Approaches to tenancy support for formerly homeless substance users

This article uses evidence from research on the work of a tenancy support team run by a housing association in a Midlands city to increase understanding of how different patterns of housing support contribute to the long-term resettlement of formerly homeless substance users who live in independent accommodation. It has long been recognised that ‘simply putting a roof over someone's head does not always solve his or her homelessness’ (DTLR, 2002: 7; NAO, 2005: 29). Sustainable solutions to homelessness require a range of housing support services to prevent tenancy breakdown and a return to the streets. This is especially true for single homeless people with mental and physical ill-health, substance use and other complex needs, which Randall and Brown (Reference Randall and Brown2003: 11) have estimated to be half the relevant population, though others have suggested that the proportion of problematic drug users alone might be as high as four fifths (Fountain et al., Reference Fountain, Howes, Marsden, Taylor and Strang2003). However, the most effective combination and delivery of services has remained a matter of debate. Is tenancy sustainability just a question of risk management, or does it require a fuller restoration of people's identity, self-worth, personal relationships and supportive social networks? This article will compare the relative effectiveness of these two models of tenancy support.

In pursuit of permanent resettlement, the Government's Rough Sleepers Unit (RSU) funded Tenancy Sustainment Teams (TSTs) ‘to improve the quality of tenancy support services provided to former rough sleepers living in RSI [Rough Sleepers Initiative] accommodation, and to reduce levels of abandonment and eviction from those tenancies’ (Lomax and Netto, Reference Lomax and Netto2007: 16). Tenancy support involved assistance with generic independent living skills, specialist support for those with problems arising from mental ill-health or substance use and, significantly, help ‘to engage in “meaningful occupation” to reduce potential isolation and boredom, and to establish social and community networks’ (ibid.: 13). Thus the value of supportive relationships in tenancy sustainment was recognised. However, despite a resettlement model that appeared to go beyond risk management, this recent evaluation of the TSTs’ work could provide little evidence of success in pursuing more holistic goals.

The RSU's tenancy support work was largely limited to London, but a far more extensive programme of housing support is provided by the Government's Supporting People (SP) programme. Since 2003, SP has been seeking ‘to develop and sustain an individual's capacity to live independently in their accommodation’ (ODPM, 2004: 2). Its services have extended to 1.2 million vulnerable people, including formerly homeless people. In their overview of housing support services that might potentially attract funding from SP, Pleace and Quilgars argued that resettlement should ‘help homeless households secure suitable accommodation . . . enable the development of daily living skills . . . [and] support and enable the development of personal and social skills that will allow reintegration into social and economic life’ (2003: 9). Depending on the level of need, services can be delivered through supported housing or through ‘floating support’ provided by workers at clients’ own accommodation. This more holistic approach to resettlement seems to have been born out in SP's review of good practice in housing support (CLG, 2007) and its more recent review of floating support services (CLG, 2008). In this latter study, issues about the limits of tenancy support are raised − to which we will return − especially its duration, the complexity of needs that can be addressed and the risk of promoting new kinds of dependency.

Outside the SP programme, others have also studied what makes a sustainable tenancy. Seal (Reference Seal2005: 14) rejects the ‘good housekeeping’ model of resettlement prevalent in the 1980s for reducing it to a purely practical issue of teaching homeless people how to cook and manage a budget. Instead he prefers to see resettlement as a process of change, arguing that housing is unlikely to be sustainable unless change has occurred on at least one of the following levels: cognitive, in being able to make rational choices, e.g. about where to live; emotional, in developing positive feelings about ourselves, other people and our circumstances; and practical, in reviving old skills and learning new ones (ibid.: 25). However, he goes on to highlight other components of effective resettlement, not least of which is the establishment of supportive social networks. For instance, he refers to Tavecchio and Thomeer (Reference Tavecchio and Thomeer1999) who show the importance of alternative social networks in the sustainability of solutions to homelessness for young people who have run away from abusive families. Others have also pointed to lack of ‘conviviality’ as an important cause of tenancy breakdown. Lemos (Reference Lemos2000) reminded us that homeless people, like everyone else, want love and friendship and, if the only place they get it is on the streets, then that is where they will return.

