Housing First

Domain V · Systemic, relational, group & community · Tsemberis

What it is

Housing First is a service model, not a psychotherapy. A mobile support team helps chronically homeless adults with serious mental illness and/or addiction move straight into permanent, ordinary, scattered-site housing. Housing does not depend on being sober, taking treatment or showing you are…

Format

• Housing First is open-ended. It has no fixed session count or end date. In practice it moves through overlapping phases. The phase names below are the guide's own grouping of the manual's chapter topics and the fidelity items.
• Programme conditions (Pathways): the client agrees to (1) a weekly staff visit to the apartment, and (2) a standard lease, including paying about 30% of income towards rent. Nothing else is required.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• discharge to a shelter when the person still has a home.
• compassion fatigue, and a cynical drift towards control.
• interim housing turning into a de facto "readiness" stage.
• loneliness after move-in, and the pull back to the street network.
• one worker "owning" a client and being out of reach when they are needed.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.