This section was co-written with Housing First providers in 2023.
It was informed by workshops with people who provide support for people without secure housing, and conversations with people whose substances and have experienced homelessness.
People who do not have secure housing may find themselves without shelter, moving between shelters each night (e.g., sleeping in cars, on the street, couch surfing, or house jumping), sharing accommodation with a household, or living in uninhabitable housing.
Most people who do not have secure housing in Aotearoa are temporarily homeless, often caused by a major life event. In the long run, most of these people can maintain stable housing without ongoing support. Some people frequently transition in and out of homelessness and find it difficult to maintain stable housing, and a few are chronically homeless, and often have multiple high and complex needs.
The following are some considerations when using a harm reduction approach with people who do not have secure housing, focused predominantly on those experiencing episodic or chronic homelessness:
- Having a safe, warm, and dry place to sleep is a significant determinant of health. It is challenging to address underlying issues without having a stable and safe place to stay. Harm reduction approaches and additional support planning need to consider the person’s living situation and offer realistic options.
“Would like the [addictions] sector to understand that housing is such a determinant of health. That people in the sector understand that we are starting from a different level than when working with a housed person over unhoused. That we all need to take a more holistic-based approach to this space.” – Housing First provider
“Also, there needs to be a more coordinated approach to support people’s housing, health, and addiction needs. Currently there are no appropriate pathways for Housing First providers to refer people to adequate mental health and addiction support.” – Housing First Auckland - Services that provide support to people without secure housing have to be pragmatic and come up with innovative solutions to complex situations. Housing support providers in Aotearoa are continuing to stretch what they can provide to keep people housed. For example, housing support providers often need to respond to situations where a person who is dependent on a substance could continue to use, while minimising harm to themselves and people around them. Without initiatives such as drug consumption spaces, this situation is left to these providers to address.
- Greater investment and coordination between sectors is needed to ensure appropriate referral pathways, initiatives, and low-barrier support offerings.
“Another limitation is there is no adequate support that is tailored for the specific cohort we work with; that is, people with multiple and complex needs. In addition to investment in harm reduction initiatives, we need to consider the barriers for the people we support in accessing services.” – Housing First Auckland
- People without secure housing have a higher prevalence of coexisting mental health and substance use problems compared to the general population. Adopting a holistic approach and collaborating with other support organisations can help ensure that the person receives relevant advice and support for their situation.
“Something I would love to see more of is an understanding and a more collaborative way of working with mental health services. They don’t seem to understand the nuances between mental health and addiction, and will often expect somebody to stop using before they will support them.” – Housing First provider
- Housing support providers can be limited in what they are able to offer people in both temporary and permanent housing situations. This can be challenging when the available housing options are not in alignment with the person’s support needs and goals.
“If lodges and boarding houses are the only option, we find that people will say no as they don’t want to go backwards in their lives. They don’t feel it is right for them, so they refuse.” – Housing First provider
- Alcohol and other drug use can often serve a functional purpose for people dealing with mental health issues and/or trauma. It is important to explore the reasons and motivations behind people’s use with a trauma-informed lens and without expectation that they will reduce or stop their use.
“A key issue for the people we support and a contributor for homelessness is trauma – and this is also an underlying issue for mental health and addiction.” – Housing First Auckland
- Many people without secure housing have had negative experiences with support services, creating barriers to engagement and access. Taking additional time to establish trust and rapport, being consistent and clear with what you can offer, and meeting people where they’re at increase the likelihood of people engaging.
“Yes, the negative experiences and trauma history create significant barriers for engagement and accessing services and building trust, and rapport is key to successful outcomes. This approach of building trust and rapport first is generally not the way services work with people, and often the focus is on criteria and engagement.” – Housing First Auckland