Such findings remain relevant where homelessness is compounded by complex needs. For instance, the sense of community between residents and support workers in a supported housing facility for homeless people with long-term mental health issues (Bowpitt and Jepson, Reference Bowpitt and Jepson2007), and in a scheme for ‘hard to house’ drug and alcohol users (Gurstein and Small, Reference Gurstein and Small2005), was shown to be crucial in sustaining the tenancies of residents who move into independent accommodation. Moreover, in a comparison of support workers’ and service users’ views of good practice in the support of homeless drug users in Scotland (Neale and Kennedy, Reference Neale and Kennedy2002), service users laid greater emphasis on emotional and relational issues. The authors concluded that ‘good practice is not simply about providing permanent accommodation or ensuring abstinence from drugs. It is also about helping homeless drug users to achieve stability, feel safe and secure, meet new friends, and grow in confidence and self-respect’ (ibid.: 204).

Beyond the field of single homelessness, evidence is emerging that much of the success of rehabilitation projects in preventing homelessness for families with anti-social behaviour hangs on workers spending time building relationships of trust with families (Nixon et al., Reference Nixon, Hunter, Parr, Myers, Whittle and Sanderson2006). However, the evidence we have reviewed on effective approaches to housing support for homeless substance users suggests that, despite the apparent enthusiasm in programmes like SP for a holistic approach to resettlement, service providers seem more successful in delivering the practical support associated with a risk management model. This might lend support to the conclusions that Homeless Link drew from its recent study that independent accommodation should be limited to service users who are free of illicit drugs and only use prescribed substitutes, while supported accommodation should be the option for continuing illicit drug users, especially those deemed ‘chaotic’ (2007: 19, 26). Our study will subject this conclusion to critical investigation by seeking to show that tenancy sustainability is possible, even for continuing substance users, if a more holistic approach to tenancy support is adopted.

The study of the tenancy support team and its work

Our study evaluated the work of a tenancy support team (TST) associated with a day centre for street drinkers and substance users (‘the Centre’). We recognise that the small scale of the study makes generalisation inappropriate, but believe that distinct features of the TST enabled our study to provide a valuable addition to existing knowledge about tenancy sustainment. The TST operated a particular model of working with homeless and vulnerably housed people with various special needs, whereby the same team that ran the Centre also delivered the tenancy support service (Crane and Warnes, Reference Crane and Warnes2004). The Centre also provided drop-ins for service users and facilities for TST events. The aim of the TST was to provide support to substance users to enable them to sustain their accommodation. Service users had independent tenancies, and neither these nor their access to tenancy support were conditional upon their agreeing to eliminate or even control substance use, though their decision to access the tenancy support service indicated a desire to address perceived threats to their tenancies. Our research sought to discover the factors that contribute to tenancy sustainability, and to examine the Homeless Link (2007) claim that independent accommodation is unsuitable for continuing substance users.

The research was undertaken between October 2005 and September 2006 by a small research team comprising two employees of the housing association and a service user. Data sources included 13 semi-structured interviews, eight with service users, three with TST members and two with people in management positions, together with service monitoring records over the relevant period. The service user sample was a convenience sample derived from those who responded to an invitation. Although this recruitment method was likely to appeal to those more favourably disposed to the service, it attracted respondents better able to detail the benefits they derived from it. The staff members were purposively selected as those best positioned to answer the questions of interest to the researchers.

The interviews with service users sought to explore the contribution of the TST to the sustainability of their tenancies, their emotional health and success in looking after themselves, aspects of social integration and the management of substance use. The interviews with staff and managers were then informed by the themes that emerged from the interviews with service users, thereby giving them a degree of control over the research agenda. Monitoring data were then used to provide a profile of the service users who took part, and some objective corroboration of the experiences conveyed in the interviews.

The eight service users that took part in the research were fairly typical of the 36 clients of the TST at the time. There were three women and five men and their average age was 37. All were White and all but one was White British. All but two had previous experience of homelessness, ranging from five months to 11 years. All but one had had previous tenancies, up to four in two cases. The research participants had been TST clients for just over two years on average. They typically received weekly visits from their support workers.

Clients who felt able to sustain their tenancies independently of the TST ceased to be service users, normally by mutual agreement with their support workers. On this basis, the service could be judged a success. The purpose of the research was to identify the ingredients of this success. Two explanations will be advanced, one based on an approach to resettlement that is seen mainly in terms of the management of risk, the other based on the restoration of positive relationships and social networks. Restoration has long been associated in penology with the concept of restorative justice, which refers to a way of responding to crime that repairs the harm done and restores relationships between offenders, victims and other stakeholders (Colson, Reference Colson2000; Johnstone and Van Ness, Reference Johnstone and Van Ness2007). With homeless substance users, we are using the term slightly differently, looking at the reparation of the harm done to health and self image, and the restoration of relationships with family, community and wider social networks.

