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Housing first: A new approach to addressing youth homelessness
For the last few years, I have been volunteering with a local charity which provides advice and food to the homeless in Newcastle via weekly outreaches. They have recently completed a permanent ‘hub’ building where anyone in need of support is welcome to take a shower, have a hot meal, get advice, or just hang out and relax for a few hours.  The one thing that they can’t provide at the moment, however, is accommodation and this is an area which is increasingly difficult for many young people to secure.
In 2020 the north east was identified as having England’s highest rate outside of London of households assessed as homeless or at risk of homelessness (on the basis of presentation to their local authority).  Homelessness is by its very nature difficult to quantify. Street homeless or rough sleeping is the most visible evidence of the housing crisis but young people without a home may be found in various kinds of temporary accommodation such as bed and breakfasts, hostels, supported provision or sofa surfing with family and friends.
It has been estimated by Homeless Link that about 44% of people who access homeless services in England are aged 18-24. This is unlikely to reflect the full extent of the problem as many people affected by homelessness may not, at least initially, approach their local authority for support. This is where groups such as North East Homeless, with whom I am involved, are especially important in signposting young people to the sources of help available to them.
Research by Homeless Link found that a lack of affordable housing and emergency accommodation drive rough sleeping numbers. Although periods of rough sleeping are generally brief, they represent a time of heightened vulnerability for young people. Across a year the numbers may be small but for a young person one night on the street is one night too many.
Hostels and supported temporary accommodation are important in providing young people with a place to live, but austerity and cuts to public services place them under considerable strain. Where supported environments are available, they are effective in helping young people to move on to permanent accommodation. However, in order to do so they need to access suitable and affordable rental properties, and even in a region like the north east known for its relatively cheap housing, these can be hard to find.
Housing supply is not only an issue for young people wishing to live independently, it can also be the reason why they need to leave their parental home. Overcrowding due to a lack of affordable housing, or the breakdown of their parents’ tenancy in the private sector rental market are among the reasons given by young people for becoming homeless.  It is estimated that around one third of single homeless people in the UK have low or no support needs beyond a roof over their heads; they are homeless only because there aren’t enough houses. Centrepoint found in 2018 that as many as one-fifth of people living in supported housing may be ready to leave but can’t because there is nowhere for them to go. As explored in the blog published by Hannah earlier this year, this situation is unlikely to be improved in the north east by the ‘new’  Standard Method which uses projections based on historically low population growth followed by suppressed household formation rates experienced during the 2008 recession, meaning these projections are perpetuated in the future. This is particularly acute in the North, where the recession had a particularly significant impact.
The conditions required by most private landlords often exclude many formerly homeless people. Young people with a history of homelessness can find it difficult to provide references and refusal on the grounds of insufficient income often limits the options available to them. This means that they have access to a limited supply of local authority or housing association provision.
The Institute for Public Policy Research (IPPR) recently found that only 67% of Local Authorities are building enough affordable housing to meet their overall housing needs and fewer are delivering enough homes for low income people. There is also a focus on provision for buyers rather than renters which is an unrealistic expectation for most young homeless people. A further issue is the focus on building family accommodation when planning for social housing. This means that even where stocks of social housing are available options may be limited for young, single people. To try and address this, the IPPR has recently recommended that regional stakeholders in the north east of England consider how a ‘Housing First’ model of accommodation provision for young people could reduce homelessness and improve long-term outcomes.
The principle of Housing First uses ordinary housing in both the private rental sector and social housing sector, allocated to people in need without conditions. In the UK, the first Housing First pilot was set up in 2010 in Glasgow, followed by pilots in London and Newcastle in 2012. It’s based on the principle of housing being a basic human right and providing permanent accommodation for people straight from the street or those who have experienced repeated homelessness. Currently it is a very small sector in the UK, in 2017 there were just 32 active Housing First providers supporting around 350 people in England. The key characteristic of this approach is quick access to secure and permanent, or potentially permanent accommodation, without an extended period in supported housing or a need to prove ‘housing readiness’. Tenancies are not conditional on the acceptance of support at the beginning of the tenancy or its continuation as the tenancy progresses.
Crisis and Homeless Link recently published a report to understand what is needed to implement Housing First at scale across England, Scotland and Wales. Housing First can only work if suitable housing can be identified and accessed. In some circumstances, LPAs are willing to consider off-site affordable housing but the recently published Lichfields’ Insight on affordable housing demonstrated that on-site provision remains the priority for national policy across England and Wales, with many authorities requiring the demonstration of exceptional circumstances to justify such an approach to affordable housing provision. However, given the relatively small numbers of properties needed for Housing First, earmarking even a tiny percentage of affordable housing contributions for off-site provision could make a significant impact on the implementation of Housing First.
Aside from securing contributions towards new build facilities, options for local authorities and social housing providers could include buying existing private sector properties or converting existing larger properties into one-bedroom flats. It could potentially include the conversion of properties such as low demand sheltered housing, de-commissioned care homes, former hospital buildings, or hostels to create Housing First schemes or mixed developments in which Housing First apartments are ‘pepper-potted’.  Newcastle City Council continues to be proactive in delivering Housing First accommodation and last year Changing Lives began work on converting a 56-bed hostel into 35 self-contained flats.  The aim is to provide every resident who becomes homeless with good quality, self-contained accommodation that is part of a rapid rehousing pathway that supports people to move back into suitable and sustainable homes as quickly as possible.
Whilst the approach clearly works on a small scale, it remains to be seen if there is the political will and long-term funding available to make Housing First happen at a large enough scale to eradicate homelessness for young people with multiple complex needs.
If you would like to make a donation to NorthEast Homeless to help improve life for young homeless people in the north east you can do so using the details below:

