Housing First - Provincie West-Vlaanderen

Housing Firsthealth deteriorates as a consequence of using CHFservices 93 . There is also some evidence showingthat use of emergency mental health services issignificantly reduced among chronically homelesspeople using some CHF services 94 .There has not been a detailed evaluation of theimpacts of the Finnish Housing First programmeusing CHF services on mental health. As alreadynoted, there are some emerging concerns aboutwhether CHF services containing a number of longterm homeless people with high support needs arealways suitable places in which to recover frommental health problems, as well as from problematicdrug and alcohol use 95 .Social and economic inclusionThere is no clear evidence that CHF modelspromote either social or economic inclusion. Thechronically homeless people using CHF services areaccommodated in physically separate blocks, whichin at least some cases are architecturally distinctfrom surrounding buildings and houses. Promotingeconomic inclusion, in the sense of enabling peopleinto work related activity, education, training orpaid employment can present a challenge for anyservice providing support to chronically homelesspeople, though dedicated employment programmeshave achieved some positive outcomes 96 . In Finland,there has been some discussion of how to sociallyand economically include people living within CHFservices 97 .Cost effectivenessThere is evidence from the US and from Finland thatCHF services can generate significant ‘cost offsets’.These ‘cost offsets’ are reductions in expenditureon emergency medical services, including drugand alcohol and mental health services as wellas hospital emergency facilities, and the resultof less contact with criminal justice systems bychronically homeless people. When in stable andsecure accommodation, chronically homelesspeople generally have less contact with emergencyservices, with the police and also make muchless use of emergency homelessness shelters 98 .Development and running costs for some US andFinnish CHF services tend to be quite high, witha US study indicating savings of some $12 million(€9.1 million) from a new CHF service that had cost$11 million to develop (€8.3 million) 99 and the Finnishprogramme providing 1,250 units of CHF and otherhousing at a cost of some €201.1 million 100 .93 Sadowski, L.S.; Kee, R.A.; Vanderweele, T.J. et al.(2009) ‘Effect of a Housing and Service brokerage Program onEmergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults: A Randomised Trial’ Journalof the American Medical Association 301, 17, pp. 1771-1778.94 Larimer, M.E. et al (2009) op cit.95 Kettunen,M. and Granfelt, R. (2011) op cit.96 Burt, M.R. (2007) Evaluation of LA’s HOPE: Ending Chronic Homelessness through Employment and Housing FinalReport Los Angeles: City of Los Angeles Community Development Department97 Social Innovation Europe interview with JuhaKaakinen 2011 http://www.socialinnovationeurope.eu/magazine/localdevelopment-and-communities/interviews/ending-homelessness-finland98 Culhane, D.P. et al (2008) op cit.99 Larimer, M.E. et al (2009) op cit.100 Luomanen, R. (2010) op cit.31