The Routledge Handbook of Homelessness 2022050658, 2022050659, 9780815362104, 9781032459387, 9781351113113

Citation preview

THE ROUTLEDGE HANDBOOK OF HOMELESSNESS

The Routledge Handbook of Homelessness brings together many of the world’s leading scholars in the field to provide a ­cutting-​­edge overview of classic and current research and future trends in the subject. Comprising 41 chapters and divided into four sections, the handbook includes • • • • •

A comprehensive introduction to homelessness, referring to history, culture, causation and definitions. Contemporary and historical debates around homelessness in different academic disciplines. Homelessness relating to gender, sexuality, youth, families, migration, rurality, veterans and health. A range of c­ ountry-​­specific studies to illustrate the ways in which homelessness is researched and understood around the world. Methods of engagement and modes of analysis.

With contributors from around the world and editors from the Centre of Housing Policy at the University of York, this handbook provides a groundbreaking and authoritative guide to theory, method and the primary interdisciplinary debates of today on homelessness. It will be essential reading for students, academics and professionals across the disciplines of sociology, human geography, public policy, housing policy, social policy, social work, economics and criminology. Joanne Bretherton, PhD, is a Senior Lecturer in Social Justice and Criminology and a Senior Research Fellow at the Centre for Housing Policy at the School for Business and Society at the University of York. Professor Nicholas Pleace is the Director of the Centre for Housing Policy at the School for Business and Society at the University of York and a Member of the European Observatory on Homelessness, operating under the auspices of FEANTSA.

THE ROUTLEDGE HANDBOOK OF HOMELESSNESS

Edited by Joanne Bretherton and Nicholas Pleace

Cover image: © Getty Images First published 2023 by Routledge 4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 605 Third Avenue, New York, NY 10158 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2023 selection and editorial matter, Joanne Bretherton and Nicholas Pleace; individual chapters, the contributors The right of Joanne Bretherton and Nicholas Pleace to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library ­Cataloguing-­​­­in-​­Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Names: Bretherton, Joanne, editor. | Pleace, Nicholas, 1965– editor. Title: The Routledge handbook of homelessness / edited by Joanne Bretherton and Nicholas Pleace. Description: Abingdon, Oxon; New York, NY: Routledge, 2023. | Includes bibliographical references and index. Identifiers: LCCN 2022050658 (print) | LCCN 2022050659 (ebook) | ISBN 9780815362104 (hardback) | ISBN 9781032459387 (paperback) | ISBN 9781351113113 (ebook) Subjects: LCSH: Homelessness. | Homeless persons. Classification: LCC HV4480 .R68 2023 (print) | LCC HV4480 (ebook) | DDC 362.5/92—dc23/eng/20230308 LC record available at https://lccn.loc.gov/2022050658 LC ebook record available at https://lccn.loc.gov/2022050659 ISBN: ­978-­​­­0 -­​­­815-­​­­36210-​­4 (­hbk) ISBN: ­978-­​­­1-­​­­032-­​­­45938-​­7 (­pbk) ISBN: ­978-­​­­1-­​­­351-­​­­11311-​­3 (­ebk) DOI: 10.4324/­9781351113113 Typeset in Bembo by codeMantra

CONTENTS

List of figures List of tables List of contributors

ix x xii

1 The role of the handbook Joanne Bretherton and Nicholas Pleace SECTION 1

1

An introduction to homelessness

11

2 Historical perspectives on homelessness Eoin O’Sullivan

13

3 Causation Joanne Bretherton and Nicholas Pleace

24

4 Defining and counting homelessness Dan Treglia and Dennis Culhane

35

5 Responding to homelessness: making the human right to housing a reality in Scotland? Isobel Anderson

v

48

Contents

6 Homelessness and welfare systems Lars Benjaminsen

60

7 ­COVID-​­19 Nicholas Pleace

71

SECTION 2

Homelessness across different disciplines

83

8 Crime, punishment and homelessness Eoin O’Sullivan

85

9 Homelessness and social work: current challenges and future opportunities96 Susanne Gerull 10 Homelessness in human geography Jessie Speer

108

11 Homelessness through a feminist lens Juliet Watson

119

12 ­​­­Evidence-​­based approaches to guide health providers for people experiencing vulnerable housing and complex needs Kevin Pottie, Olivia Magwood, Ammar Saad, Sihyun (­Shaun) Baek and Alex Lee SECTION 3

130

The dimensions of homelessness

145

13 Gender Joanne Bretherton

147

14 LGBTQ+ people and homelessness Jama Shelton

158

15 Youth Paula Mayock and Sarah Parker

169

16 Children and families Deborah Quilgars and Nicholas Pleace

180

vi

Contents

17 Migration and ethnicity Teresa Consoli

191

18 Rural dimensions of homelessness Mark Bevan

200

19 Veteran homelessness Stephen Metraux and Emily Moore

211

20 Homelessness and health through the lens of social quality Judith Wolf and Maša Filipovič Hrast

222

21 Complex needs and Housing First Nicholas Pleace

234

22 Homelessness and substance use Paula Mayock and Branagh O’Shaughnessy

244

23 Costs Nicholas Pleace

256

SECTION 4

International experience of homelessness

267

24 Home truths: homelessness in Australia Guy Johnson, Fiona Carey and Susan McCallum

269

25 Modern mass homelessness in Canada Stephen Gaetz

280

26 Homelessness in China Della Qiu, Carole Zufferey and Siyi Tang

290

27 Homelessness in Denmark Lars Benjaminsen

298

28 Homelessness in Finland Saija Turunen and Riitta Granfelt

307

29 Homelessness in Germany Volker ­Busch-​­Geertsema

316

vii

Contents

30 Homelessness in Hungary Nóra Teller, Fruzsina Albert, Boróka Fehér and Péter Győri

325

31 Ireland and homelessness Sarah Sheridan and Sarah Parker

335

32 Homelessness in Italy Caterina Cortese and Teresa Consoli

344

33 Homelessness in Japan Yoshihiro Okamoto and Joanne Bretherton

355

34 Homelessness in Poland Magdalena Mostowska

364

35 Homelessness in Portugal Isabel Baptista

374

36 Homelessness in Slovenia Maša Filipovič Hrast

384

37 Sweden Marcus Knutagård

394

38 UK Nicholas Pleace and Joanne Bretherton

404

39 Homelessness in the United States Samantha Batko and Dennis Culhane

413

40 Homelessness in Montevideo: policy implications and future challenges423 Fiorella Ciapessoni 41 Homelessness futures Nicholas Pleace and Joanne Bretherton

433

Index445

viii

FIGURES

12.1 Diagram of the guideline development process (­From Schunemann et al. 2014; with permission (­pending from CMAJ)) 20.1 The social quality approach and factors influencing participation and thus health and ­well-​­being (­Wolf, 2016) 24.1 National homelessness agency recurrent expenditures, real and nominal; people present; financial year ­2000–​­2001 onwards 27.1 Homelessness in Denmark 2­ 009–​­2019 36.1 Map of Slovenia indicating regional coverage by shelters for homeless (­g rey ­areas – ​­areas with existing shelters) 37.1 Number of children affected by enforced eviction in Sweden, ­2008–​­2021 39.1 Trends in homelessness in the United States, 2­ 009–​­2019 40.1 Evolution of homelessness (­­2006–​­2020)

ix

133 225 275 300 389 399 417 425

TABLES

5.1 Five main goals of legislative change in Scotland (­f rom Prevention Review Group, 2021) 12.1 H.O.U.S.E. medical mnemonic 14.1 Creating a safe and affirming programme 24.1 Comparison of ABS operational categories and the cultural definition 24.2 2016 census results, by operational group 27.1 Conceptual and operational definition of homelessness in Denmark 30.1 Estimated number of homeless people in Hungary according to ETHOS Light categories (­2019, 2021, during the second wave of COVID, and 2022) 32.1 Homeless people in Italy per gender, citizenship, age, education and duration of condition (­years ­2011–​­2014) 32.2 ­High-​­intensity homelessness cities 32.3 Homeless people in the Caritas Counselling Services (­total 28,697)  – ​­year 2017 32.4 Homeless people encountered into the Caritas Counselling Services per educational and occupational status (­total 28,697)  – ​­year 2017 34.1 Data gathered in the four latest national homelessness counts 35.1 People living in roofless and houseless situations, Portugal, 2021 35.2 Variation rate of the number of people living in different types of homelessness situations by NUTS ­II – ​­Inland Portugal, 31.12.20 and 31.12.21 (%) 36.1 Programmes for the homeless in Slovenia, ­2007–​­2019

x

54 138 164 271 272 299

328 347 348 350

351 368 377

378 386

Tables

36.2 Social protection benefits by function, ­1995–​­2015 (% of total expenditure)391 37.1 Homelessness in Sweden 1­ 993–​­2017 396 37.2 Number of applications and enforced evictions in Sweden 2­ 018–​­2021 399 39.1 National homelessness p­ oint-­​­­in-​­t ime estimates, 2020 414

xi

CONTRIBUTORS

Fruzsina Albert is a Research Professor and Head of the research department on Families and Social Relations at the Institute for Sociology of the Centre for Social Sciences and a Professor of Sociology at the Institute of Mental Health of Semmelweis University, Budapest. She served as an expert on the European Social Policy Network. Her research interests include the study of interpersonal networks, social inclusion, gender and aging. Isobel Anderson is the Chair in Housing Studies in the Faculty of Social Sciences at the University of Stirling, where she has worked since 1994. She has previously held a range of research and teaching leadership roles at Stirling. She is active in the European Network for Housing Research (­ENHR). She founded the Working Group on Welfare Policy, Homelessness and Social Exclusion (­W ELPHASE), jointly c­ o-​­ordinating this from 2004 to 2013. Sihyun (­Sean) Baek is a Medical Student at the University of Ottawa. His research interests include social accountability in medicine and mental healthcare for marginalized groups. Isabel Baptista  is an Independent Researcher with over twenty years’ poverty and social exclusion research experience, with particular expertise in homelessness and g­ ender-​­based violence. She is the Social Inclusion Leader of the Network Core Team of the European Social Policy Network (­ESPN). She has authored and ­co-​­authored several publications on homelessness, including the 2019 European Social Policy Network (­ESPN) study on National Policies to Fight Homelessness and Housing Exclusion, covering all EU Member States and seven n ­ on-​­EU European countries.

xii

Contributors

Samantha Batko is a Principal Research Associate in the Metropolitan Housing and Communities Policy Center at the Urban Institute, where her research focuses on homelessness, housing instability, housing assistance, and supportive services. She has expertise in several US Department of Housing and Urban Development homelessness programs. Before joining Urban, Batko spent 12 years at the National Alliance to End Homelessness. Lars Benjaminsen is a Senior Researcher at The Danish Centre for Social Science Research (­V IVE). Since 2005, he has also been a member of the European Observatory on Homelessness. His research focuses on social marginalization, homelessness and on social interventions for people with complex needs and their use of the welfare system. Mark Bevan specialised in research on rural homelessness during his time at the Centre for Housing Policy, University of York. He currently works for the charity Inspire North, parent organisation of Community Links and Foundation, which provide services to address mental health, domestic abuse and homelessness in the North of England. Volker ­Busch- ​­Geertsema is a Sociologist and Senior Research Fellow and Board Member of the Association for Social Planning and Social Research (­Gesellschaft für Innovative Sozialforschung und S­ ozialplanung – GISS) in Bremen, Germany. ​­ Since 2009, he has been a Coordinator of the European Observatory on Homelessness and since 2015 he has been an Honorary Professor at Heriot Watt University, Edinburgh. Volker specialises in homelessness research and has participated in a number of European Research networks on homelessness. He is the author of several books and a large number of articles on different aspects of homelessness and housing policy in Germany, Europe and beyond. Fiorella Ciapessoni Capandeguy is an Instructor at the Faculty of Social Sciences, Universidad de la República (­UdelaR), Uruguay and a PhD Candidate at the University of York. Her research interests centre on homelessness, housing pathways, social policy and resettlement policies. Fiona Carey  is a PhD Candidate within the Unison Housing Research Lab at RMIT University and has a social work background working in housing and homelessness. Her research looks at ontological security and ­place-​­making within community housing settings, and how this relates to tenant ­well-​­being. Teresa M. Consoli is an Associate Professor in Sociology of Law at the University of Catania, Department of Social and Political Sciences. As a member of the Scientific Committee of the Italian Federation of Organizations for Homeless People (­Fio.PSD), she monitored the implementation phase of Housing First in Italy, 2016, and with Antonella Meo edited the book Homelessness in Italia, 2020.

