Andrew Garraway: Housing First and harm reduction in Highland



Andrew Garraway

Homeless Network Scotland hosted a webinar on Housing First and Harm Reduction this week to mark International Overdose Awareness Day. By bringing together a range of contributors from third sector, Health and Social Care Partnerships, the NHS and the Scottish Government, the webinar offered an opportunity to reflect on the realities of delivering on the principle of harm reduction against the backdrop of increasing drug-related deaths in Scotland.

One major takeaway was the importance of thinking beyond partnerships and establishing multi-disciplinary, integrated teams in order to ensure people can get the support they need, maintain high levels of tenancy sustainment, and contribute to a decrease in drug-related deaths.

Nurse practitioner Andrew Garraway, from Highland Housing First, spoke at the event and today explores the impact of Housing First on drug use and harm reduction.

There’s a new approach to addressing homelessness in the Highlands for people whose experiences have been made worse by trauma, addictions and mental ill health. Housing First Highland is a Scottish Government-funded pilot project alongside the Highland Alcohol & Drug Partnership.

In Highland, the number of applications assessed as homeless or threatened with homelessness is below the Scottish average at 934 for 2020/21 compared to 1729 in 2010/11, a 45% reduction compared to a 34% fall across the board during that time. However, in common with most parts of country, Highland works with individuals who either ‘get stuck’ in the system or return to homelessness frequently.

Housing First is an approach shown to successfully address repeat homelessness for most tenants over the long term, with 84% tenancy sustainment in Scotland’s Pathfinder programme, which has been running since 2019. A Housing First tenancy is permanent, allows tenants’ preference over areas of choice where possible and provides intensive, indefinite and flexible wrap-around support.

In 2019 a small integrated team to take forward Housing First was formed from Highland Council (Homeless Service), NHS Highland (Drug & Alcohol Recovery Service) and Salvation Army (Housing Support). My role involves risk assessment, management, and harm reduction alongside colleagues.

The team’s focus has been on those people who have had entrenched histories of homelessness and those at high risk of drug related harm and death in the context of a 5% increase in drug related deaths in 2020 across Scotland. Highland, at 13.3 per 100,000 population, has the lowest rates but the impact on communities and families of each tragic loss of a life to drugs overdose is felt just as sharply and painfully.

Our first clients have now been in their homes for approaching one year. In that time people have been maintaining their tenancies. We have seen a reduction in drug use and tenants have had significantly fewer incidents of overdose. Substance use generally appears to be more controlled and less harmful. There are exceptions where recovery is taking longer. Critically, GP and specialist health services have been able to engage with people where before they would not be registered, could be difficult to contact or would not always follow treatment. This appears to have resulted in lower incidence of medical issues, admissions and intervention overall.

The approach is recovery focused and trauma informed and within the integrated team we have access to housing expertise, health and harm reduction, and specialist housing support. The team can also link clients in with other partner agencies for tenants to access the services they wish. This enables people to settle in their permanent Housing First tenancies, to sustain these, and to further their recovery. There is no ‘wrong door’ because services are joined up.

Housing First has been successful throughout the world and in recent years this success has been replicated here. The model differs from the “tenancy readiness” approach which requires a person to prove they are “ready” for a tenancy before they are allocated one. But there are too many stages within that staircase model where the system can fail an individual, or old habits take hold. Housing First removes this pre-condition before a tenancy and is now an important part of our response for people with the sharpest experiences of homelessness in The Highlands.



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