Housing First in Lille Vincent MORIVAL, ABEJ Solidarité

Transcription

1 Housing First in Lille Vincent MORIVAL, ABEJ Solidarité

2 A Government led trial One of the largest trials of the Housing First Model in Europe 4 cities : Paris, Toulouse, Marseille and Lille Led by DIHAL, the inter-ministerial body responsible for the national homelessness strategy A 6 year programme, large scale and experimental 705 homeless people: 353 were housed, 352 received the usual homelessness services Budget : Ministry of Health : 2,5 M ; Ministry of Housing : 3 M

3 Randomised controlled trial Inclusion First inclusion: Aug 2011 Last inclusion: Feb 2014 Test and control groups randomly assigned Quantitative Evaluation Principal outcome: number of hospitalised days Secondary outcome: Quality of life, recovery, clinical aspects, social cost, addiction Qualitative Evaluation Analysis of implementation Recovery individual process and trajectory Professional practices Final results Comparisons cost/effectiveness Comparison between the two groups

4 What is ABEJ Solidarité? A few numbers 1985 : creation of ABEJ 200 members 305 employees (273,5 ETP) 83 subsidised contract employees 116 volunteers (7827hours) 16 volunteers (doctors/nurses) 6000 people used ABEJ s services in 2017 (1200 people under 25) A third sector organisation that specialises in working with homeless people with mental health and other challenges Annual Budget: 17 million euros

5 An innovative model (1) Recovery orientation and harm reduction approaches We base our actions on people s strengths to help them recover No need to abstain from drugs or alcohol Rapid acces to self-contained housing units with security of tenure No pre-conditions such as a requirement to receive treatments Housing is a tool to help people ABEJ holds the legal agreement with private landlords, guarantees rent until the client is ready to take over

6 An innovative model (2) Priority given to user choice Choice of the flat Choice of the activities Flexible, open-ended offer of «floating» support No limitation of duration No limitation of age People who go back to the streets stay in the programme High degree of staff availability to users

7 What is different in Lille? A real partnership between the psychiatric sector and the social sector Multi-disciplinary team(21 staff members) : 6 social workers (2 EPSM, 4 ABEJ) 4 nurses (EPSM), 1,5 psychologist (EPSM), 0,7 psychiatrist (EPSM), 2 peer support workers (EPSM), 1 person responsible for finding housing (ABEJ) 1 coordinator (ABEJ) 0,6 secretary (EPSM)

8 Difficulties we encountered Where to find housing? Lille authorised only 5 units. We had 15 clients there Some cities simply refused. Stigmatisation of the public Going farther from Lille makes providing the intensive support services to the clients more difficult Finding affordable housing fast is challenging Some people have lived in many different flats! Resistance in the psychiatric sector No treatment as pre-requirement Presence of peer workers Just a trial. What if the programme stops?

9 Results of the trial (1) Public that benefited from the programme A very marginalised population : 8 years rough sleeping, 4,5 years in the streets, all of them with psychiatric problems, 80% with addictions. Social effects: - 72% of the clients are satisfied by the programme - 85% are still in their housing - They accept their illness more easily - They accept their treatments more than the test group - Less use of hospitals: 37 days as opposed to 103 days for the test group - Almost all of them have a GP - All of them are in contact with their families - 20% have a job or are in training

10 Results of the trial (2) Economic effects: - More cost effective than all the classic approaches - Fewer stays in prison than the test group - Same number of hospitalisations, but much shorter for Housing First clients (50% less). That represents an economy of /client/year - The cost of the programme is estimated at a year and the avoided costs at a year

11 Results of the trial (3)

12 From a trial to a permanent project Dec 28th 2016: A law is passed and the trial is transformed at the end of 2017 into a permanent project («ACT Un Chez Soi D Abord») : - Housing First is now going to be financed on the basis of the trial period for the medical part, with a slight decrease for the social part - Each programme has to transform into a GCSMS: It s an organisation based on the cooperation between social and medical structures. - Three obligatory members in this GCSMS: A medical institution, a social institution, a center specialised in treating addictions - Missions of the project : Accompanying the client in his search for housing Promoting the client s healthcare (access to the healthcare system and providing direct healthcare) Supporting his social life Supporting his search for a job or training Helping the client in accessing cultural and leisure activities Helping the client move on from the project (but without a deadline).

13 Key factors to succeed - Cooperation between the psychiatric sector and the social sector in relationship to actors specialised in addictions - Allowing clients to have control of their own lives and giving them the possibility to access housing before treating them - Having a sufficient number of professionals to support clients in their new housing.

14 More information - ABEJ Website:

15 Vincent MORIVAL, Directeur du Pôle Hébergement