xiii

Contributors

Caterina Cortese  currently works for Fio.PSD, the not for profit organization specialising in Homelessness and Housing Exclusion in Italy. She is a Sociologist with PhD in Policy Analysis (­Sapienza of Rome). She has more than ten years of experience in research on poverty studies, welfare and territorial services. She has aptitude for policy analysis, data collection, case study, qualitative social research and writing activities. Her most recent publication was the first book published on Housing First in Italy (­2016). Dennis Culhane is the Dana and Andrew Stone Professor of Social Policy at the School of Social Policy and Practice at The University of Pennsylvania. Culhane is a nationally recognized social science researcher with primary expertise in the field of homelessness. From July 2009 to June 2018, he served as the Director of Research at the National Center on Homelessness Among Veterans, an initiative of the U.S. Department of Veterans Affairs. He is a leader in the integration of administrative data for research and directs Actionable Intelligence for Social Policy (­A ISP), an initiative that promotes the development of integrated data systems by state and local governments for policy analysis and systems reform. Boróka Fehér has worked with homeless people in Hungary since 1999. She is a policy officer of the Policy Department of the Budapest Methodological Centre of Social Policy (­BMSZKI), the homeless service provider of the City of Budapest. Her field of special interest is finding data in order to support the situation and services available for homeless women, empowering and participative ways of working. She is a member of FEANTSA’s Women’s Cluster. She holds a PhD in Social Work and Social Policy. Stephen Gaetz is a Professor in the Faculty of Education at York University in Toronto Canada. He is the President of the Canadian Observatory on Homelessness and the Homeless Hub at York University as well as the ­Co-​­Director of Making the S­ hift – Youth Homelessness Social Innovation Lab and the Toronto ​­ Centre of Excellence on Youth Homelessness Prevention. Dr Gaetz works in collaboration with partners to conduct research and mobilize this knowledge so as to have a greater impact on solutions to homelessness, and in particular the prevention of homelessness. In 2017, Dr Gaetz was awarded the Member of the Order of Canada. Susanne Gerull has been a Professor for Theory and Practice of Social Work at the Alice Salomon University of Applied Sciences (­Berlin/­Germany) since 2008. Her research focuses on poverty, unemployment, homelessness and l­ow-​­threshold social work. Before her doctorate, she worked as a social worker for homeless people in two social welfare offices in Berlin. Péter Győri  is the President of the Menhely Foundation, the Head of the “­February Third” Working Group, and an economist, urban sociologist, and social politician. He teaches at ELTE and ORZSE University. Previously, he was the xiv

Contributors

professional manager of the Budapest Methodological Social Centre and the head of the Housing and Social Policy Committee of the Capital City Municipality. Riitta Granfelt pioneered Finnish Homelessness research focused on women. She recently retired from a long career as a university lecturer focused on social work. Maša Filipovič Hrast is an Associate Professor at the Faculty of Social Sciences, University of Ljubljana. Her research focuses on social policy and the welfare state, housing policy, and social inclusion issues. Guy Johnson is a Professor of Urban Housing and Homelessness and the Director of the Unison Housing Research Lab at RMIT University, Melbourne, Australia. He has been involved in the area of precarious housing and homelessness for over three decades, initially as a practitioner and then as a researcher. Guy’s research investigates theoretical and applied questions relating to the dynamics of homelessness and housing, and the factors that shape peoples’ pathways out of various institutional arrangements. Marcus Knutagård is an Associate Professor at the School of Social Work, Lund University. His research interests include housing policy, homelessness and the importance of place for how social work is ­organized – ​­its moral geography. He is involved in several research projects on homelessness. One of them is Scanian ­ ejection – ​­Homelessness Policies and Strategies for RefHomes: Reception, Settlement or R ugee Settlement. Alex Young Soo Lee is a graduate of McMaster University Bachelors of Health Sciences Program and a t­hird-​­year medical student at the University of Ottawa. Over the last eight years, Alex has been working as an active leader in the community through his involvement with numerous mental health and addiction services and community housing initiatives. His work has focused on improving access to healthcare for the vulnerable population through institutional reform and educating health professionals to improve patient care. He continues to be a leader throughout his medical training, creating initiatives that foster equity, diversity, and inclusion across Canada in his role as the Director of Students Affairs for the Canadian Federation of Medical Students. Olivia Magwood  is a Research Associate at the Bruyère Research Institute (­Ottawa, Canada) and a Doctoral Candidate in Population Health at the University of Ottawa. She is also a fellow of the Cochrane Equity Methods Group where she focuses on considerations of health equity in evidence synthesis and health decision making. Paula Mayock is an Associate Professor at the School of Social Work and Social Policy, Trinity College Dublin. Her research focuses primarily on the lives and experiences of marginalised youth and adult populations, covering areas such as xv

Contributors

homelessness, drug use and drug problems. Paula is the Author of numerous articles, book chapters and research reports and is an Associate Editor to the international journal Addiction. Susan McCallum  is a PhD Candidate at RMIT University’s Unison Housing Research Lab and National Homelessness Specialist with The Salvation Army Australia. Susan’s research examines the experience of moving into social housing after ­long-​­term homelessness and the connection between the meaning of this transition for people and the process of ‘­settling in’. Stephen Metraux is the Director of the Center for Community Research & Service and Associate Professor of Public Policy at the University of Delaware. Dr Metraux has done pioneering work using administrative and survey data to assess housing outcomes, services use across systems, and impacts of housing and services interventions among homeless and formerly homeless households. He worked as a Policy Analyst at the US Department of Veterans Affairs from 2010 to 2018 as part of the VA’s initiative to end homelessness among veterans. Emily Moore is a Legislative Correspondent in the office of U.S. Senator Tom Carper and a Masters student in the Urban Affairs and Public Policy Program at the University of Delaware. Magdalena Mostowska, PhD, is a Sociologist, Lecturer and Researcher at the Faculty of Geography and Regional Studies at the University of Warsaw. Her research interests include urban studies, social and housing policies, but also qualitative research methods and research ethics. She has conducted a number of research projects on migrant as well as women homelessness in Poland and abroad. Currently, she is exploring youth homelessness as well as mortality and deaths of people experiencing homelessness in Poland. Branagh O’Shaughnessy  is a Postdoctoral Research Fellow at the School of Social Work and Social Policy, Trinity College Dublin. Her research focuses on well-​­ being of adults experiencing homelessness and mental the psychological ­ health issues, with particular interest in e­mpowerment-​­orientated c­ommunity-​ ­based interventions. Eoin O’Sullivan is the Senior Dean of Trinity College Dublin, a Professor in Social Policy and was the Head of the School of Social Work and Social Policy between 2011 and 2018. He has been a member of the European Observatory on Homelessness since 1992, and an editor of the European Journal of Homelessness since 2009. Yoshihiro Okamoto is a Professor at Chukyo University, Nagoya, Japan in the School of Business and Public Policy. He has undertaken research on the Japanese experience of homelessness, housing exclusion in Japan and undertaken comparative research on homelessness in Japan and the UK. xvi

Contributors

Sarah Parker is a Systems and Policy Researcher interested in engaging with complexity to understand social processes in the areas of homelessness and health. She is a Research Fellow at the Centre for Health Policy and Management, School of Medicine, Trinity College Dublin (­TCD), where her work examines how C ­ OVID-​­19 has impacted health reform. She is a former Irish Research Council Scholar whose doctoral research was a mixed methods study on the dynamics of family homelessness in Ireland. She has ­co-​­authored numerous ­peer-​­reviewed articles, reports and book chapters. Kevin Pottie is a Family Physician Researcher whose systematic reviews and clinical guidelines are transforming the ­community-​­based clinical approach to refugee and homeless health care. He holds the Ian McWhinney Research Chair in Family Medicine at Western University, London, Ontario, Canada. He is a Professor in the Departments of Family Medicine and Epidemiology and Biostatistics, Western University, and an Adjunct Professor in Family Medicine at the University of Ottawa, Canada. Della Qiu  holds a Master of Social Work degree from the University of South Australia and a Bachelor of Law from Shanghai University, China. This is her second collaboration with Dr Carole Zufferey on homelessness in China. Their first chapter was published in the 2018 Routledge book edited by Zufferey and Yu titled Faces of Homelessness in the Asia Pacific. Deborah Quilgars is a Senior Research Fellow at the Centre for Housing Policy at the School for Business and Society at the University of York. Deborah has been conducting and leading research into lone adult (­single) homelessness, family, child and youth homelessness and evaluative research on supported housing and Housing First services since the 1990s. Ammar Saad is an Epidemiologist from the University of Ottawa, Canada, and a Member of the Canadian Homeless Health Research Network. He ­co-​­led multiple research studies on e­ vidence-​­based interventions to improve the health and ­well-​­being of people living with homelessness and ­co-​­developed the first Canadian guideline for homeless health. He’s currently completing his medical training at Damascus University, Syria. Jessie Speer is an Assistant Professor in the Department of Geography and Environment at the London School of Economics. Her research examines struggles over urban and domestic space at the margins of housed society. She engages political economic, feminist, and postcolonial approaches to urban displacement to examine how unhoused people contest normative domesticity and capitalist housing markets in the United States. Jama Shelton is an Associate Professor at the Silberman School of Social Work, Hunter College and the associate director of the Silberman Center for Sexuality and Gender. Their scholarship centers the housing and homeless experiences of LGBTQ+ young people, with particular attention to the structural barriers rooted xvii

Contributors

in cis/­heterosexism that often constrain their housing stability. Dr. Shelton also examines the role of the social work profession in moving beyond binary thinking as a key component of social justice work. Sarah Sheridan is an Independent Researcher with particular expertise in homelessness and housing. She is a Lecturer and Visiting Research Fellow in the School of Social Work and Social Policy at Trinity College Dublin and a Board Member of Threshold, a charity which works to prevent homelessness in Ireland. Previously, Sarah worked in research management roles in the Irish Human Rights and Equality Commission and Focus Ireland. Siyi Tang  holds a Master of Social Work degree from the University of South Australia and a Bachelor of Law from Shanghai University, China. Siyi has experience working in Shanghai University Social Research Centre, where she was involved in social surveys of Shanghai citizens. Nóra Teller is a Sociologist at the Metropolitan Research Institute in Budapest. Her research and consultancy expertise relates to issues of social housing, housing (­de)­segregation, housing finance, housing exclusion of Roma, homelessness, evaluation of using EU funds for social inclusion, covering CEE countries and selected old member states. She is a member of the European Observatory on Homelessness and the European Network of Housing Research, and acts as a ­co-​­editor of the European Journal of Homelessness. Dan Treglia is an Associate Professor of Practice at the University of Pennsylvania. He has dedicated his career in government and academia to addressing homelessness and other social policy concerns through collaborative and innovative research that engages governments, nonprofits, and people with lived experience. He has a PhD in Social Welfare from the University of Pennsylvania’s School of Social Policy and Practice and a Masters in Public Policy from Harvard’s Kennedy School. Saija Turunen is the Head of Research at ­Y-​­Foundation, Finland. Currently Saija c­o-​­leads the knowledge development work group of the Housing First Europe Hub and her research interests include impact assessment, women’s homelessness and subjective ­well-​­being. Juliet Watson  is a Senior Lecturer in the School of Global, Urban and Social Studies at RMIT University and Past President of the Australian Women’s and Gender Studies Association. A sociologist and social worker, Juliet has extensive research, teaching, and practice experience in homelessness and g­ ender-​­based violence. Her recent research includes studies of pregnancy and homelessness, crisis responses for women escaping domestic violence, and feminist activism. Carole Zufferey is a Senior Lecturer in Social Work, Justice and Society, University of South Australia. xviii

Contributors

Judith Wolf is Professor of Social Care and head of Impuls, the Netherlands Centre for Social Care Research, at Radboud University Nijmegen Medical Centre. She is also Director of the Academic Collaborative Center for Shelter and Recovery and the Academic Collaborative Centre for Public Mental Health. She has been conducting both academic and applied research on the health and social care needs of socially vulnerable people (including homeless people and women experiencing domestic abuse) for over 30 years. Carole Zufferey is a Senior Lecturer in Social Work, Justice and Society, University of South Australia.

xix

1 THE ROLE OF THE HANDBOOK Joanne Bretherton and Nicholas Pleace

Introduction Routledge handbooks are designed as an educational resource that brings together some of the world’s leading scholars to provide a c­ utting-​­edge overview of classic and current research. This volume was agreed before the ­COVID-​­19 pandemic struck; however, the writing, editing and ultimately the contents of this handbook were modified by the multiple and sustained impacts of the virus. One consequence was that this book went to press rather later than had been anticipated; another was that as the pandemic waxed and waned, the editors asked the authors to reconsider their original submissions. The editors also authored an additional chapter, exploring what ­COVID-​­19 might mean in terms of how academic and policy research, as well as service, programme and strategic designs, responded to and understood homelessness. This first chapter describes the parameters of the research and analysis presented in this handbook. The chapter begins with the focus of this handbook and moves on to provide an overview of the ways which this handbook seeks to present the latest analysis and thinking about homelessness at the international level.

