part of this model, since it is clear that, without adequate and sustainable housing, and without good organisational and inter-agency systems, the individual is much less likely to make use of treatment interventions to build long-lasting freedom from drug dependency.

The main findings

Current provision

There is a very limited supply of emergency accommodation in Knowsley, with only none for single women, and no supported housing schemes providing accommodation specifically for substance misusers in the borough. A total of 65 units of temporary accommodation is available for single homeless men and young people. As a result of this restricted range of supply, temporary accommodation outside the borough is used by people from Knowsley, and the study found at least 18 organisations in Liverpool, Sefton, and St Helens where people from Knowsley may be accommodated. At the time of the study, 7 people from Knowsley with substance misuse problems were accommodated by one of those providers outside the area Knowsley area.

There is good provision of floating support schemes, with a total of 55 units working specifically with this client group. Not all referral agencies are clear about who this provision aims to support.

Drug and alcohol services are spread around the borough, but not all services are available in all parts of the borough, and not all treatment services provide help to access housing as part of their work (a practice recommended by NTA). There are no drop-in services for drug or alcohol users or for people with housing problems in Knowsley.

There are several services offering help with finding housing in the Knowsley area. A monthly session in each of the Drug Intervention Project offices is the only service specifically for drug users. In addition, the floating support service offered within the Substance Misuse social work team provides help to resolve housing problems for people leaving residential rehabilitation facilities.

Scale of need for housing and support

An analysis of existing data revealed the following findings about the housing needs of substance misusers in Knowsley:

• Around 1040 adults are in drug treatment in Knowsley, including 715Problematic Drug Users; in addition,134 young people are currently in treatment, and 535 adults are in treatment in Knowsley for alcohol problems.
• Knowsley has more people entering drug treatment than nationally, across the region, or across a group of comparator authorities, but a lower proportion of these people have a housing need than in the country as a whole, the North West or the group of comparator authorities
• The snapshot survey found 145 people with both housing and substance misuse problems in touch with agencies in Knowsley. This is likely to be an under-estimate of need as the local alcohol services, Probation, and YOT were not able to contribute to the survey carried out at the time of the study, as well as most of the social housing providers.
• 64(44%) were already in independent accommodation, but still had a housing problem; 37 people (26%) were living in some form of temporary accommodation, a relatively high figure for this client group given the low level of temporary accommodation within the borough;34 people (23%) had no accommodation at all. A further 7 are staying in supported housing outside the borough.
• A further 18 tenants with a combination of drug and alcohol problems were at risk of losing their tenancies for reasons linked to their substance misuse problems
• From these figures, it is that around 220 people from Knowsley have a housing need, of whom around 100 people (45%) have their own housing but are at risk of losing for a reason associated with substance misuse, 15 are sleeping rough or sofa surfing, another 50 are in other very transient situations, and 55 are in temporary accommodation but do not yet have a settled housing solution.
• The scale of need, using the North West Needs Model indicates that the gross need is for 60 supported housing units, and 200 units of floating support, indicating a gap of 60 supported housing units, and 145 floating support units

Pathways - existing services, barriers and gaps

As shown above, there is a need for additional emergency and other supported housing in Knowsley for substance misusers, including provision for women. Supported housing needs to support people to move towards recovery, and strategies for addressing the needs identified in this study must seek to improve access to abstinence-based provision and provision which houses people who are still using, both those in treatment and those still at more chaotic stages of drug use.

These developments should be complemented by:

• Guidance on how to work safely and effectively with drug users, to comply with Section 8 of the Misuse of Drugs Act 1971
• Actions to address rough sleeping in the borough
• Improvements in the services offered to single homeless people to help them to resolve their housing problems
• Training for treatment agencies on the housing system, and for housing agencies on how to help service users to access and maintain treatment

The study found that more help was needed for people wanting to use the High Priority Panel, that there were particular barriers for substance misusers in providing the right documents to support their applications for settled housing, and that access to the private rented sector could be helped through broadening the Bond Scheme (note that this has now happened, since the study took place). To help to sustain independence once people are housed, the study found that further help could be given to make sure that appropriate adaptations are available for people with mobility problems arising from long term substance misuse, and that for some people sharing their housing would be preferable to living on their own.

The study led to a key conclusion that more inreach services are needed, both treatment services going into supported housing, and housing services which can help drug and alcohol users to resolve their housing problems more speedily. More work is also needed on developing effective communication between treatment and housing agencies, on publicising the work done to achieve good housing pathways for people leaving residential rehabilitation, and working with prisons to jointly address housing problems before release.

It is also recommended that data collection systems should be improved so that the scale of need for housing and support amongst substance misusers is more easily identifiable in future, through a system of recording the needs of all individuals seeking help with housing problems.

