Housing First - Provincie West-Vlaanderen

Housing First〉〉Mental health problems (e.g. depression)without problematic drug or alcohol use.〉〉Mental health problems with low use of drugsand/or alcohol.〉〉Mental health problems with heavy use ofdrugs and alcohol.What does PHF cost?While it is more economical than the staircaseapproach (see discussion under Evidence ofEffectiveness), the PHF service is not a low costservice. PHF provides an extensive range ofsupport services. A sample budget provided in themanual on PHF produced by Pathways suggeststhat a PHF scheme can be developed and run forone year at a cost of $1.5 million (approx. €1.23million) 36 . It is difficult to exactly cost the servicefor France because the salaries, housing costs andother operating costs will not be the same as is thecase for New York. There are important differencesin context. These centre on the amount of welfarepayments available to chronically homeless people,which will be significantly higher in France andalso the fact that social housing is available to usein France. Using US costs, a PHF team handling70-80 chronically homeless people would costapproximately €482,500 in direct salary costs forone year of operation.To these costs must be added: benefits foremployees, transport for the mobile workers,furniture purchase, medical supplies, movingexpenses, apartment maintenance (on behalf ofprivate landlords) and costs for transport. The PHFsample budget adds another €270,000 to coverthese costs, another €57,000 for administrative andsupervisory costs and a further €287,000 for anoffice in which the team are based, taking the totalbudget to about €1.23 million.A French PHF service would probably have lowerdirect costs. There are several reasons for this.Direct salary costs may be less because Francehas extensive healthcare provision that wouldbe accessible to service users, i.e. it might not benecessary to directly employ as many medicalprofessionals in a French PHF service. If a FrenchPHF service were able to mobilise the socialhousing stock to implement PHF, there might beless reliance on housing specialists. In addition, ifa PHF service was operated by a medium or largesize French NGO, many administrative tasks couldbe handled by existing bureaucracy, rather thanrequiring dedicated staffing. Some of the additionalcosts of the PHF service might be less in France,for example public transport is much more widelyavailable and cheaper than in the USA.Risk managementDelivering a service by using mobile support that isprovided to people in their own homes presents anumber of risks that are not present in a communalservice. The evidence base on how PHF managesrisk is not extensive, although there is somedescriptive information in the PHF manual 37 . Thekey risks that could potentially arise centre onsomeone using the PHF service becoming seriouslyill, or overdosing, and the possibility that a serviceuser might harm themselves or (less likely) harmsomeone else, including one or more staff from themobile support services. The techniques used tomanage risk are:❱❱Assessment of needs on referral to theservice. PHF would not refuse to engage with achronically homeless person because they wereseriously ill, very likely to overdose or presenteda potential risk to themselves or others. However,judgements are made about how practical it isfor PHF to support each individual.❱❱Twenty-four availability of one member of theACT or ICM team by mobile telephone.36 Tsemberis, S. (2010a) op cit p. 219-222.37 Tsemberis, S. (2010a) op cit.17