Defining homelessness for the handbook This volume is an attempt to explore the dynamics, detail and debates about homelessness in contemporary society. The emphasis is firmly on conveying international experience and thinking around the subject of homelessness, but within a conceptual and practical framework that is realistic and accurate. A Nordic conception of homelessness, such as that found in Denmark or Finland (­A llen et al., 2020), incorporates what the ETHOS European typology of homelessness would term housing exclusion (­FEANTSA, 2005), i.e. people in states DOI: 10.4324/9781351113113-1

1

Joanne Bretherton and Nicholas Pleace

of ‘­h idden’ homelessness, living with relatives, friends and acquaintances because they have nowhere else to go. Homelessness in these contexts includes a population who are, from a Northern European standpoint, (­very) inadequately housed people who lack security of tenure, privacy, physical safety and the wider controls over their living space we associate with the, arguably somewhat nebulous, idea of ‘­home’ (­Meers, 2021). This is in marked contrast to the idea that homelessness only refers to people living rough or in emergency shelters. In essence, the idea of what constitutes ‘­homelessness’ in much of North Western Europe (­­Busch-​ ­Geertsema et al., 2014) can encompass significant elements of the housed populations in Southern and Eastern Europe, let alone the wider world, who would not necessarily be defined as experiencing homelessness, nor necessarily see themselves as experiencing homelessness. Homelessness is a relative state (­Pleace and Hermans, 2020). If most people living around you are in s­elf-​­constructed basic dwellings in an informal settlement, with perhaps patchy access to power, clean water and sanitation, it is still possible to be (­relatively) ‘­homeless’ because you can lack any sort of dwelling whatsoever and have to live on the street. If you are the only one in a s­ elf-​­constructed basic dwelling with no security of tenure (­i.e. no rights to the land you live on), poor access to clean water and power and most of the people around you are in adequate, legally secure, properly built housing with utilities, then you are the one who might be defined as homeless. Beyond that, if most people have legal security, physical security, are warm, dry and have sanitation and enough living space, and your home is small, insecure, damp, overcrowded and perhaps unsafe, then you might again be defined as homeless in relative terms, particularly if people living rough, or in ­self-​ b­ uilt basic structures in informal settlements, are few in number, or as in a country like Finland, simply not present in any sort of numbers (­A llen et al., 2020). The point here is that each ‘­level’ of relative homelessness constitutes a state of unique distress relative to other people in a society, whatever the norm of home is within that society because it is a state of deep poverty and exclusion, distinct from other forms of poverty and exclusion, because the people involved have no home. A home is distinct from simple housing because it has emotional, cultural and psychological dimensions, although as has been noted elsewhere, the line between housing, home and the idea of a human right to housing is yet to be clearly drawn, if indeed it can or should be drawn (­Meers, 2021). Homelessness means more than lacking a roof because it has these psychological, cultural and emotional dimensions around lacking a settled, adequate, affordable home and homelessness is not a single, clearly definable absolute because of the relativities that exist in how we define and respond to ‘­homelessness’ in different contexts. ETHOS attempts to define a state of homelessness by reference to physical (­housing), social (­a private space over which control is exercised, including who one lives with) and legal (­essentially security of tenure) domains (­­Busch-​­Geertsema, 2010). The typology has been criticised as inconsistent, as while exclusion from the social and legal domains constitutes homelessness, exclusion from the physical does not. The best example here is ETHOS, in its original form, defining hidden homelessness, i.e. staying with relatives, friends or acquaintances in the absence 2

The role of the handbook

of anywhere else to go, which means someone has no control over the physical, social or legal domains, i.e. they do not control their own space, they do not have their own (­private) space and they have no legal rights, as not being homeless, but instead in a state of ‘­housing exclusion’ (­A more et al., 2011; Pleace and Bretherton, 2013). This was modified in the subsequent development of ETHOS ‘­Light’, designed to be compatible with census counts of people experiencing homelessness (­­Busch-​­Geertsema, 2010). ETHOS is probably the closest thing to a global definition, influencing ideas about how to define homelessness across the European Union and beyond; it is ultimately a construct of the European and Global North. Homelessness can, and quite often has been, represented as a quite ­simple  –­​ ­­shared  – ​­global problem. To make this possible, homelessness has to be defined only in terms of people living rough or street homelessness or in emergency shelters, i.e. as houseless poverty, and, sometimes, by extension, as poverty in informal, unregulated or ­semi-​­regulated settlements (­a lso popularly known as shanty towns or squatter areas) (­­Busch-​­Geertsema et al., 2016). Initiatives to end homelessness, either internationally or globally, the Institute of Global Homelessness (­IGH) is one example, focus their efforts on the shared, extreme experience of people living rough and in various forms of squatting (­IGH, 2021). This addresses some aspects of homelessness, including some of the most extreme forms but it is focused on forms of homelessness that, by many definitions of homelessness in the Global North, form only a small fraction of the homeless population (­Culhane and Kuhn, 1998; Pleace and Hermans, 2020; Treglia and Culhane, this volume). One issue here is that there is a tendency to focus on the visible, i.e. those openly living rough and in emergency accommodation because defining, finding and accurately counting people who are squatting or experiencing hidden homelessness are difficult (­Pleace and Hermans, 2020). There are broader issues with the counting of people experiencing homelessness (­Treglia and Culhane, this volume) accurately. These issues arise whenever people are not in spaces that unambiguously signal they are ‘­homeless’ for long enough for enumeration to take place, i.e. on the street or in an emergency shelter for only a short period, and around counting populations whose experience of homelessness is inherently mobile, such as individuals or families who are ­sofa-​­surfing in a succession of precarious situations (­­Busch-​ ­Geertsema, 2010; Pleace and Bretherton, 2013; Pleace and Hermans, 2020). In practice, this often means that people experiencing homelessness chronically and episodically, i.e. on a ­long-​­term or repeated basis, in a relatively fixed position, which tends to be lone men with high and complex needs often including severe mental illness and addiction, tend to be counted, while other forms of homelessness are largely missed or significantly undercounted (­O’Sullivan et al., 2020). Importantly, these definitional and methodological errors mean that the gender dynamics of homelessness are largely ignored. One issue here is that living rough and shelter use appears to be a disproportionately lone male experience, when in fact it is not (­Bretherton and Pleace, 2018). Another is that existing research on shelter dwelling and rough sleeping populations overcounts those people whose homelessness has become recurrent or sustained because of high and complex needs, simply because whenever enumeration, surveys or research is undertaken, it 3

Joanne Bretherton and Nicholas Pleace

is the people with high and complex needs, who often face the greatest barriers to exiting homelessness, who are most likely to be there. For decades, the distortions generated by flawed methodology have supported a narrative that ‘­homelessness’ is triggered by high and complex needs, particularly addiction combined with severe mental illness, something that can, most charitably, be described as a gross oversimplification that borders on distortion (­O’Sullivan et al., 2020; Treglia and Culhane, this volume). Bretherton and Mayock (­2021), in a review of the evidence on women’s homelessness, highlight what they define as spatial, administrative and methodological flaws in data on homelessness. The spatial error stems from only counting homelessness in easily reached, easily definable homeless spaces, i.e. spaces like the street, where women hide themselves, and m ­ ale-​­dominated shelters, which women avoid. The administrative error from only defining certain experiences as ‘­homelessness’, around gender, involves classifying mainly lone women with children as ‘­family’ homelessness and recording domestic abuse that results in homelessness only as ‘­domestic abuse’ if a woman enters a refuge or similar service. The methodological flaws centre on using ­cross-​­sectional methodologies to count an essentially dynamic population. This last issue can be illustrated in the flaws in rough sleeper counts, i.e. people are not living rough all the time, people hide and counts rarely cover entire areas (­Bretherton and Mayock, 2021). Distorted images of ‘­homelessness’ as street dwelling lone men with complex needs bypass the emergent evidence on the gender dynamics of homelessness. It has become evident that total experience of homelessness is much more evenly distributed between people identifying as female and male, particularly when wider definitions than people living rough or in informal settlements are employed. Women are much more likely to experience ‘­h idden’ homelessness, something less well recognised than people living rough, even though women in these circumstances lack control over their own space and hence physical safety and privacy, any sort of legal rights, experience abuse and precarity can have high and complex needs (­Bretherton, 2017; Bretherton and Mayock, 2021; Bretherton, this volume; Watson, this volume). Other dynamics of homelessness also tend to get downplayed because young people (­Mayock and Parker, this volume), LGBTQI homelessness (­Shelton, this volume), migration (­Consoli, this volume) and family homelessness (­Quilgars and Pleace, this volume) are also less evident when homelessness is only defined or responded to as people living rough or in shelters. The line between what is and what is not homelessness can quickly become political and ideological, as much as it is theoretical or empirical, and it can be described as an inherently contested concept (­Bretherton and Pleace, this volume). Arguments about structural, individual, behavioural and indeed medical causation are explored throughout this volume, including discussion around where the line between ‘­homeless’, ‘­housing exclusion’ and ‘­adequately housed’ should be drawn. These arguments inevitably link to politics and ideology because they quickly become about what society should be like, whether housing should be enshrined as a human right and enforced by law, whether the negative effects of Capitalism should be curtailed in relation to housing and labour markets. In essence, debates 4

The role of the handbook

about homelessness quickly start to become about whether extreme poverty is ultimately explicable in terms of individual pathology, a choice to become homeless, deliberately manufactured inequality or some interrelationship between characteristics, needs, experiences, choice and context. Homelessness might be ‘­bad luck’ (­O’Flaherty, 2010) or be more explicable in terms of individual pathology than structure (­Parsell, 2018) or be more about poverty and inequality than anything else (­Bramley and Fitzpatrick, 2018), but, equally, there may not be a single explanation any more than there is a single form of homelessness (­Neale, 1997; Pleace, 2016). Taking this broader definition of homelessness and trying to encompass a reality of complex, intersecting and diverse experience of homelessness take this volume in a specific direction. In practical terms, it means focusing on research, thought and theory that look at homelessness as something beyond lone men with complex needs, whose street and shelter homelessness is somehow supposedly ‘­caused’ by characteristics and experiences shared by much larger populations who are not homeless, such as addiction and poor mental health. This means drawing on the work and ideas of academics and policy researchers who have looked at homelessness in broader ways and at different angles. This handbook is by no means exclusively focused on the Global North (­Ciapessoni, this volume; Qui et al., this volume), but the editors recognise that it is skews towards those countries where the most research has been done, and where the understanding of homelessness and its multiple dimensions have received the most detailed consideration. The conclusion of this handbook devotes some space to exploring where the gaps in evidence are, the arguments about stopping some forms of methodologically and conceptually flawed forms of homelessness research and how we might start to think about reconciling the relativities of homelessness with our understanding and exploration of homelessness as a global phenomenon.

An overview of the handbook This handbook is divided into four main sections. Section 1 provides an introduction to homelessness, covering how our understanding of homelessness has changed and current ideas and debates about the nature of homelessness. Section 2 explores homelessness from interdisciplinary perspectives, including criminology, social work research, human geography, feminist theory and the perspectives of medical researchers. Section 3 presents chapters on the dimensions of homelessness, incorporating discussion of the gender dynamics of homelessness, sexuality and homelessness and the experience of different groups of people, including young people, children and families, migrants and ethnic minorities, veterans and people with high and complex needs. This section also looks at rurality and homelessness and our understanding of the financial and social, as well as the human costs, of homelessness. Section 4 presents perspectives of homelessness from around the world, including Australia, Canada, China, Denmark, Finland, Germany, Hungary, Ireland, Italy, Japan, Poland, Portugal, Slovenia, Sweden, the UK, the USA and Uruguay. 5

Joanne Bretherton and Nicholas Pleace

In Section 1, O’Sullivan’s chapter on the history of homelessness considers the complexities that stem from understanding homelessness varying over time and space and how we can effectively explore the history of a form of poverty and exclusion that only began to be talked about as ‘­homelessness’ in the second half of the last century. The chapter also explores what are some interesting and disturbing continuities in how we have understood and responded to homelessness and how the legacy of attitudes and systems from many decades ago have continued to shape policy responses to homelessness. The next chapter, from the editors, explores the debates about the causation of homelessness. The chapter argues that ‘­zombie’ ideas about individual pathology still exist in homelessness research that persist despite mounting evidence that structural causation has a significant role, also exploring how newer research on women’s experiences of homelessness has highlighted the importance of individual choice and action, alongside other factors, in shaping trajectories through homelessness. Later in Section 1, Treglia and Culhane explore the definition and enumeration of homelessness, exploring the complexities, limits and also the political dimensions of how homelessness is measured. Drawing on the example of the USA, they explore how effective systems for counting homelessness can be developed. Anderson’s chapter examines how societies respond to homelessness, drawing on the example of Scotland, which has experienced rapid progress and multiple challenges as it moves towards a more effective national strategy. Benjaminsen’s chapter is an examination of the intersection of homelessness and welfare systems, which draws on p­ an-​­European and other international comparisons, considering the arguments around the idea that countries with extensive social protection systems experience both less homelessness and homelessness in different forms, compared to countries with limited welfare, social services and social housing. The next chapter, from Pleace, looks at what is still, in 2022, a developing situation around ­COVID-​­19 and its effects on homelessness around the world. This chapter highlights how the pandemic has highlighted homelessness and housing inequalities and how ‘­complex’ problems around reducing rough sleeping were, at least temporarily, greatly reduced when significant resources were aimed at them as a result of the pandemic. Section 2 begins with O’Sullivan’s chapter on the criminological interpretation of homelessness, exploring the longstanding relationships between homelessness and institutional systems designed to punish, police, deter and segregate criminal populations and the criminalisation of homelessness itself. Gerull explores homelessness from a social work perspective in the following chapter, looking at how homelessness connects and fails to connect with social care and social work systems and structures and what that means for developing effective responses to homelessness, including the tensions between empowerment and risk management in service responses. Speer then examines homelessness from a social geography perspective, exploring how social geographic analysis of public space, institutional space and private space can bring new perspectives on understanding homelessness. Watson’s chapter is concerned with how the application of feminist theoretical lens can allow for the unique and disparate experiences of homeless women to be 6