Tenancy sustainability and the management of risk

In the risk management model, the ultimate risk is a return to homelessness and the purpose of tenancy support is to use a range of skills and services that effectively prevent this. Homelessness may be triggered by eviction for non-payment of rent, anti-social behaviour or poor household management. Alternatively, tenants may simply abandon their tenancies. We would therefore expect effective tenancy support to emphasise managing conflicting demands on limited budgets. Chief among these will be the pressures arising from uncontrolled substance use. Additionally risks to health may arise from patterns of substance use and poor diet.

Service users in our study were well aware of the precariousness of their tenancies.

This was reinforced by support workers. ‘Let's face it, if the bills don't get paid they will loose the tenancy; it's as simple as that.’ Short of losing the tenancy, life could still become very uncomfortable. ‘If you don't pay anything, they're just going to come round and cut your electric off and cut your phone off and cut your telly off and everything else.’

It is small wonder that budgeting was high on support workers’ priorities. A service user described what happens. ‘We write everything down, all my bills: electricity, hot water, heating, energy, N Power, water – Severn Trent water – BT, all that.’ This wasn't the end of the matter, according to one support worker, because ‘with some we have to see [them] on payday and take them to Post Offices and make sure they pay their bills and everything.’ Alternatively, ‘it's getting as many standing orders set up with people as you can . . . and getting people to understand the concept of standing orders and stuff like that if they've never had bank accounts [before].’ Service users were very conscious of the importance of this support. One confessed that ‘before, I'd sort of do one, go away on the streets and disappear.’ Another admitted that ‘if [I] didn't have her there saying you need to pay your bills, you need to do this, you need to do that, I'd probably just not do it.’

Support workers’ concerns extended to those aspects of service users’ lifestyles that seriously threatened their health. One put it bluntly: ‘If I didn't have them [the TST], I'd probably be dead.’ Malnutrition was a particularly critical issue, as another service user explained. ‘When I came back to [Midlands city] about a year and a half ago . . . I weighed just over six stone, and my boyfriend was just under ten stone.’ A support worker explained how the Centre provided a lifeline.

Managing threats to health from uncontrolled substance use was crucial to overall risk management. One service user got to the nub of the issue. ‘I'm a heavy cannabis smoker, know what I mean? I don't buy nothing apart from cannabis, tobacco and rizlas, know what I mean? So it all goes pear shaped.’ A service manager elaborated.

The substance use itself had to be controlled, or money management would be little more than a vain hope. This was never simply a question of imposing an abstinence regime unless this was the service user's choice. The aim instead was to empower the user to bring this area of their lives under their own control. Diaries were an important tool to this end, but what was critical was how the diaries were used and what they meant to the service user. Above all, this approach promoted honesty, from the service user that uncontrolled drug use was likely to kill them, and from the support worker that drug use was not going to end overnight. As one heroin and crack cocaine user for ten years explained:

What is emerging is that risk management entailed more than imparting a set of skills in household management and controlling drug and alcohol consumption; the relationship with the tenancy support worker was crucial. As one drinker explained, ‘I do things like drinking diaries . . . so I can actually record what I am actually drinking. And it does help having people, just so you know in the back of your mind that, if something did go wrong, then . . . it's only at the end of the phone.’ In the next section, we will explore the role that relationships with support workers and wider social networks play in the quest for tenancy sustainability.

Tenancy support and the restoration of lives

One further risk ran much deeper than financial mis-management or uncontrolled substance use. A support worker explained it very succinctly. ‘There's one more thing which is even more . . . than anything to do with bills . . . and that's loneliness and people living on their own.’ It is what costs service users their tenancies. ‘It's that loneliness that is a killer, and it is a killer because it can make people go back to what they were doing before they got into a home.’ In short, as a service user explained, ‘It's easy to revert back to old ways and back to old friends because you feel lonely.’ Homeless people need to restore so much more than their housing, and, if this is not recognised, they will simply return to what sustained them in their homelessness.

So to limit the analysis to the management of risk would be to ignore the bulk of the evidence presented to us on the effectiveness of tenancy support. What we were witnessing was a process of social re-integration involving the restoration of service users’ lives, their sense of who they are and to whom their lives matter. This restoration was not just a product of sustaining tenancies: it was intrinsic to its effectiveness. We argue not that risk management strategies were inappropriate, but that they worked only in the context of the restoration of lives and relationships. The part played by tenancy support in nurturing this restoration is the subject of this next section; but we stress that the seeds came from the service users themselves. Four relationships will be examined: with support workers in creating a model for a relationship of healthy inter-dependency, with themselves in generating a new identity and self-image with which to confront the world, with their neighbours and the wider community, and with social networks of which they were part. The role of family will be critically examined in this respect.