Image credit: Ev on Unsplash

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Planning for better mental health

Planning for better mental health

Justine Matchett 23 Oct 2019
I have recently completed an RTPI training module looking at the role town planning can play in promoting good mental health in the United Kingdom (UK) and thought that there were some simple, useful messages worth sharing, which could make us all better at our jobs, irrespective of the area of planning within which we work.
There is known to be a close interrelationship between physical health and mental health. Poor physical health can exacerbate mental health issues and there is clear evidence of the benefits of physical exercise on mental health. The same correlation of the impact of the spatial environment on physical and mental health applies. Mental health in the UK is known to be poor, with time-to-change.org.uk reporting that one in four people are believed to be affected by a mental health problem in any year. Mental health conditions including anxiety, depression, bipolar, schizophrenia and stress can be more common, long lasting and impactful than many physical conditions. There are also large numbers of people affected by progressive neurological disorders such as dementia as well as autism spectrum conditions. Poor mental health has significant economic costs and it is estimated that mental ill health is responsible for the loss of 72 million working days at a cost of £35 billion each year in the UK. This strengthens the need for planners to take a more preventative role in addressing mental health.
Where you live can have a direct impact on your mental health. The charity MIND surveyed 2,000 people in 2017 and found that four in five people with mental health problems have lived in housing that has made their mental health worse. Of these 70% reported experiencing an issue with the quality of their housing such as damp, mould, treat of eviction, overcrowding or unstable tenancies. The links between poor quality housing and mental health cannot be ignored and the RTPI and others have reported that the increase in permitted development rights is making the situation worse.
Particularly worrying is that half of all mental health issues (excluding dementia) are established by the age of fourteen. According to the Mental Health Taskforce, the quality of housing is important but equally so is the opportunity for play. This is also recognised by the World Health Organisation (WHO). The RTPI is currently working alongside the Real Play Foundation to develop a tool to identify the ‘play gap’ in cities where there is inadequate access to appropriate play spaces for children. One developed this will be used to help assess and understand the complexity of play in cities, identifying interventions and measuring outcomes. Publication is expected sometime in 2020.
It is also important to consider the mental health of teenagers as a specific group. Providing safe schools and communal spaces where they cab interact safely is something we should be planning for. This approach should continue into higher education provision as mental health problems are estimated to affect one in four university students, with suicides having reached a record high and the number of dropouts significantly increasing. Research has been undertaken by Burohappold exploring how the built environment can affect the mental health of students. This found that connectivity is key, connection within and between buildings, across campuses and within University City Masterplans. The key outcome of this work was the recognition of the need to use the built environment to promote social interaction and mindful activity and for movement and transport to be a pleasant experience. This research noted the importance of designing to create ‘sticky points’ which encourage social interaction between students. It supported the ‘mind the gap’ principles developed by the Institute for Mental Health, based around creating places which are safe, green, active and prosocial where people can bump into each other for informal interaction.
There is also currently much debate about how to build housing appropriate for our aging population. Older people are generally more vulnerable to loneliness and social isolation, particularly resulting from living along, and this can have a major impact on their mental health. According to Age UK more than one million people go a month without speaking to a neighbour, friend or family member. The Alzheimer’s Society currently estimates there are 850,000 people with dementia in the UK. This is predicted to rise to one million in 2021 and to two million by 2051. Staying active, both physically and mentally, is vital for people with dementia and helps them stay well for longer. There is therefore an increasing need for planners to work to create places that are familiar, legible, distinctive, accessible, comfortable and safe. The local environment is a fundamental factor contributing to the quality of life of older people, it can either be enabling or disabling. Having access to amenities like local shops, doctors, post offices and banks within easy, safe and comfortable walking distances contributes to people with dementia being able to live independent and fulfilling lives for longer. Access to greenspace and nature is known to have particular benefits for people with dementia and in June 2019 the NPPG changed to include a strengthening of advice on planning with people with dementia. It also provides helpful guidance on the characteristics of a dementia friendly community.