The role of the handbook

explored. Finally in Section 2, Pottie et al.’s chapter explores homelessness, particularly homelessness linked to limiting illness, mental health and disability from a medical research perspective, arguing that a p­ atient-​­centred care approach, which focuses on understanding someone’s needs, is at the core of effective practice. Section 3 begins with a chapter from Bretherton, who looks at why women’s experience of homelessness has never been fully acknowledged, before moving on to consider the nature and extent of women’s homelessness. The longstanding failure to fully recognise need and develop ­women-​­specific services is then discussed. Shelton’s chapter explores sexuality and homelessness, exploring evidence around the disproportionate number of lesbian, gay, bisexual, transgender, queer and other sexual and gender minorities (­LGBTQ+) experiencing homelessness and the factors underpinning their ­over-​­representation. In the next chapter, Mayock and Parker explore the growing concerns about rising levels of youth homelessness from a European and Irish perspective, arguing that the crisis in youth homelessness is strongly associated with young people’s exclusion from housing markets. Quilgars and Pleace explore child and family homelessness in the following chapter; this looks at the scale of family homelessness; before moving on to discuss the current evidence base, the chapter also explores the consequences for children who experience homelessness and considers how best to address family homelessness. In her chapter, Consoli looks at the intersections of migration, ethnicity and homelessness. As she points out, exploring the issue from a ­pan-​­European perspective, migrant homelessness is a real and pressing problem, where tensions between humanitarian responses and border control add complexities and racism, including the experience of ethnic minority of European citizens, is never far below the surface. Bevan’s chapter looks at the rural dimensions of homelessness, exploring the extent to which there is a need for a tailored response in rural areas and how the challenges of (­apparent) relative ‘­invisibility’ of homelessness in rural areas are met. Metraux and Moore look at the experience of homeless veterans, drawing on the experience of the USA, but also incorporating a wider international analysis; they consider why levels have fallen and argue that veteran homelessness is best understood as a microcosm of wider homelessness. ­Filipovič-​­Hrast and Wolf examine the interrelationships between homelessness and health in their chapter, arguing that a framework that seeks to understand how the social marginalisation and exclusion of homelessness impacts on health is the best way to frame and respond to the mutually reinforcing relationships between some forms of homelessness and poor mental and physical health. The next chapter, from Pleace, explores the often controversial and often distorted picture of the interrelationship between homelessness and complex needs, focusing on the ways in which ideological imagery and ­quasi-​­fictional narratives have influenced often ineffective strategic and service responses to homelessness and looking at how innovations like Housing First can help develop more effective strategies. Mayock and O’Shaughnessy look at the relationships between addiction and homelessness in the next chapter in Section 3, arguing that the associations are multifaceted and complex and looking at the evidence around which interventions, again including 7

Joanne Bretherton and Nicholas Pleace

Housing First, are likely to provide the most effective support. Pleace’s chapter explores the multifaceted costs of homelessness which are greatest, in terms of health, ­well-​­being, life chances and quality of life, for people who experience recurrent and sustained homelessness. Section 4 concludes this handbook. In this section, each chapter follows a broadly similar structure, exploring the dimensions of homelessness in a particular country. Johnson et al. look at Australia, arguing that, over the last four decades, substantial energy has been directed towards ending homelessness in Australia with little success and examining the reasons why this has been the case. Gaetz looks at Canada, arguing that homelessness has developed in parallel with underinvestment in affordable housing and spiralling housing costs and highlighting the issues around indigenous homelessness in that country. Qiu et al. look at homelessness in China, exploring arguments about the association between socioeconomic exclusion and experience of homelessness and exploring the ways in which homelessness is defined and responded to in China. Benjaminsen explores homelessness in Denmark in his chapter, exploring why a wealthy country which has retained public policies centred on income redistribution and extensive social protection has experienced a persistent homelessness problem. Granfelt and Turuen look at Finland in their chapter, showing the very considerable successes of what is regarded as the single most effective example of a national homelessness strategy at the time of writing, but also sounding notes of caution about some ongoing challenges. ­Busch-​­Geertsema’s chapter is concerned with German experience of homelessness, exploring a complex world of varied policy responses at regional level and looking at the challenges around defining and enumerating homelessness. Teller’s chapter looks at homelessness in Hungary, exploring how it has changed over time, the interrelationships between homelessness and a housing system orientated towards maximal home ownership and the sustained attempts to criminalise homelessness. Sheridan and Parker focus on homelessness in Ireland; their chapter examines why homelessness has, despite significant public investment, not only persisted but shifted in both its nature and extent and intersections between homelessness and sustained shortages in affordable housing supply. Consoli and Cortese look at homelessness in Italy in their chapter, looking at the development of policy and practice in a context where different definitions of homelessness exist and the emergence of a more focused and innovative response to homelessness, including significant development of Housing First. Okamoto and Bretherton look at homelessness in Japan in their chapter, exploring why homelessness exists and persists in one of the world’s most successful economies which is also one of the world’s most socioeconomically equal societies. Mostowska looks at homelessness in Poland, exploring how the problem emerged and was responded to and how social protection systems that emphasise the role of the family, rather than the State, may influence the experience and nature of homelessness. Baptista examines homelessness in Portugal, looking at how homelessness has been defined, responded to and the emergence of a national strategic response that is starting to see homelessness in different ways. 8

The role of the handbook

Slovenian homelessness is the subject of the chapter by ­Filipovič-​­H rast and she explores why it has been difficult to get greater policy recognition of homelessness as a social problem and the challenges around developing a consensus around how best to prevent and reduce homelessness. Knutagård examines Swedish homelessness in his chapter, arguing that the nature of homelessness is best understood in relation to the deregulation and privatisation of housing markets that has occurred in the last 20 years and exploring the reasons for the haphazard development of Housing First and other innovative responses to homelessness. The editors have written a chapter on homelessness in the UK, arguing that England, Scotland, Wales and Northern Ireland have, collectively and individually, often managed to simultaneously demonstrate innovation, success in tackling homelessness and also demonstrated how to make a policy mess in responding to homelessness. Batko and Culhane look at homelessness in the USA in their chapter, arguing that progress has been made and progress has been lost in a policy context in which broader housing market forces have often been important in understanding the nature and extent of homelessness. Section 4 concludes with a South American perspective, with Ciapessoni looking at homelessness in Uruguay where she argues that there is evidence of an interrelationship between homelessness poverty, violence, public safety and social exclusion. This handbook is a reference work, which means that each chapter is freestanding, and it is also the product of multiple authors with multiple perspectives, which means that the ways in which homelessness is defined and interpreted are not necessarily consistent throughout every single chapter, something that also reflects significant national differences in how homelessness is perceived. That said, certain sets of chapters are interrelated, for example, the chapters by Watson, Bretherton and Shelton on gender and sexuality and the chapters by O’Sullivan, Mayock and Pleace on criminological interpretations of homelessness, addiction and homelessness and Housing First and complex needs. As noted, the chapters in Section 4 follow a similar structure, with the intent being that a reader can, for example, use these to ­cross-​­compare experiences of homelessness in European, Australasian, ­A sia-​­Pacific and North and South American perceptions of, and responses to, homelessness.

References Allen, M., Benjaminsen, L., O’Sullivan, E. and Pleace, N. (­2020) Ending Homelessness in Denmark, Finland and Ireland. Bristol: Policy Press. Amore, K., Baker, M. and Howden-Chapman, P. (­2011) The ETHOS Definition and Classification of Homelessness: An Analysis. European Journal of Homelessness 5(­2), p­p. ­19–​­37. Bramley, G. and Fitzpatrick, S. (­2018) Homelessness in the UK: Who Is Most at Risk? Housing Studies 33(­1), p­p. ­96–​­116. Bretherton, J. (­2017) Reconsidering Gender in Homelessness. European Journal of Homelessness 11(­1), p­p. ­1–​­21. Bretherton, J. and Pleace, N. (­2018) Women and Rough Sleeping: A Critical Review of Current Research and Methodology. London: St Mungo’s. Bretherton, J. and Mayock, P. (­2021) Women’s Homelessness: European Evidence Review. Brussels: FEANTSA.

9

Joanne Bretherton and Nicholas Pleace ­Busch-​­Geertsema, V. (­2010) Defining and Measuring Homelessness. In O’Sullivan, E. et al. (­eds) Homelessness Research in Europe: Festschrift for Bill Edgar and Joe Doherty. Brussels: FEANTSA, p­p. ­19–​­39. ­Busch-​­Geertsema, V., Benjaminsen, L., Filipovič Hrast, M. and Pleace, N. (­2014) The Extent and Profile of Homelessness in European Member States: A Statistical Update. Brussels: FEANTSA. ­Busch-​­Geertsema, V., Culhane, D. and Fitzpatrick, S. (­2016) Developing a Global Framework for Conceptualising and Measuring Homelessness. Habitat International 55, p­p. ­124–​­132. Culhane, D. P. and Kuhn, R. (­1998) Patterns and Determinants of Public Shelter Utilization among Homeless Adults in New York City and Philadelphia. The Journal of the Association for Public Policy Analysis and Management 17(­1), p­p. ­23–​­43. FEANTSA (­2005) European Typology of Homelessness and Housing Exclusion. Brussels: FEANTSA. Institute for Global Homelessness (­2021) A Global Framework for Understanding Homelessness. IGH http://­ighomelessness.org/­­w p-​­content/­uploads/­2019/­10/­g lobalframeworkfor undertanding.pdf (­accessed December 2021). Meers, J. (­2021) ‘­Home’ as an Essentially Contested Concept and Why This Matters. Housing Studies. DOI: 10.1080/­02673037.2021.1893281. Neale, J. (­1997) Homelessness and Theory Reconsidered. Housing Studies 12(­1), p­p. ­47–​­61. O’Flaherty, B. (­2010) Homelessness as Bad Luck: Implications for Research and Policy. In Ellen, I.G. and O’Flaherty, B. (­eds) How to House the Homeless. New York: Russell Sage Foundation, p­p. ­143–​­182. O’Sullivan, E., Pleace, N., ­Busch-​­Geertsema, V. and Hrast, M. F. (­2020) Distorting Tendencies in Understanding Homelessness in Europe. European Journal of Homelessness 14(­3), p­p. ­109–​­135. Parsell, C. (­2018) The Homeless Person in Contemporary Society. London: Routledge Pleace, N. and Bretherton, J. (­2013) Measuring Homelessness and Housing Exclusion in Northern Ireland: A Test of the ETHOS Typology. Belfast: Northern Ireland Housing Executive. Pleace, N. (­2016) Researching Homelessness in Europe: Theoretical Perspectives. European Journal of Homelessness 10(­3), p­p. ­19–​­4 4. Pleace, N. and Hermans, K. (­2020) Counting All Homelessness in Europe: The Case for Ending Separate Enumeration of ‘­H idden Homelessness’. European Journal of Homelessness 14(­3), p­p. ­35–​­62.

10

SECTION 1

An introduction to homelessness

2 HISTORICAL PERSPECTIVES ON HOMELESSNESS Eoin O’Sullivan

Introduction Writing a history of homelessness is particularly problematic for a number of reasons. First, what we understand as homelessness has varied over time and space, even in the case of the countries of the global north that this chapter focuses on. Our contemporary broad understanding of homelessness as a form of residential instability due primarily to affordable housing supply constraints, that can be resolved through the provision housing, with support if necessary for a relatively small minority, is historically relatively novel. Earlier accounts focused primarily on the labour market rather than the housing market to explain rates of homelessness, and on individual deviancy and indolence to explain their lack of participation in the labour market. Policy was geared to deterring individuals from surviving outside the strictures of the labour market by criminalising n ­ on-​­productive activities such as begging, by curtailing indiscriminate charity and for those who persisted in attempting to operate outside the labour market, detention in a range of poor law, criminal justice and hybrid institutions, where work or labour was mandatory. Second, and related to the above point, who we think of as ‘­homeless’ has also varied over time and space. As Hopper has observed: ‘­seeking to impose order on the hodgepodge of dislocation, extreme poverty, migrant work, unconventional ways of life, and bureaucratic expediency that have, at one time or another, been labelled homeless my well be a fool’s errand’ (­2003, ­p. 18). The range of terms utilised to describe this hodgepodge includes tramps, hoboes, bums, idle and disorderly, poor and indigent, rogues and vagabonds, incorrigible rogues, vagrants, idle and dissolute, mendicants, beggars, casuals, dossers, of no fixed abode, etc., usually a precise legal construct or ­self-​­described,1 and sometimes geographically specific such as ‘­swaggie’ in Australia (­Gerrard, 2017). In addition, partly due to the reach of the various vagrancy laws, public drunkenness, prostitution and criminality were DOI: 10.4324/9781351113113-3

13

Eoin O’Sullivan

often intertwined with descriptions of the ‘­homeless’. For example, in the case of Norway, vagrants were defined as persons ‘­addicted to idleness and drunkenness’ (­U lvund, 2012, ­p. 30); in the case of the United States, Cresswell (­1999, ­p. 186) argues that ‘­m any commentators during the period ­1875–​­1939 referred to female tramps and prostitutes in almost the same breath, often assuming that the two were more or less equal’. Third, the institutional response to homelessness has varied over time and space; largely punitive measures from the Middle Ages were gradually replaced by ostensibly reformatory measures at the beginning of the 20th century, with a more medical/­therapeutic tendency evident in the second half of the 20th century (­M aeseele et  al., 2014), with measures that respond to homelessness through the provision of housing increasingly in the ascendency in the 21st century. However, we need to be mindful that the punitive has always retained a residual and supporting role to the reformative and inclusive, that the therapeutic often concealed a punitive dimension and that the punitive has the capacity to resurface in surprising ways in different places and at different times.

