Homeless people tend to have individualised, complex needs. But their first requirement is simple—a home.
Access to social and health services plays a key role in guaranteeing quality of life. This is particularly relevant for the most vulnerable in society, such as homeless people—for whom access may be particularly difficult even when services are potentially available.
In October 2019 the European Commission and the Belgian government, with the support of the consultancy ICF, commissioned from the author a thematic report to feed a peer review on social assistance to homeless people. This involved representatives and experts from Austria, Cyprus, the Czech Republic, Germany, Greece, Hungary, Italy and Romania, as well as from the European commission and NGOs.
Among the many studies conducted over the years to analyse failure to take up social assistance, only a few consider the situation of homeless people (here, here and here). The reasons for non-take-up are quite varied:
- lack of information—homeless people do not take up rights because they are unaware of them;
- costly or complex access—application procedures are complex, homeless people frequently lack the resources to navigate the bureaucracy and, even when they know about their rights, homeless people frequently do not apply due to long waiting times or because ‘what is on offer is not adapted to people’s needs’;
- social barriers—these include the fear of being stigmatised, a subjective perception of lack of need, pride or a lack of trust in institutions;
- administrative barriers—the central impediment to access here being the lack of a stable address;
- benefit conditionality—people claiming benefits such as minimum income may be required to undertake a work activity as a condition for receiving the benefit, not always possible for the most vulnerable; and
- limited availability of services in rural areas.
In many countries the route to obtaining social assistance and exerting fundamental social rights is registration in the population register. Having no postal address affects homeless people in a range of ways: it does not allow them to receive social welfare payments, to gain access to a general practitioner and medical care, nor to apply for work. It does not even allow them to vote or join a library.
To ensure that homeless people take up their rights several initiatives have been identified.
Granting a reference address, even if fictitious, seems to empower homeless people to ‘take matters into their own hands and be more independent’. In several countries a reference address is available but obtaining it may entail a very long wait and complex procedures.
A reference address can be a mere administrative concept but, as in Belgium, it can also be envisaged as a form of social assistance and as a gateway. Other support—housing, financial, psychological, medical and social—can then be provided to reintegrate the homeless person into society.
In Ireland, the postal service launched in April 2019 the Address Point, a service based in post offices to allow homeless people to receive mail relating to medical appointments and applications for schools or jobs. The Address Point has been developed with the support of several homeless charities—in October one third of homeless people in the country had already signed up to it.
Homelessness can’t be solved with an address alone. But this can help give individuals a part of their identity back.
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Outreach to promote access to social and health services, by qualified social workers with the involvement of NGOs, has proved particularly effective. Outreach teams are primarily designed to connect people living rough with existing services, beyond shelters.
The Dutch strategy to reduce non-take-up is a good example: in the Netherlands, the take-up rate is near to 100 per cent. A special unit was created to help homeless individuals secure access to social benefits and manage their money. Homeless individuals are given shelter before being redirected to a specific service in accordance with their needs.
In France the government established a partnership with Les Restos du Coeur, a network of 2,000 locations providing basic support each year to more than one million people in need. This network will be connected to the national social-protection network and will facilitate a first contact between people in need and the authorities.
Lowering the access threshold is another strategy to reduce rates of non-take-up of social benefits by homeless people. It can be achieved by making the services more accessible through improved design or by removing administrative hurdles. Online access to service provision, for example, is an inadequate entry point for homeless people. Several initiatives have been identified to support them in gaining access to the telematics welfare system.
Another strategy concerns the involvement of ‘experts by experience’. In Finland and in Belgium former service users provide support to the government in understanding the difficulties and obstacles to access, and are consulted about how services should be designed and run.
Collaboration between services and tailor-made assistance through case management addresses a characteristic of homeless persons—the presence of different, often complex, needs which require the involvement of a wide range of service providers to tackle. Tailored case-management is the success factor in service provision, being built around the individual user and integrating housing policies, social services and health (including drugs and mental health) services.
The ‘housing first’ approach to avoid rough sleeping is adopted by EU member states which do not count on temporary solutions but provide different policy answers—considering that, for homeless people, a home is the first step towards social integration. This approach is evident across 16 countries, including Finland, Denmark, Germany, France, Ireland, Italy, the Netherlands and the UK.
The housing-first approach, rather than moving homeless people through stages towards stable housing, moves them directly from rough sleeping or shelter to a permanent and independent home with adequate support. Such interventions treat the right to housing for homeless people as the primary and essential element for regaining autonomy.
Finland is the most advanced example. An integrated Finnish homelessness strategy was launched in 2008, its goal to halve long-term homelessness by 2011. While this was not achieved, the strategy nevertheless proved quite effective: despite the contemporaneous economic crisis, which saw long-term homelessness rise considerably elsewhere in Europe, in Finland it fell by 28 per cent.
The succeeding phase of the strategy (2012-2015) proposed as a goal to eliminate long-term homelessness by 2015 through prevention, more efficient use of social housing, strengthening of housing-advice services and the successful integration of the housing-first approach within a wider array of services. Finland has not achieved the elimination of homelessness but it has been reduced to the lowest levels in Europe, near to Denmark and Norway. Between 2012 and 2016 total homelessness in Finland fell by a further 16 per cent. What is particularly interesting is that this result has been achieved in a very short time.
In Belgium too, in recent years, the housing-first approach has been making an impact. An evidence-based evaluation demonstrated that it is the most effective response to chronic homelessness, with 93 per cent of individuals supported still in housing after three years.
Studies show that strategies based on the presumption that the needs of homeless people can be met with standard services are proving ineffective. Successful policies are centred on individual needs and preferences. This seems to be the reason why ‘housing first’ is much more effective at ending homelessness than other approaches adopted across Europe.
Neither the author’s paper for the European Commission nor this article based on it should be taken as reflecting the official position of the commission.
Chiara Crepaldi is head of the European Social Policies Research Unit at the Istituto per la Ricerca Sociale in Milano and a member of the board of the Associazione per la Ricerca Sociale. She co-ordinates research, evaluation and monitoring of projects on social and health policies and services at national and EU level, concerning poverty and social exclusion of vulnerable target groups and social sustainability.