This is the final post in our series on the Critical Ingredients of Housing First. So far, we’ve covered the other essential elements for implementing an effective Housing First program—a low threshold admission policy, reduced service requirements, separation of housing and services, consumer education, and eviction prevention. Our future blog posts will focus on other aspects of working in a housing first program, looking in-depth at harm reduction in service delivery, and other topics relevant to the people involved in Housing First programs.
Harm reduction is a pragmatic approach to risky behaviors. Harm reduction recognizes that most of us regularly engage in activities with the potential to cause harm including sex, driving, sports, and alcohol or other drug use. People get something out of taking risks. Whether it’s a means of feeling good or relieving pain, we do potentially harmful things, and with good reason. Instead of only trying to eliminate these activities, harm reduction connects with people by avoiding judgment about their behaviors, expressing curiosity about both the benefits and costs, providing resources to do it in the safest way possible, and shifting the focus to improving the quality of life for the individual and their community.
Harm reduction recognizes and employs a broad spectrum of strategies to minimize or remove harm. Yes, that includes abstinence! Harm reduction supports any effort to reduce harm that people choose for themselves. Traditionally applied to substance use, the philosophy of harm reduction has been incorporated into social service agencies’ work with their participants around all potentially harmful behaviors. In order to successfully practice Housing First, we need to incorporate a harm reduction approach to service delivery.
As we discussed in an earlier blog post, the Housing First model is based on the principle that housing is a human right. That means that we should not only provide housing resources to people who are practicing abstinence from drugs and alcohol. If every person who uses these substances were homeless, there would be millions more people living on the streets and in shelters. While the issues participants face can create challenges in maintaining housing, they are not insurmountable nor are they grounds to deny a basic human right. Harm reduction providers protect the right to housing by focusing on the consequences of drug use (e.g. nonpayment of rent or excessive visitors) and not just use itself.
Blocking access to housing programs based on drug use alienates the most vulnerable members of our communities experiencing homelessness. As a study on the Collaborative Initiative to Help End Chronic Homelessness highlights, nearly 3 out of 4 people experiencing chronic homelessness have a substance use disorder. People who are homeless and have a substance use disorder must be offered the same options and rights as other people who are homeless. If Housing First is to succeed, substance use can no longer be a barrier to accessing housing. Homelessness does not cure addiction; stability, connection, and unconditional support do.
Homelessness does not cure addiction;
Housing is a powerful motivator to get a person’s foot in the door and link them to a case manager or community-based support team. The harm reduction approach is what keeps them engaged. In Housing First programs, participants have a reduced level of fear about losing their housing, which improves the quality of their relationships with staff. One Housing First participant explained: “I mean that’s scary when your housing is tied to your ability to remain abstinent. I mean you live kind of in a constant fear…It’s not conducive to remaining sober with that kind of pressure and it’s not conducive to remaining housed…It’s a huge relief when you realize your housing is not tied to your ability to remain abstinent.” Establishing a relationship where it’s safe to speak openly about drug use is difficult. Our participants have been conditioned to avoid the topic since it typically leads to doors being closed on them. By allowing participants to be honest, harm reduction can help participants go beyond all-or-nothing thinking and look for ways to mitigate potential problems associated with their drug use.
Harm reduction embraces the belief that participants are experts in their own lives. They are best equipped to define the problems they face, as well as their goals and strategies to overcome them. Harm reduction workers support participants by ensuring they are informed about the potential harms of risky activities and how to improve their safety. Harm reduction strategies in housing include meeting a person’s most basic needs—eating well, getting regular sleep, and paying rent first to maintain the security of housing. Simply attending to these needs can offset some of the greatest harms caused by drug use or other risky behaviors. While we can’t guarantee that people will always make the safest choice, harm reduction ensures that they are making informed decisions about the risks they take and accepts their right to choose for themselves.
Ultimately, Housing First is a harm reduction approach to housing. It creates access to resources for participants without requiring that they meet predetermined outcomes, engages collaboratively with them about their concerns, and respects the choices that they make. As one Housing First staff member said, “Harm reduction and Housing First are working hand-in-hand. You can’t have one without the other, you just can’t.” Housing First gives us an opportunity to reach the most vulnerable people experiencing homelessness and help them secure the supports they want and need. By fostering trusting, therapeutic relationships harm reduction helps people recognize and make use of opportunities for positive change. It shifts our focus away from completely eliminating risky behaviors and onto the person's well-being.