Managing Vagrants There is a long tradition of scholarship in examining vagrancy laws and how they have been introduced, adapted and modified to ensure the maintenance of social order (­for an early example, see Gillin, 1929 who provides a brief overview of the development of repressive methods and institutions to manage vagrants and beggars in the latter half of the 19th century drawing largely on the pioneering work of ­R ibton-​­Turner, 1887). However, the origin of vagrancy laws and their role in maintaining social order is subject to considerable debate. Chambliss (­1964) argued that the vagrancy laws provided an example of how elites utilised the legal system to maintain their dominant economic position, or as Chambliss himself expressed it: ‘­shifts and changes in the law of vagrancy show a clear pattern of reflecting the interest and needs of the groups who control the economic institutions of the society’ (­1973, ­p. 442). For Chambliss, vagrancy laws, originating in England in 1349, were a legislative innovation, which reflected the socially perceived necessity of providing an abundance of cheap labour to landowners during a period when serfdom was breaking down and when the pool of available labour was depleted. With the eventual breakup of feudalism, the need for such laws eventually disappeared and the increased dependence of the economy upon industry and commerce rendered the former use of the vagrancy statutes unnecessary. As a result, for a substantial period, the vagrancy statutes were dormant, undergoing only minor changes and, presumably, being applied infrequently. The vagrancy laws were subjected to considerable alteration over time through a shift in the focal concern of the statutes. While in their inception, the laws focused upon the ‘­idle’ and ‘­those refusing to labour’ after the turn of the 16th century and emphasis came to be upon ‘­rogues’, ‘­vagabonds’, ‘­and others who were suspected of being engaged in 14

Historical perspectives on homelessness

criminal activities’. Alder (­1989a, ­p. 222) has criticised Chambliss arguing that his historical analysis was flawed and that detailed case studies invalidate his thesis, suggesting that ‘­economic concerns were but one among a multitude of pressures that influenced the development of criminal law’ (­see also Chambliss, 1989 and Alder, 1989b for rejoinders). Vagrancy codes were substantially modified in the 19th century to regulate those who threatened social order, particularly tramps and beggars, with the key objectives of regulating the migratory patterns of those tramping from place to place in search of shelter and work; in particular to prevent indiscriminate alms giving through begging and thus facilitate ­non-​­participation in the labour force, and to ensure that the undeserving poor did not consume the food and occupy the shelter reserved for the deserving poor. In the United States, linked ordinances specifically targeted those who exposed ‘­d isease, maiming, deformity, or mutilation for the purpose of begging; the so called “­ugly” laws’ (­Schweik, 2009, ­p. 2). In the case of the Vagrancy Act, 1824 passed first in England and Wales and then extended to Scotland and Ireland in 1871, the legislation distinguished between ‘­idle and disorderly persons’ or ‘­rogues and vagabonds’ or ‘­incorrigible rogues’, with ascending levels of punishment for each category. These modifications were linked with the restructuring of the poor laws in Britain, in particular the development of the workhouse system in 1834 (­Driver, 1993). To safeguard against relief programmes that could spawn the rise of a dangerous class of wanderers, laggards and parasites, within the workhouses of Ireland, England, Scotland and Wales, for example, casual wards, separate from the workhouse, were provided, where inmates had to engage in tedious and repetitive tasks such as breaking stone and picking oakum to earn their shelter and meagre sustenance (­see Crowther, 1981, 1992 and Higginbotham, 2017 for overviews of casual wards in England) and in a number of continental European countries, labour colonies were established (­see below) for this class. While the conditions for those convicted under the Vagrancy Act, 1824, and receiving a prison sentence were undoubtedly bleak and severe, with limited diets and substantial time on the treadmill (­Ignatieff, 1978), the specialist accommodation under the poor laws tended to be even bleaker. From both historical accounts and contemporaneous accounts of the lives of tramps and vagrants, poor law facilities were punitive degrading institutions (­Freeman, 2001; Higbie, 1997; Ranasinghe, 2012) or as Vorspan (­1977, ­p. 60) neatly put it: official Poor Law policy towards vagrants combined a legal recognition of their right to relief with a determination to award this relief under intensely disagreeable conditions’ with the result that prisons were viewed as less punitive than the Casual Wards. Even for those who did not end up in the poor law facilities, as Kimber (­2010) has shown in her case study of a homeless woman in Australia in the first 40 years of the 20th century, long sojourns in criminal justice facilities was the fate of those at the margins of society. 15

Eoin O’Sullivan

Vagrant Colonies A key concern for those charged with managing vagrants was how to classify them in order to distinguish those temporarily idle arising from labour market fluctuations, and those who were ‘­habitually idle’ resulting from acculturation or natural disposition. In recognition of the existence of both categories (­a nd many in between), most countries had both charitable/­poor law responses to vagrancy in addition to penal sanctions. Endless variations of categorisations of vagrants and mendicants can be found in polemical tracts, research reports and government enquiries towards the end of the 19th and beginning of the 20th century, but all usually distinguished between a­ ble-​­bodied labourer who was temporarily out of work, those who were impaired, either physically or intellectually, and most importantly, the habitual parasitical vagrant/­beggar/­t ramp. In addition, it was during this period, as Garland argues, ‘­novel ways of thinking and acting were applied to a whole range of otherwise separate penal and social problems …’ (­Garland, 2019, ­p. 6) whereby penal, social and economic issues were increasingly seen as related and intertwined. At the end of the 19th century, the ‘­vagrancy question’ was both a national and a transnational issue (­Wadauer, 2011). Although there were significant national variations in approach to managing vagrancy, with, for example, France and Germany laying much greater stress on the disabilities of vagrants than was the case in Britain which stressed their inherent deviancy (­A lthammer, 2016), and the French response to vagrancy was primarily via the criminal justice system rather than the poor law as was the case the England (­Lawrence, 2004), the International Penitentiary Congress was a key forum for discussing transnational responses to vagrancy (­A lthammer, 2014). At the 5th International Congress in Paris in 1895, a consensus was emerging that vagrancy should be effectively removed from the penal and criminal justice realm, and that vagrancy policy should be ­re-​­orientated towards rehabilitation rather than punishment. Althammer (­2014) argues that this came about due to the influence of shifts in the broader penological sphere where penal reformers were proposing penological principles based on the reforming of the offender, rather than the existing system of retribution in proportion to the gravity of the offence. As vagrancy was a relatively minor offence, it tended to only attract a relatively short prison sentence of a week to a month, which was deemed ineffective in deterring or curbing vagrancy and begging (­Garland, 1985, p­ . 64). Furthermore, even where harsh laws were in place, Courts tended not to apply the full rigour of the law and in practice the application of law was erratic (­A lthammer, 2018). For example, Alice Solenberger (­1911, ­p. 9) in her seminal study of vagrants in Chicago at the beginning of the 20th century observed that the ‘­vagrancy laws are as a rule rather laxly enforced and begging is a safe as well as a lucrative business’. There was also an extraordinary variation in the application of vagrancy laws in the United States, with, for example, vagrancy laws in some States applying to ‘­­able-​­bodied men’ only (­M illis, 1898). In addition, as Ranasinghe (­2012) notes in relation to Canada, the sheer number of vagrants entering the prison system for s­ hort-​­periods 16

Historical perspectives on homelessness

of time was putting considerable strains on the administration of justice and the ability to accurately classify offenders according to their capacity for rehabilitation. Furthermore, the existing principles of punishment for vagrancy were based on proportionality, resulting in relatively short sentences that were viewed as neither reforming the individual vagrant, deterring those considering a life of vagrancy nor removing the habitual vagrant from society to prevent contamination. To successfully address vagrancy required indeterminate sentences which would allow for the detention of the vagrant in specialised institutions until deemed reformed, rather than the ­short-​­term fixed sentences that were proving unsuccessful in addressing vagrancy; such indeterminate sentences would also act as a deterrent to those contemplating a life of idleness and crime. In addition, it was recognised by the reformers that for those who were not amendable to reformation, they should be detained indefinitely to protect society from their immediate depredations and to ensure they wouldn’t reproduce, an issue that attracted the interest of Eugenicists (­Pringle, 1926). What spurred this debate in 1895 was that a model that embodied these reformative, deterrent and punitive principles had recently opened in Merxplas in Belgium.

A City of Vagabonds: The Largest Colony of Mendicants in the World, Merxplas, Belgium The above quote is the title of an article from the American Journal of Sociology in 1910 (­Van Schelle, 1910) on the experiment in Merxplas. The context for Merxplas was a change in legislation in Belgium in 1891 which allowed for the detention of vagrants in a colony for no less than two years and no more than seven years, compared to the previous legislative regime which allowed for short prison sentences, generally between one and seven days (­Willink, 1905; Binder, 1916). Introduced by the Minister for Justice, Jules Le Jeune, those who were committed were those who ‘­instead of seeking to support themselves by work, exploit charity as professional beggars or who, by reason of habits of idleness, drunkenness or vice, live in a state of vagabondage, or as procurers of prostitution’. For Willink, the primary purpose of Merxplas was to as a ‘­means of repression of vagrancy and mendicancy’ (­1905, ­p. 124) and that ‘­i f so large a number of irreclaimable men as there at Merxplas can be kept healthy, sober, employed, out of active mischief and restrained from multiplication, is a considerable achievement’ (­1905, ­p. 125). In Merxplas, it can be argued, we see the physical manifestation of the various debates that had raged over the previous centuries over how best to manage the vagrant. Although Merxplas was not the first nor the only labour colony in Continental Europe,2 it was the fullest realisation of the application of contemporary scientific reason and best practice to manage vagrancy. It was also the most extensive colony dedicated to reforming and containing vagrants, and simultaneously embodied, as discussed below, the contradictions and failures of successive institutional attempts to manage residential instability. At the beginning of the 20th century, the practice of confining vagrants and beggars in many continental European countries were under envious scrutiny from 17

Eoin O’Sullivan

British and American visitors. In England, Vorspan (­1977, ­p. 75) argues that by the 1880s, labour colonies were ‘­promoted by every conceivable public and private organisation’ where professional tramps should be compulsorily detained for lengthy periods in penal colonies modelled on existing German, Belgian, Dutch and Swiss settlements. This course of action would accomplish numerous objectives. It would deter prospective vagrants, not merely from public relief but from the nomadic life altogether; it would remove vagrants from the public domain and thereby lesson the incidence of sleeping out, petty crime and begging; it would facilitate the reclamation of habitual tramps; and, finally, it would prevent professional vagabonds from exploiting public assistance to the ‘­deserving’.

Critique of the Labour Colonies While many observers of the continental labour colonies were rhapsodic in their support of such institutions, others were decidedly underwhelmed by the actual practice and outcomes of these colonies in comparison to the rhetoric of the promoters of such institutions. For example, the Rev. J.J. McCook, having reviewed the labour colonies in Germany, France and England in the last decade of the 19th century, concluded that: ‘­The labour colonies are by no means an unmitigated good. They have not come up to the expectation of their founders. But there seems no reason to doubt that things are better with than were without them’ (­1893, ­p. 763). Likewise, Mavor (­1893) in his detailed description of various types of labour colonies in operation across England, Demark, Germany, Holland and France noted that irrespective of the type of colony, be they for families or for single men, they were very costly and the reformatory benefit doubtful.

Rethinking Responses to Vagrancy While labour colonies fell out of favour, the casual wards and allied institutions associated with the poor laws remained in place in many European countries, surviving until the late 1960s and early 1970s. In the case of England, Krafchik (­1983) has argued that while the material conditions in the casual wards remained much the same in the first half of the 20th century as they were in the second half of the 19th, the vagrant was reconceptualised administratively as someone not who was unwilling to work, but was incapable of working, thus requiring treatment. This reconceptualisation was not based on a diagnosis of those in the casual wards, but rather it was ‘­derived from political, financial and administrative pressures’, particularly around the division of responsibility for the unemployed and vagrants between the Ministry for Health and the Ministry for Labour. Similarly in Sweden, vagrancy was reconceptualised as a medical issue, in particular the misuse of alcohol from the 1920s onwards, but rather than lessening the likelihood of detention, it actually increased the likelihood, but on the grounds of treatment rather than punishment (­A ndersson, 2017). 18

Historical perspectives on homelessness

In North America, homelessness was largely contained to specific geographical areas rather than specific institutions, albeit that the skid row areas that contained the homeless spawned a range of institutions and agencies with ambitions to salvage their souls and alleviate their apparent excessive alcohol consumption (­Bibby and Mauss, 1974). The inhabitants of these institutions were surplus to labour requirements and hence the application of vagrancy laws gradually dissipated. As the relationship with the labour market declined and this surplus population were contained either within skid row in North America or various poor law or charitable institutions in Europe, there was no ‘­need nor rationale for disciplining them’ (­Hopper, 1990, ­p.  24). In addition to the hybrid congregate state institutions of criminal justice and poor law, prominent in the skid rows of North America and cities of Europe were religiously inspired shelter services that traded salvation for shelter, albeit that they failed on a ‘­colossal scale’ (­Rooney, 1980) in achieving their objective of salvation for the homeless, rather simply subjected them instead to degrading and humiliating rudimentary services.

