Side event: Homelessness and substance use in city centres: balanced and evidence-based policies

Organized by the Government of Greece, Correlation – European Harm Reduction Network, the Pompidou Group/Council of Europe, and Santé Mentale et Exclusion Sociale – Europe

National Drug Coordinator, Greece: Homelessness in downtown Athens is an important challenge, exacerbated by factors such mental health conditions, substance use problems, the financial crisis and the influx of refugees fleeing war. We thought a side event to discuss common challenges might be positive to exchange information and advance towards solutions. These issues do not exist in isolation, they intersect and potentiate vulnerability. Homelessness is a common ground. So maybe there’s a common ground in policies also. Maybe looking at it as a kind of cross-cutting theme, across different groups, we can conclude on good practices to inform policies not on substance use but on homelessness and how they affect different groups of the population. Homelessness can be cause and effect of the factors we discussed (substance use, mental health, refugee status).

Katrin Prins-Schiffer, Correlation – European Harm Reduction Network / De Regenboog Groep: This is an important event and probably one of the first events at CND on the matter. We see the same in the harm reduction and addiction sectors; usually homelessness is left behind. What you see is the numbers of people sleeping rough; but not on homelessness. Different countries have different criteria to measure homelessness. Only Finland has decreased homelessness. They have invested a lot in Housing First. All other countries report increases in homelessness. Part of the problem is that the housing market is under a lot of pressure, mostly because of a lack of affordable housing. There’s al problems of shared standards and definitions in defining homelessness. Nut there’s also a lack of national and local mechanisms and strategies to address these issues. In the Netherlands, 31,000 according to CBS and 60,000 according to the Dutch Federation of Emergency Accommodations. 40% lives in the main cities. Housing costs in the Netherlands remain among the highest in Europe. Impact disproportionate on young people. There is a number of people who use drugs, but low level of injecting drug use and most relatively stabilised. But homelessness remains a big challenge to them. We have 150,000 rent-controlled dwellings in Amsterdam; but this is not a lot for a city of 1.2 million; and it’s really hard to access these dwellings. In terms of reasons for homelessness, the majority are about impending evictions or end of renting contract, and leaving home after conflict (ex. Kicked out by parents). There is an ‘integrated care system’ whereby local governments are responsible for housing and homeless care. This approach has existed for 20 years and emerged from the necessity perceived as deriving from public order problems related to open drug scenes and homeless people sleeping rough. The Police was a stakeholder demanding change in this regard. So, in a neighbourhood in Amsterdam, a building that people could access drug consumption rooms, social workers, OST, social benefits, debt control, a broad range of services of health and welfare. The biggest cities of the Netherlands developed the G4 Plan Against Homelessness (2006-2014). These integrated aporoaches are now the standard and support around 8,000 people every year. In terms of the system’s main principles, it’s about focusing on the overall needs; not just drug use, homelessness or mental health. It’s a kind of self-sufficiency matrix including finances, housing, relationships, legal problems, community participation. And  it’s a very good overview on which area someone might need more or less support. This system is based on the needs on the individual, not on the organisation and its specific focus. There’s one case manager coordinating and monitoring the overall support and care. Housing First is the aim, but the housing market is under so much pressure that it’s difficult to provide. IN terms of challenges, this one’s the first. And it’s reflected in the fact that 34 people every week become homeless; most of them are “self-sufficient” but don’t have access to housing. Non-EU people also struggle to access services because of their legal status. A programme developed by De Regenboog offers a low-threshold programme whereby ‘economic homeless’ people are welcomed and support is provided.

Victor Soto, SMES Europe: I want to focus in certain ideas that one should take into account when putting these services in place. I belong to SMES Europe, created after the Rome Conference. One of the last projects we did was the “Dignity and Wellbeing Exchange for changing”. It aimed to develop tools for professionals working with people living in the street. We had to divide what we wanted to say in different areas: social, health, housing, recovery, outreach, networking, staff care. In terms of methodology, meetings in different countries, with local experts, policymakers, administrators, even partners’ experiences. They would tell us what should be a model of good practice to service people in those situations. Why are people homeless? Policies (housing policies, health policies) and individual situations (mental conditions, traumatic events, etc.). So we need to address both dimensions. We need a legal framework to implement what we’re aiming to do. Sometimes, this legal framework can be stigmatising; they don’t facilitate our work. For instance, shelters with regulations that do not allow people to use certain substances. It’s a simple example but very clear. Also, that in order to have benefits you need to be in a positive administrative status in the country. So, we need to pay attention to specific groups (families – vulnerable groups living in the street, women , youngsters – this is a major problem in Barcelona). The cross-sectional characteristic in all of these different groups is addictions, which need to be tackled. When developing the approaches we want to implement, we belive they should be based on assertive/proactive stiles – we go and visit the people, in the street, wherever. We came out with “inreach” – when that person goes to a service, we go see them so that we ensure continuity of care. Although we keep on talking about this, they rarely happen. Because services are fragmented, atomised. Without real networking between them. To facilitate this, we need mixed teams: people in a team should have the power to make decisions (ex. If someone needs accommodation). What happens often is that social workers in a mental health team cannot sign people into council-led services…which is a hindrance. Mental health and addictions tend to be completely separate services and we need to address this. In the Catalan national strategy, there are more community services integrating these. Examples of good practice: conflict management table – in a neighbourhood, there will be issues related to sleeping rough; that table will include authorities from librarians, policepeople, etc. to decide how to approach people. Homelessness is not a fixed category, it should be approach through different lines of action.

Pompidou Group: The situation of precariousness and legal uncertainty of  some migrants and refugees makes it easier for them to fall pretty to transnational crime networks. The present responses are not always well adapted to these situations. To reach these groups, interventions models need to be adjusted to cultural backgrounds, (…). Specific interventions for unaccompanied children are needed. As the operational context was been changing, stakeholders in this field need to be flexible, in line with operational realities. Common guiding principles need to be developed and revised as practice develops. To develop these principles, we need to learn from each other: what works and what doesn’t, find common ground for cooperation and support. The Pompidou Group organises capacity building activities organised with the national drugs coordinator of Greece. 75 participants from 14 countries from different professions. These activities provide a better understanding between the relationship between substance misuse, migration and homelessness.  Facilitates the exchange of practical experiences and approaches between different countries and professionals. The Pompidou Group is now setting a support network for professionals, including an online platform to be launched this year.


Questions and answers

Aura Roig, Metzineres: I’m concerned about the invisibility of women. One of the main causes of homelessness for women is about trauma and violence. What could you say about this?
Victor Soto: This is one of the priority groups for us. If the homeless people are exposed by specific violence, being a woman is even worse. Some shelters don’t have that perspective. Even group therapy could be specific for certain gender identities.
Katrin Prins-Schiffer: Not sure how this is tackled in Amsterdam. I hope there’s a gender-specific approach. But I agree that drop-in are very male-driven and the atmosphere is very macho and it is a hard space for women to access.
National Drug Coordinator, Greece: And being a woman is another risk factor on top of the ones mentioned.
Victor Soto: It was called ‘hidden homelessness’. It’s the fastest growing population, women living in the street.
Katrin: And women with children are more exposed to be living in poverty

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