Good, carefully considered design is even more important inside the home, whether this is a family home, extra care housing, residential care or nursing care. Often small changes can be enough to help someone living with dementia to be more independent by providing an environment that is clearly defined, easy to navigate, and feels safe. Whilst the internal layout of buildings is usually beyond the scope of the role of planners, it is still worth being aware of the key principles of good design, which include:
  • Safe environment – avoid trip hazards, provide handrails and good lighting;
  • Visual clues – clear signage, sightlines and routes around the building; Clearly defined rooms – so the activities that take place there can be easily understood;
  • Interior design – avoid reflective surfaces and confusing patterns. Use age and culturally appropriate designs;
  • Noise – reduce noise through location of activities and soundproofing. Provide quiet areas as people with dementia can be hyper-sensitive to noise;
  • Natural light or stronger artificial light – many people with dementia have visual impairment or problems interpreting what they see;
  • Outside space – access to safe outside space, with good views from inside the building as daily exposure to daylight improves health.
These features of good design reflect the Housing our Ageing Population Panel for Innovation (HAPPI) principles, which are based on ten key design criteria. Many are recognisable from good design generally, but they have particular relevance to older persons' housing which needs to be able to adapt over time to meet changing needs.
Also of relevance to the consideration of the impact of planning on mental health is an understanding of autism. Autism is a spectrum disorder which affects how people see the world and interact with others. All autistic people share similar characteristics but being autistic will affect them in different ways. Whilst there are around 700,000 autistic people in the UK there is still a lack of awareness about how the physical environment can affect people with autism. Things to think about in planning new urban spaces include acoustics in terms of minimising background noise and spatial sequencing, providing a logical order of spaces to help people with their routine. The provision of ‘escape’ places where they can experience respite from the over stimulation of the built environment is also important. This is handled particularly well by Disney where their theme parks include quiet spaces where people can relax when they become over stimulated or want some down time. Also important is compartmentalisation to define the use of spaces so the user knows what to expect when they enter. Sensory zones and safety are also particularly important for people with an altered state of their own environment.
There is much evidence of the therapeutic benefits of spending time in the natural environment, with MIND reporting that spending time in a green space or bringing nature into everyday life can benefit both your mental and physical wellbeing. In this context it is important to create natural settings in people’s neighbourhoods and in their daily routines. Something as simple as reducing the frequency of cutting grass verges can lead to wildflower displays which can be beautiful and uplifting.
Whilst national policy stresses the importance of physical health interventions it says very little about mental health. However national and local planning policy does talk a great deal about ‘wellbeing’ without really defining what wellbeing is. According the WHO there is no universally accepted definition of wellbeing as this depends upon culture and situation. However the organisation ‘What Works Wellbeing’ describes it as “about people and creating the conditions for us all to thrive. Its quality of life and prosperity, positive physical and mental health, sustainable thriving communities.”
What is clear is that planning interventions to create good mental health cannot be taken in isolation. It requires a joined up approach, with integrated and effective partnerships developed with care and service providers including social care, housing providers, health and wellbeing boards, NHS Trusts, public health authorities and charities. We can play our role in developing and maintaining these partnerships.
Overall, planning for mental health meets a number of existing objectives, such as revitalising high streets, preserving biodiversity, promoting arts and culture and tackling air quality and obesity. What is needed is a little more thought about how we integrate these things together. For example adding more greenspace into a development not only improves the mental health of people using the space but it can tackle air quality, enhance biodiversity and can improve the vitality and aesthetics of our environment.
With the quality of our environment inherently linked to our state of mental health, the RTPI is currently carrying out research to explore policies and practices that enable healthy placemaking with a particular emphasis on accommodating and tackling mental health issues. It is anticipated that this will lead to the publication of practice guidance for RTPI members an a centralised store of evidence of best practice that planners can use and interpret in their own work. In the meantime, the main message from this training is that essentially much of planning for good mental health is about good town planning, and that is something that all of us at Lichfields can contribute to.

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