Managing Vagrant Women Contemporary accounts of homelessness for most of the 19th and 20th centuries viewed vagrants as ‘­m ale, workshy, content to live off charity and criminality’ (­Crowson, 2020, ­p.  1488), with accounts of homeless women only emerging in the last two decades of the 20th century as part of the story of the ‘­new homeless’. For example, Allsop (­1967) in his history of Hobos refers only to ‘­the hobo and his history’. O’Sullivan (­2016) has suggested that women were in fact homeless in large numbers in the 19th and 20th centuries (­see also Bloom, 2005), not simply emerging in the late 20th century, but rendered invisible as they largely utilised a range of ­female-​­only services that were usually not formally designated as services for the homeless (­see also Oudshoorn et al., 2018). Rather than using the publicly provided casual wards or privately provided lodging houses that offered communal ­shelter-​­type accommodation, females utilised a range of other sites, including convents, refuges and asylums. By focusing their investigative attentions largely on accommodation services formally designated as ‘­services for the homeless’, investigators and enumerators concluded that the majority of those deemed homeless were male. Females were thus rendered relatively invisible as a result of the research methodologies deployed in counting the homeless. As a result of this methodological blindness, the small number of women found on skid row or in accommodation designated for the homeless was usually described in exotic terms, often in terms of their lack of domesticity and deviant sexuality. This is also the case in the late 19th and early 20th centuries, where Davies in her case study of vagrancy in Melbourne noted the gendered interpretation of vagrancy ‘[w]heras men were condemned primarily for failing to participate in the labour market, women were principally criticised for sexual impropriety and for other forms of unfeminine behaviour’ (­1990, ­p. 30). Over the 19th and 20th centuries, economic and social pressures, particularly in a context of recurrent shortages of affordable accommodation, have generated homelessness among men 19

Eoin O’Sullivan

and women. However, the strategies adopted by women to escape literal homelessness were more diverse than those of males, and with a range of ­female-​­specific accommodation services available to them, often organised around protecting the virtue of females and the morals of society. The thesis is supported by Althammer’s (­2018) work on the ‘­d isappearance’ of vagrant women from crime statistics in the second half of the 19th century. In her careful statistical analysis, she notes a ‘­m assive decline in the ratio of females among apprehended beggars and vagabonds in the course of the nineteenth century’ (­2018, ­p. 741). This was a consequence, she argues, of a range of charitable institutions emerging in the second half of the 19th to provide poor relief to the deserving poor, and women were deemed to be more deserving than men. This resulted in ‘­public and expert discourse on the vagrancy issue around 1900 was almost exclusively centred on the male offender’ (­2018, ­p. 745).

Conclusion The development of colonies of various types for vagrants represented the distillation of debates about how best to manage those who were without stable accommodation and not attached the labour market. Fusing poor law and criminal law principles, they were to both deter and reform this ‘­surplus population’, but ultimately failed on both counts. In the ­post-​­World War II period in most Western industrial economies, homelessness was generally seen as a residual problem, consisting largely of single men, a problem that would gradually wither away as welfare states broadened and deepened their reach to support vulnerable households. However, by the early 1980s, initially and most visibly in the United States, it became apparent that homelessness had not faded away; rather, the number experiencing homelessness was increasing and was no longer experienced almost exclusively by single men. As the number of people experiencing homelessness increased during the 1980s and 1990s, the basic model of provision that prevailed for single men in earlier periods (­i.e., rooming houses, shelters and other congregate facilities providing basic subsistence, infused with various strands of rehabilitative, religious and redemptive assumptions) was simply expanded, rather than changed to respond to the needs of the increasingly diverse population who were experiencing homelessness. These historical reflections add to the debate on the utility of providing shelters as the primary response to homelessness, particularly when our primary response to, for example, a disability, wither physical or mental, is not to cluster individuals with such disabilities in congregate settings, as was the case in the 19th and first half of the 20th centuries (­Scull, 2015) but rather to provide an individualised range of supports. Shelters have their origins in the late 19th century and their emergence was determined by the construction of a range of other institutions to manage the poor, including workhouses, prisons and a vast array of asylums and penitentiaries, where the vagrant didn’t clearly fit, necessitating the construction of a separate institution for their containment and rehabilitation. The failure of these institutions to reform or rehabilitate, to desist or to deter was clearly evident by the 20

Historical perspectives on homelessness

end of the 19th century, but it was to take several decades before the majority of these massive mausoleums of misery gradually fell into disuse and disgrace. However, two of the institutions have not only survived, but have thrived, the prison and the shelter, despite their failures to achieve what their advocates have hoped for, for over 150 years.

Notes 1 For example, hobos worked and wandered, tramps wandered but did not work and bums neither worked nor wandered (­Bloom, 2005; see also Anderson, 1923); whether you were described as a rogue or an incorrigible rogue depended on the number of convictions under the Vagrancy Acts, with a third conviction labelling you an incorrigible rogue. 2 Such was the interest in vagrant colonies of various forms that Hart could produce a ­15-​­page bibliography of published material on the subject in 1925 (­see Hart, 1927).

References Alder, J.S. (­ 1989a) A Historical Analysis of the Law of Vagrancy. Criminology 27(­2), p­p. ­209–​­229. Alder, J.S. (­1989b) Rejoinder to Chambliss. Criminology 27(­2), p­p. ­239–​­250. Allsop, K. (­1967) Hard Travellin’: The Hobo and His History (­L ondon: Hodder and Stoughton). Althammer, B. (­ 2014) Transnational Expert Discourse on Vagrancy around 1900. In Althammer, B., Gestrich, A. and Grundler, J. (­Eds.) The Welfare State and the ‘­Deviant Poor’ in Europe, ­1870–​­1933 (­Basingstoke: Palgrave Macmillan), p­p. ­103–​­125. Althammer, B. (­2016) Controlling Vagrancy: Germany, England and France, ­1880–​­1914. In Althammer, B., Raphael, L. and T. S­ tazic-​­Wendt (­Eds.) Rescuing the Vulnerable: Poverty, Welfare and Social Ties in Modern Europe (­New York: Berghahn Books), p­p. ­187–​­211. Althammer, B. (­2018) Roaming Men, Sedentary Women? The Gendering of Vagrancy Offenses in ­Nineteenth-​­Century Europe. Journal of Social History 51(­4), p­p. ­736–​­759. Anderson, N. (­1923) The Hobo: The Sociology of the Homeless Man (­Chicago: University of Chicago Press). Andersson, R. (­2017) A Culture of I­ ntervention—​­Vagrancy and Drug Treatment in Sweden from the Late 19th Century Until Today. In Smith, P.S. and Ugelvik, T. (­Eds.) Scandinavian Penal History, Culture and Prison Practice (­L ondon: Palgrave Macmillan), p­p. ­103–​­125. Bibby, R. and Mauss, A. (­1974) Skidders and their Servants: Variable Goals and Functions of the ­Skid-​­Row Rescue Mission. Journal for the Scientific Study of Religion 13, p­p. ­421–​­436. Binder, R. (­1916) The Treatment of Beggars and Vagabonds in Belgium. Journal of the American Institute of Criminal Law and Criminology 6(­6), p­p. ­835–​­848. Bloom, A. (­ 2005) Towards a History of Homelessness. Journal of Urban History 31(­6), p­p. ­9 07–​­917. Chambliss, W.J. (­1964) A Sociological Analysis of the Law of Vagrancy. Social Problems 12 (­1), p­p. ­67–​­77. Chambliss, W.J. (­1989) On Thrashing Marxist Criminology. Criminology 17(­2), p­p. ­231–​­238. Chambliss, W. (­1973) Elites and the Creation of Criminal Law. In Chambliss, W. (­Ed.) ­Sociological Readings in the Conflict Perspective (­Reading, MA: ­Addison-​­Wesley), p­p. ­430–​­4 44. Cresswell, T. (­1999) Embodiment, Power and the Politics of Mobility: The Case of Female Tramps and Hobos. Transactions of the Institute of British Geographers 24(­2), p­p. ­175–​­192. ­ ife-​­Stories of Late Victorian and Crowson, N.J. (­2020) Tramps’ Tales: Discovering the L Edwardian Vagrants. The English Historical Review 135(­577), p­p. ­1488–​­1526.

21

Eoin O’Sullivan Crowther, M.A. (­1981) The Workhouse System ­1834–​­1929: The History of an English Social Institution (­Athens: University of Georgia Press). Crowther, M.A. (­1992) The Tramp. In Porter, R. (­Ed.) Myths of the English (­Oxford: Polity Press), p­p. ­91–​­113. Davies, S.E. (­1990) Vagrancy and the Victorians: The Social Construction of Vagrants in Melbourne, ­1880–​­1907. PhD thesis, History Department, University of Melbourne. Driver, F. (­1993) Power and Pauperism: The Workhouse System ­1834–​­1884 (­Cambridge: Cambridge University Press). Freeman, M. (­2001) ‘­Journeys into Poverty Kingdom’: Participation and the British Vagrant, ­1866–​­1914. History Workshop Journal 52, p­p. ­99–​­121. Garland, D. (­1985) Punishment and Welfare: A History of Penal Strategies (­A ldershot: Gower). Garland, D. (­ 2019) Punishment and Welfare Revisited. Punishment and Society 21(­3), p­p. ­267–​­274. Gerrard, J. (­2017) The Interconnected Histories of Labour and Homelessness. Labour History 112, p­p. ­155–​­174. Gillin, J.L. (­1929) Vagrancy and Begging. American Journal of Sociology 35(­3), p­p. ­424–​­432. Hart, M.G. (­1927) Farm Colonies for Misdemeanants (­A Bibliography). Journal of Criminal Law and Criminology 17(­4), p­p. ­626–​­639. Higbie, F.T. (­1997) Crossing Class Boundaries: Tramp Ethnographers and the Narratives of Class in Progressive Era America. Social Science History 21(­4), p­p. ­559–​­592. Hopper, K. (­1990) Public Shelter as “­a Hybrid Institution”: Homeless Men in Historical perspective. Journal of Social Issues 46(­4), p­p. ­13–​­29. Hopper, K. (­2003) Reckoning with Homelessness (­Ithaca: Cornell University Press). Ignatieff, M. (­1978) A Just Measure of Pain: The Penitentiary in the Industrial Revolution, ­1750–​ ­1850 (­Harmondsworth: Peregrine). Kimber, J. (­2010) ‘­A Nuisance to the Community’: Policing the Vagrant Woman. Journal of Australian Studies 34(­3), p­p. ­275–​­293. Krafchik, M. (­1983) Unemployment and Vagrancy in the 1930s: Deterrence, Rehabilitation and the Depression. Journal of Social Policy 12(­2), p­p. ­195–​­214. Lawrence, P. (­2004) Policing the Poor in England and France, ­1850–​­1900. In Emsley, C., Johnson, E. and Spierenburg, P. (­Eds.) Social Control in Europe, ­1800–­​­­2000 – ​­Volume 2, (­Columbus: Ohio State University Press), p­p. ­210–​­225. Maeseele, T., Roose, R., ­Bouverne-​­De Bie, M. and Roets, G. (­2014) From Vagrancy to Homelessness: The Value of a Welfare Approach to Homelessness. British Journal of Social Work 44, p­p. ­1717–​­1734. Mavor, J. (­1893) Labour Colonies and the Unemployed, Political Economy 2, p­p. ­26–​­27. McCook, J.J. (1893) A Tramp Census and Its Revelations, The Forum August pp.753–766. Millis, H.A. (­1898) The Law Relating to the Relief and Care of Dependents. III. Immigrants and Tramps. American Journal of Sociology 3(­5), p­p. ­631–​­648. O’Sullivan, E. (2016) Women’s Homelessness: A Historical Perspective. In Mayock, P. and J. Bretherton (Eds.) Women’s Homelessness in Europe (London: Palgrave macmillan). Oudshoorn, A., Van Berkum, A. and Van loon, C. (­2018) A History of Women’s Homelessness: The Making of a Crisis. Journal of Social Inclusion, 9(­1), p­p. ­5 –​­20. Pringle, J.C. (­1926) The Merxplas Beggar Colony: An Experiment in Applied Eugenics. The Eugenics Review, 18, p­p. ­1–​­6. Ranasinghe, P. (­ 2012) Vagrancy as a Penal Problem: The Logistics of Administering ­ ate-­​­­Nineteenth-​­Century Canada. Journal of Historical Sociology 25(­4), Punishment in L p­p. ­531–​­551. ­R ibton-​­Turner, C.J. (­1887) A History of Vagrants and Vagrancy and Beggars and Begging. (­London: Chapman and Hall). Rooney, J.F. (­1980) Organizational Success through Program Failure: Skid Row Rescue Missions, Social Forces 58(­3), p­p. ­9 04–​­924. Schweik, S.M. (­2009) The Ugly Laws: Disability in Public (­New York: New York University Press).

