Case Study – Peter

Peter was well known to services for over 20 years. He was described as an entrenched rough sleeper who had been homeless for a long time. Peter was known as a “revolving door customer” who was “in and out of trouble” and had been on a “cycle” of staying in hostels and being evicted often because of his drug use. As one stakeholder explained, “he was chaotic because of his drug use and used to overdose a lot”, with frequent ambulance call-outs. Peter joined Housing First in October 2019, whilst in temporary accommodation. His first tenancy started almost 10 months later, at the end of July 2020. In the interim, he stayed in various types of temporary accommodation. Peter’s first tenancy lasted around five months, then he moved straight into his second tenancy in December 2020. He left his first property because a lot of people were calling for him and he did not feel safe. His second tenancy was in supported accommodation for people with alcohol and/or substance misuse problems. This move was deemed appropriate and necessary, despite deviating from the Housing First principle of separation between tenancy and support, and perhaps non-negotiables (e.g., permanent offer of support, non-conditional access to housing) depending on the conditions attached to that supported accommodation. This is an example of a pragmatic compromise on fidelity to Housing First principles to accommodate individual’s specific needs at a certain time.

Peter was described as vulnerable and had often been taken advantage of by other people. This was, in part, why supported accommodation was sought. Stakeholders emphasised that “[Housing First] understood what could be offered there, so they really pushed and advocated for Peter to go there”, although it took time and perseverance. The belief was that the provision of social and leisure activities onsite would offer the opportunity to see, and achieve, “a different kind of lifestyle”. Stakeholders perceived his engagement with health services to have improved, especially since he moved into supported accommodation. Drug use remains part of his identity, as Peter himself acknowledges, “I don’t know how to live without using drugs”. Although his drug use remains “up and down”, his use of heroin has reduced, and he is on a methadone programme. In contrast to his history of overdosing in hostels, Peter had not overdosed since joining Housing First. That the support continues irrespective of drug use was considered crucial for Peter. Having one worker who provided consistency and continued support was considered important: “(worker) will go at Peter’s pace when he relapses or when things don’t go according to plan. Peter knows that (worker) will still be there for him”. In his interview, Peter perceived the support as having decreased more recently and urged “I’ll be honest, I do still need support”. Stakeholders highlighted that, due to Covid restrictions, Peter’s peer mentor could not visit, and the wider facilities at his accommodation were closed. There was concern from one stakeholder that “he’s gone a bit downhill” in the past couple of months because “he’s stuck there and limited”; the suggestion was that his drug use had potentially increased and his relationship with the service had suffered because of Covid restrictions.