Recommendations

To address the issues found in this study, 7 key objectives are proposed, with a number of key actions under each:

Objective 1: Ensure there is sufficient emergency accommodation to meet needs of people with substance misuse problems

Action 1a: Ensure that the existing emergency accommodation is used as effectively as possible, which will involve assisting the service to manage those with the most complex presenting needs, including substance misusers, and developing routes into emergency housing to give more priority for people from Knowsley

Action 1b: Develop additional emergency accommodation – for all groups, but notably for women, for substance misusers fleeing domestic abuse, for young people with substance misuse problems, and for those where there is no likelihood that they will stop drinking in the near future

Action 1c: Develop an action plan for identifying and addressing rough sleeping in the borough

Action 1d: Review the arrangements made to accommodate an applicant who may be in priority need, prior to a homeless assessment being completed

Action 1e: Provide guidance for applicants on the homelessness assessment process, and on the documentation they will need, and review the list of documents needed

Objective 2: Ensure that temporary accommodation provided for drug and alcohol users is sustainable, for as long as it is needed

Action 2a: Develop information which shows where substance misusers can be accommodated, and which schemes will allow people to use alcohol on site and which will not

Action 2b: Provide supported housing organisations with guidance on the implications of Section 8 of the Misuse of Drugs Act 1971 for supported housing

Action 2c: Provide guidance across all supported housing provision in Knowsley on expectations of service providers when a resident is asked to leave

Objective 3: Ensure that there is access to a range of specialist supported housing to support recovery from drug and alcohol misuse

Action 3a: Work with neighbouring local authorities to ensure that there is access to a range of specialist supported housing based locally, accessible to people with drug or alcohol problems from Knowsley

Action 3b: Publicise how funding packages can be arranged for people who need residential rehabilitation or rehabilitative supported housing (currently all outside Knowsley), so that the options including schemes in Merseyside, other North West areas, and elsewhere, are clear to service users and other agencies working with them

Action 3c: Explore whether there are any other ways of helping people to keep their homes whilst staying in specialist supported housing, or to access settled housing when they leave, including referrals to the High Priority Panel, and use of Discretionary Housing Payment

Objective 4: Improve access to sustainable long term housing for people with substance misuse problems, to support recovery and long term abstinence

Action 4a: Update and re-issue publicity material about the High Priority Panel and how applications can be made to it, ensuring that this covers cases where an applicant does not wish or need to move into supported housing first, and information about help to obtain a furniture package

Action 4b: Review the documents and proof needed for registration with KHT

Action 4c: Ensure that the new CBL scheme is accompanied by good support systems for vulnerable groups, that mechanisms exist to classify vulnerable people as Band B in terms of bids without them necessarily having to spend time in supported housing first, and that exclusion policies comply with the spirit of housing legislation and guidance

Action 4d: Review the way that adaptations are sought, and what support is needed for minor repairs to be done, for people with physical health needs

Action 4e: Develop cheap furniture schemes and transport to help people move in and sustain long term accommodation

Action 4f: Investigate ways of accommodating former substance misusers in shared settled accommodation

Action 4g: Provide good publicity material about floating support services, to be widely distributed, and review whether there are enough schemes to help all client groups including young people with substance misuse problems

Objective 5: Develop treatment interventions which incorporate casework and case management activities to help to resolve housing problems

Action 5a: Develop two programmes of training aimed at providing housing and substance misuse staff with the knowledge and skills needed to support substance misusers with housing problems:

-training on housing matters for treatment agency staff, along with resource material, so that they can make effective referrals into the housing services appropriate to meet their needs of their clients, and support them to make use of these services

-training for housing staff on helping service users to access and maintain drugs and alcohol treatment services

Objective 6: Identify smoother pathways from transience to settled housing

Action 6a: Re-commission treatment services in such a way that they are able to help substance misusers to resolve their housing problems quickly and in an appropriate way, and to sustain their accommodation. The model adopted for re-commissioned services should be based on a principle of establishing good case management which helps to prevent homelessness, or to help people to move smoothly along identified pathways towards long term housing

Action 6b: Ensure that there is clarity about the respective role and contribution of existing floating support services and when and how referrals should be made to the different services

Action 6c: Ensure that there is adequate drug / alcohol treatment input into all supported housing where substance misusers are accommodated

Action 6d: Provide clear information about how to achieve smooth pathways for people leaving residential rehab who had no accommodation to come back to

Action 6e: Work with the Prison and Probation Services to seek earlier identification of prison release for drug users who have nowhere to return to

Action 6f: Identify a forum for frontline workers from housing and substance misuse sectors to meet together, on a short term or long term basis

Objective 7: Improve the range and quality of information gathered about housing need amongst people with drug and/or alcohol problems

Action 7a: Develop a system which is able to regularly collect data about the needs of people who are homeless or seek help to resolve their housing problems from any agency in Knowsley

More information

For further information, the full report and appendices can be found at:

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Peter Fletcher Associates Executive Summary Jan 27th 2010