22

Historical perspectives on homelessness Scull, A. (­2015) Madness in Civilisation: From the Bible to Freud, from the Madhouse to Modern Medicine (­L ondon: Thames & Hudson). Solenberger, A.W. (­1911) One Thousand Homeless Men: A Study of Original Records (­New York: Russell Sage Foundation). Ulvund, F. (­2012) “­A Deterrent to Vagabonds, Lazy Persons and Promiscuous Individuals”: Control and Discretion in the Norwegian Workhouse System, ­1845–​­1907. Crime, Histoire & Sociétés/­Crime, History & Societies 16(­2), p­p. ­29–​­54. Van Schelle, A.F. (­1910) A City of Vagabonds: The Largest Colony of Mendicants in the World, Merxplas, Belgium. American Journal of Sociology 16(­1), p­p. ­1–​­20. Vorspan, R. (­1977) Vagrancy and the New Poor Law in ­Late-​­Victorian and Edwardian England. The English Historical Review 92(­362), p­p. ­59–​­81. Wadauer, S. (­2011) Establishing Distinctions: Unemployment versus Vagrancy in Austria from the Late Nineteenth Century to 1938. International Review of Social History 56(­1), p­p. ­31–​­70. Willink, H.G. (­1905) The Belgian State Labour Colonies. Charity Organisation Review 17(­99), p­p. ­118–​­126.

23

3 CAUSATION Joanne Bretherton and Nicholas Pleace

Introduction This chapter explores the debates about the causation of homelessness. The first part of this chapter looks at the history of how homelessness has been interpreted. The second part looks at the important role of evidence and how it has informed debate, generating important new ideas about the nature of homelessness and also examines the persistence of ‘­zombie ideas’ about causation that take little account of the evidence base. This chapter concludes by arguing that the most widespread narratives about changing explanations for homelessness tend to oversimplify a diverse mix of often ideologically driven ideas that have formed at varying degrees of distance from an incomplete evidence base.

Shifting narratives of homelessness causation In the 19th century, explanations of homelessness were often not terribly complicated; it was often seen as a matter of lazy, criminal, mobile and constantly intoxicated beggars drifting from one naïve charitable individual or institution to another. Confident in referring to no authority other than himself, ­R ibton-​ T ­ urner’s 1887 A History of Vagrants and Vagrancy, which ranges from 368 AD to 1886 and encompasses much of Europe as well as the UK in its 720 pages, describes ‘­modern begging’ in the following terms: The principal varieties of begging are now termed lurks (­f rom the Welsh llerc, a fit of loitering): the fire lurk (­pretended losses by fire), the shipwrecked or disabled sailors lurk, the accident lurk, the sick lurk (­pretended illness); some time up their arms in a very clever way, others feign fits … (­­Ribton-​­Turner, 1887, p­p. ­311–​­312) 24

DOI: 10.4324/9781351113113-4

Causation

This idea of criminal drifters, misrepresenting themselves as in a dire situation in order to receive alms that were meant for the genuinely deserving poor, avoiding work to live a wasteful life, took a long time to fade. In part, this was because this image had deep cultural roots and, arguably, even deeper political roots. To be outside what had been highly structured and rigorously enforced hierarchies had long meant defiance of autocratic, inherited rule that defined itself as appointed by God. Peasants and labourers were not supposed to go wandering about, or to behave in any way at all that differed from the ways in which peasants and labourers were supposed to behave (­Pound, 1971). The idea of deviance was also compelling, perhaps particularly to the simultaneously priggish and prurient culture of Victorian England, which enjoyed salacious accounts of the lives of ‘­vagabonds’, i.e. people experiencing homelessness in workhouses and casual wards, delivered by authors (­a more appropriate term than journalist) entering these spaces in disguise (­Freeman and Nelson, 2008). When the Victorians were reading this, the idea that ‘­vagrancy’ or ‘­vagabonds’, was explained by criminal deviants choosing not to conform, take responsibility or to be a part of society, had been around for centuries. In the 1970s, researchers across the Global North were still exploring homelessness using a not dissimilar framework, what O’Sullivan has described as looking for ‘­a process of disaffiliation from society because of the individual deficits of the homeless themselves’ (­2006, ­p. 72). Researching British service provision in the ­m id-​­1970s, ­Macgregor-​­Wood noted that this logic still pervaded the ways in which shelters were designed. The statutory requirements assume that the root cause of vagrancy (­or being without a settled way of living) lies within the individual client and that, if techniques can be discovered and put into practice to change his pattern of living and his attitudes, he [sic] will cease to make use of reception centres … (­­Macgregor-​­Wood, 1976, p­p. ­391–​­392) ­ acgregor-​­Wood found services operating with reference to a series of false asM sumptions about the nature of the population they were designed for. Most people using shelters did not stay for long and the minority that did had underlying mental and physical health conditions and addiction. There was no evidence of a ‘­process of disaffiliation’; instead, ­long-​­term homelessness looked like something else, essentially people with sets of unmet, complex treatment and support needs (­­Macgregor-​­Wood, 1976). Alongside this were larger populations making only ­short-​­term use of shelters, who did not have these complex needs. The idea that homelessness was not explicable as deviant behaviour, but about issues like mental health, addiction and, as ­Macgregor-​­Wood suggested in 1976, structural issues, was firmly in place by the 1980s (­Caton, 1990). The reception centre is unable to meet their needs which are principally for ­low-​ r­ ent accommodation for single people and appropriate health care and support. (­­Macgregor-​­Wood, 1976, ­p. 389) 25

Joanne Bretherton and Nicholas Pleace

The story of the shifting understanding and debates about the nature of homelessness is probably told most effectively in Neale’s 1997 paper Homelessness and theory reconsidered (­Neale, 1997). It may seem odd to be citing a paper that is a quarter of a century old to begin a discussion of contemporary theory and ideas about homelessness causation in 2021 but her work remains important in explaining and criticising three core ideas that have emerged, faded, remerged and combined in the literature on homelessness causation written from the 1960s onwards (­O’Sullivan, 2006; Pleace, 2016). As Neale identifies, the first set of ideas on causation centred on individual pathology, the idea that homelessness was determined by characteristics and behaviour. The second set of ideas centred on the inherent economic inequalities generated by free markets combined with inadequate social protection system, i.e. homelessness was generated by capitalism when welfare, health and, where present, social or public housing systems provided safety nets that were inadequate. The third set of ideas tried to bring these together, into what was later called a ‘­New Orthodoxy’ (­Pleace, 2000), which essentially argued that limits and flaws in social protection systems placed populations with particular characteristics, such as addiction and severe mental illness, at a heightened risk of homelessness. These ideas were described by Neale as follows: Absolutes and universal truths relating to homelessness and homeless people do not exist. The differences between homeless individuals are multiple and are not adequately explained by grand theory or by structural forces such as capitalism and patriarchy. (­Neale, 1997, ­p. 59) This criticism was echoed, much later, in Gowan’s 2010 theorisation of homelessness causation in the USA. She argued that narratives around causation fluctuated between ‘­sin, sickness and the system’, where ‘­sin’ meant criminality and deviance, ‘­sickness’ meant poor health and particularly poor mental health and ‘­the system’ meant the structural drivers of deep economic and social inequity, combined with often highly limited social protection systems in America (­Gowan, 2010). As Neale had before her, she found that no single ‘­explanation’ of homelessness causation worked well. Some homeless populations had high rates of mental illness, for example, but why was it the case that in relative terms, hardly anyone who had a psychiatric diagnosis was homeless. Equally, if the real driver behind homelessness causation was poverty, it was not clear why only a tiny fraction of the economically and socially marginalised population became homeless (­O’Sullivan et al., 2020). The ideas of the new orthodoxy, that homelessness was a function of particular combinations of ‘­sin, sickness and the system’, were conceptually messy, arguing that ­ ell-​­being, the homelessness causation involved behaviour, experience, health and w economy and social protection systems, but never quite explaining what exactly was happening. The idea that individual behaviour, choices, experiences and characteristics explained how homelessness is caused has come under attack. The problem was that 26

Causation

the ‘­patterns’ of homelessness causation that had been described were found to lack the strength of even a clear statistical association, b­ ecause – ­​­­again – ​­it was all very well using a quantitative analysis to identify and flag the supposed patterns of behaviour, support need and other characteristics, but the fact that most people with these supposedly ‘­homelessness causing’ characteristics, like addiction or mental illness, were not homeless and had not been homeless just would not go away (­O’Sullivan, 2020). In the meantime, ethnographic and other detailed research was also reporting a lot of variation in the detail of homelessness causation: This creates a problem for the new orthodoxy, because it is derived from these two models, advancing the idea that individual characteristics and experiences combine to predispose some individuals to being vulnerable to the structural factors that precipitate homelessness. Consistent associations between experience, characteristics or structural factors and entering homelessness have not been demonstrated, in fact the opposite has tended to have been demonstrated. (­Pleace, 2000, ­p. 592) There are a group of researchers who refuse to see homelessness in largely or wholly structural terms. They have explored the idea that the reason research could not see the pattern of association between behavioural and individual factors and homelessness was that the data were not fi ­ ne-​­grained enough. On one level, it looked like there was something there because some (­though not by any means all) people experiencing homelessness appeared to share characteristics. For example, youth homelessness was associated with disrupted childhoods, with contact with child protection/­social services and there were apparently high rates of addiction, mental illness and contact with criminal justice systems among people living rough and living in emergency shelters on a sustained or repeated basis. This was interpreted as meaning that the nuances, the fine detail of homelessness causation, were being missed; it was not that the ideas about the various combinations of behaviour, experiences, characteristics and support needs increasing the risk of homelessness were wrong; it was rather that the taxonomies that had been constructed lacked the necessary granularity (­Fitzpatrick, 2005). Over time, some of these arguments shifted towards an approach that, rather than looking for specific combinations of characteristics, needs and experiences in explaining homelessness causation, pursued the idea that behaviour was the wildcard that needed to be understood, i.e. people’s actions were central to causation (­Parsell, 2018). These arguments were centred on two ideas: the first was that, while there was deep inequity (­in the OECD, where most of these scholars lived), this did ­not – ​­indeed could n ­ ot – ​­explain homelessness. Here, the logic was the same that had produced doubt about structural causation of homelessness before, i.e. given how many people were stigmatised, socially, economically and politically marginalised in those societies, it seemed unlikely that homelessness could be directly ‘­caused’ by inequality, i.e. poverty was a necessary, but not a ‘­sufficient’, condition to cause homelessness (­Fitzpatrick, 2005). Again, the apparent clusters of characteristics associated with homeless populations, even if they lacked the strength to 27

Joanne Bretherton and Nicholas Pleace

be described as having true explanatory power, were drawn on scholars resistant to the idea that homelessness causation merely required, as some were suggesting, capitalism plus ‘­bad luck’ (­O’Flaherty, 2010). Moreover, those who advocated largely structural/­system explanations of homelessness were attacked for ‘­d iminishing’ people who experienced homelessness, i.e. denying their humanity by denying the significance of their agency, refusing to recognise that their choices were important (­McNaughton, 2008; Parsell, 2018). In practice, purely structural explanations of homelessness are an extremely rare breed, with most mainstream homelessness research arguing some version of the new orthodoxy, sometimes emphasising systems above behaviour and characteristics and sometimes individual choice, life experience and support needs above systems (­Pleace, 2016). Equally, purely individualistic explanations of homelessness are no longer that common, although arguments that homelessness is primarily associated with sin (­a s addiction) in combination with severe mental illness (­sickness) saw a resurgence in the 1980s in the USA (­Basuk, 1984), they were fairly quickly dismissed (­Craig and Timms, 1992; O’Sullivan, 2020).

New evidence and new ideas It is difficult to underestimate the impact of Culhane and a group of North American scholars on the understanding of homelessness causation since the early 1990s. The process of change is still ongoing and is far from over but the challenge this work has presented to individual pathology as an explanation for the causation of homelessness has been profound (­Culhane and Kuhn, 1998; Kuhn and Culhane, 1998; Culhane, 2018). The assumption that homelessness in the USA was very strongly associated with ­h igh-​­cost, ­h igh-​­risk populations who had a mix of extremely high rates of addiction, mental illness and frequent contacts with criminal justice services was very widespread during the 1980s and 1990s (­O’Sullivan, 2006). The extensive data from which these ideas had been generated was based on c­ ross-​­sectional or ‘­snapshot’ surveys that were focused on locations in which people slept rough and, primarily, on emergency shelters. Research teams swept in and swept out quickly, talking to everyone using a service or living rough or in unregulated settlements in particular areas, over a short period of time. Culhane and others had the idea of looking at shelter use over time, i.e. the data recorded on who was going in and out of shelters over a year or more, rather than looking at who was there on a given day or during a particular week. This research did not find something completely new. There was already evidence that a minority of people experiencing homelessness with high and complex needs could become ‘­stuck’ in homeless shelters and temporary supported accommodation (­Dant and Deacon, 1989). Indeed, the same pattern of a small group of repeated and ­long-​­stay residents had been reported in the workhouses and casual wards of the ­19th-​­century England (­H igginbotham, 2008). However, the use of administrative data meant that it was possible to explore the patterns of American homelessness shelter use at scale. 28

Causation

The research of Culhane and others found that bulk of homelessness among the US shelter users was not associated with high and complex needs like addiction and severe mental illness. Most of the population experiencing homelessness and using shelters did not use those shelters for very long. Around 80% of the users of homelessness shelters in New York and Philadelphia were ‘­transitional’ and they were not very likely to have mental health, substance abuse or medical problems. By contrast, around 10% of shelter users were episodic (­repeatedly) homeless people and 10% were chronic (­­long-​­term) homeless, and both groups had high rates of mental health problems, addiction and high and complex support and treatment needs. The episodically and chronically groups, around 20% of people experiencing homelessness, were much more likely to be using a shelter on any given day, simply because they used it more often and for longer. This meant that using ­cross-​ s­ectional surveys to study homelessness had resulted in seriously oversampling the minority of people experiencing homelessness who had high and complex support needs (­Culhane, 2018). Alongside using methods that had significantly overcounted people with high and complex needs, research had been focused on ‘­homeless’ places, i.e. where there were groups of people living rough, in an encampment/­unregulated settlement and, most frequently, people living in homeless shelters. Homelessness was however not confined to these places. Populations like young people and, particularly, lone women and women with children were often using informal arrangements, staying with friends, relatives and acquaintances, rather than living rough or using shelters and other homelessness services (­O’Sullivan et al., 2020). These populations were being undercounted, with the homelessness being experienced by women, who with other ‘­h idden’ homeless populations lacked privacy, housing rights and the safety of their own home, being particularly underrepresented (­Bretherton, 2020). The work of Culhane and others on the ageing of homeless populations has also undermined arguments that homelessness causation should be largely explained in terms of individual choice, behaviour and characteristics. People experiencing homelessness on a l­ong-​­term or repeated basis, the ‘­chronic’ and ‘­episodic’ populations with high needs, were concentrated in particular age cohorts, i.e. they were all a similar sort of age. Rather than there being a relatively steady flow into ­long-​ t­erm and repeated homelessness, which one might expect if homelessness is being triggered by a certain mix of individual behaviour, characteristics (­a nd structural factors), chronic and episodic homelessness were mainly happening in specific age groups. These cohorts appeared to be people who had been young during recessions, had become homeless and been unable to exit homelessness on a sustainable basis (­Culhane et al., 2013). Some of those promoting the role of individual pathology in homelessness causation (­Parsell, 2018) also assert that economy, policy and structure still play a role. For example, specific programmes or sudden shifts in welfare policy might bring numbers of people experiencing homelessness up or down, even if causation were mainly explained in terms of behaviour, choices and individual characteristics. However, this did not really explain why, if behaviour and other characteristics 29

Joanne Bretherton and Nicholas Pleace

were important, episodic and chronic homelessness was so heavily concentrated in specific age groups (­Culhane et  al., 2013). This research suggested that economic downturns, i.e. the system, was more strongly associated with populations entering ­long-​­term and repeated homelessness than factors like choice, behaviour, mental illness or addiction (­Culhane et al., 2013). As these populations became collectively older, their health needs were increasing, intensifying the challenges of ending these forms of homelessness and requiring new strategies and services (­Culhane et al., 2020). Alongside this, there was a growing array of evidence showing that other assumptions about behaviour, experience and characteristics and their relationship with homelessness causation were arguably standing on brittle glass. Addiction, long presented as a trigger for homelessness, increasingly seemed to exist in a complex and nuanced relationship with homelessness. There was evidence that intravenous and other ‘­hard’ drug use could start after homelessness occurred and evidence that it sometimes remained constant, occurring before, during and, importantly, after homelessness (­Pleace, 2008). Rather than one (­addiction) always triggering the other (­homelessness), addiction and certain forms of homelessness existed in mutually reinforcing, but inconsistent relationships (­Kemp et al., 2006; Bourgois and Schonberg, 2009). Likewise, mental illness, rather than necessarily being a consistent ‘­trigger’ event that could lead to homelessness, had long been realised to be occurring in the same way, both before and during the experience of homelessness (­Snow and Anderson, 1987). Research on homeless families formed the final bloc of evidence questioning the idea that behaviour, characteristics, experiences and/­or choice were the main causal factors in homelessness. The experience of family homelessness was highly gendered; it was most likely to be experienced by women with dependent children and was triggered by relationship breakdown and, unlike lone male homelessness, was often associated with domestic abuse. Women experiencing homelessness with dependent children are poor and, like the populations of lone homeless adults who experience transitional homelessness, they are not characterised by high levels of addiction, mental illness or other high and complex support needs, whether one is talking about the UK, Europe or the USA (­Fitzpatrick and Pleace, 2012; Baptista et al., 2017; Shinn and Khadduri, 2020). The causation of family homelessness is linked to individual experiences, including domestic abuse, but is also associated with poverty and socioeconomic exclusion; it also reflects the choices of (­m ainly) women but there is little evidence in support of the idea that it is solely triggered by individual pathology, by Gowan’s (­2010) categorisations of ‘­sin’ and ‘­sickness’ (­Bretherton and Mayock, 2021). Finally, there has been a range of research suggesting that the nature of welfare systems changes the nature of homelessness. Important in this field is the work of Benjaminsen on Danish homelessness, which appears to exist in a narrower way than in many other high GDP economies, being both more rarefied and much more clearly associated with high and complex support needs than is the case in the USA or some other European countries (­Benjaminsen and Andrade, 2015). Benjaminsen’s contention (­Benjaminsen, 2016) is that the much more extensive 30

Causation

social protection systems of Nordic countries drastically reduce the prevalence of homelessness being generated by simple poverty combined with ‘­bad luck’, seen in societies like the USA (­O’Flaherty, 2010; Shinn and Khadduri, 2020). This builds on the work of Meert (­2005) who argued that homelessness in Denmark was a ‘­residual’ problem because of the extent of social protection systems and Stephens and Fitzpatrick (­2007), who argued that there is a broad association between welfare systems and the nature and extent of homelessness. Finnish experience of homelessness, which again has been centred on the challenges of reducing small levels of ­long-​­term homelessness associated with high support needs in a context in which extensive social protection systems seem to largely prevent homelessness being caused by simple poverty, broadly reflects that of Denmark. Denmark and Finland stand in marked contrast to a country like Ireland, where the drivers of homelessness clearly include low levels of affordable housing supply and there is a broad association with poverty (­A llen et al., 2020).

The limits of evidence and ‘­zombie’ ideas There are limits in what is understood about homelessness causation. The existing evidence base is almost always derived from populations whose homelessness has occurred. While it is possible to explore patterns in statistical and administrative data and talk to people about what happened to them, this is not the same as being able to observe the process of homelessness causation actually happening. Such an unethical research project, watching acute human distress occur and actively not intervening to stop it, should never be permitted of course. However, the point being made here is a need to recognise that data on homelessness causation are never going to exist as live feeds. Paul Krugman has described the existence of ‘­zombie ideas’ in economic policy (­K rugman, 2020). Zombie ideas will not die in the face of evidence. There are clear reasons to question the idea that homelessness causation is largely or wholly explicable in terms of individual pathology. This includes the evidence that structural factors, e.g. poverty, insufficient housing supply, welfare systems and so forth, make a difference to the nature and extent of homelessness. There is also the seemingly endless challenge of finding evidence that clearly and consistently shows that individual choice and particular sets of characteristics are the main drivers of homelessness causation. The assumed associations between homelessness and certain characteristics, like addiction, criminality and mental illness, are not grounded on carefully collected evidence but are instead linked to cultural images and constructs of poverty as deviance that reach back into the p­ re-​­modern (­Pleace, 2016). It is not that someone cannot become homeless as a result of addiction, or criminality or severe mental illness, or some combination of all three, but this is not the sole cause of majority of homelessness. It would also be illogical to suggest that individual actions and choices have no effect on trajectories into and through homelessness, i.e. someone can actively choose to be homeless; indeed, it may be the least worst option they have (­Parsell, 2018). However, the instant there is a suggestion that behaviour is always 31

Joanne Bretherton and Nicholas Pleace

more significant in causing homelessness than say, inequality, or the nature and extent of social protection systems, these arguments fall over (­Benjaminsen, 2016). Importantly, as the definition of homelessness widens, to encompass families, to people living precariously with friends, relatives or acquaintances, to populations who are not living rough and not in emergency shelters, the supposed associations between behaviour, experience, characteristics and homelessness get progressively weaker. As soon as the homeless population is not defined and measured by selective, ­cross-​­sectional (­­time-​­limited) sampling that is focused on people on the streets and in emergency shelters, the ratio of people with supposedly ‘­causal’ characteristics of mental illness, criminality and addiction plummets, while poverty and inequality emerge as constants (­Bramley and Fitzpatrick, 2018). Yet, the zombie idea that homelessness is always primarily driven by sin or sickness, or a combination of the two (­Gowan, 2010), refuses to lie down. Krugman’s ‘­zombie ideas’ are not just about the irrational standing in face of evidence, as the motivation for promoting them is also political (­K rugman, 2020). Homelessness is portrayed in ways that protect vested interests in existing structures, which means narratives that emphasise individual pathology are promoted. In some countries, like the UK, this means emphasising the image of homelessness as being primarily ‘­rough sleeping’, which can be clearly associated with individual pathology, especially among l­ong-​­term and repeated rough sleepers who have high and complex support needs (­A nderson, 1993). In reality, the number of people sleeping rough is a tiny fraction of total homelessness, around 5,000 at any one point (­­pre-​­pandemic), but a lot of political heat, noise and money is expended around ‘­ending’ this form of homelessness through special programmes. Far less attention is drawn to family homelessness, which is not associated with addiction, mental illness or criminality, but with poverty and domestic abuse, i.e. with multiple inequalities, despite (­­pre-​­pandemic) some 120,000 children in statutorily homeless families being in temporary accommodation in England at any one point (­O’Sullivan et al., 2020). The truth about homelessness causation is neither simply structural or systemic nor simply individual or behavioural. As Neale (­1997) wrote a quarter of a century ago, absolutes and universal truths relating to homelessness and homeless people do not exist, and behaviour, inequalities, policy, experiences and choices can all play a role in how homelessness is caused. However, our understanding of homelessness causation will always be limited if the context in which it is occurring is deliberately or thoughtlessly downplayed because of an obsession with trying to understand it in largely, or wholly, individual terms.

References Allen, M., Benjaminsen, L., O’Sullivan, E. and Pleace, N. (­2020) Ending Homelessness in Denmark, Finland and Ireland. Bristol: Policy Press. Anderson, I. (­1993) Housing Policy and Street Homelessness in Britain. Housing Studies, 8(­1), p­p. ­17–​­28. Baptista, I., Benjaminsen, L., ­Busch-​­Geertsema, V. and Pleace, N. (­2017) Family Homelessness in Europe. Brussels: FEANTSA.

32

Causation Basuk, E.L. (­1984) The Homelessness Problem. Scientific American, 251, p­p. ­28–​­33. Benjaminsen, L. and Andrade, S.B. (­2015) Testing a Typology of Homelessness across Welfare Regimes: Shelter Use in Denmark and the USA. Housing Studies, 30(­6), p­p. ­858–​­876. Benjaminsen, L. (­2016) Homelessness in a Scandinavian Welfare State: The Risk of Shelter Use in the Danish Adult Population. Urban Studies, 53(­10), p­p. ­2041–​­2063. Bourgois, P. and Schonberg, J. (­2009) Righteous Dopefiend. Berkeley: University of California. Bramley, G. and Fitzpatrick, S. (­2018) Homelessness in the UK: Who Is Most at Risk? Housing Studies, 33(­1), p­p. ­96–​­116. Bretherton, J. (­2020) Women’s Experiences of Homelessness: A Longitudinal Study. Social Policy and Society, 19(­2), p­p. ­255–​­270. Bretherton, J. and Mayock, P. (­2021) Women’s Homelessness: European Evidence Review. Brussels: FEANTSA. Caton, C.L. (­ed.) (­1990) Homeless in America. Oxford: Oxford University Press. Craig, T. and Timms, P.W. (­1992) Out of the Wards and onto the Streets? Deinstitutionalization and Homelessness in Britain. Journal of Mental Health, 1(­3), p­p. ­265–​­275. Culhane, D.P. and Kuhn, R. (­1998) Patterns and Determinants of Public Shelter Utilization among Homeless Adults in New York City and Philadelphia. Journal of Policy Analysis and Management, 17(­1), p­p. ­23–​­43. Culhane, D.P., Metraux, S., Byrne, T., Stino, M. and Bainbridge, J. (­2013) The Age Structure of Contemporary Homelessness: Evidence and Implications for Public Policy. Analyses of Social Issues and Public Policy, 13(­1), p­p. ­228–​­244. Culhane, D.P. (­2018) Chronic Homelessness Centre for ­Evidence-​­Based Solutions to Homelessness (­Washington DC). Available at: https://­w ww.usich.gov/­­tools-­​­­for-​­action/­­ literature-­​­­review-­​­­and-­​­­research-­​­­brief-­​­­on-­​­­chronic-​­homelessness/ (­accessed January 2023) Culhane, D.P., Treglia, D., Byrne, T., Metraux, S. et al. (­2019) The Emerging Crisis of Aged Homelessness: Could Housing Solutions Be Funded from Avoidance of Excess Shelter, Hospital and Nursing Home Costs? University of Pennsylvania: Philadelphia. Available at: http://­ works.bepress.com/­dennis_culhane/­223/ Dant, T. and Deacon, A. (­1989) Hostels to Homes? The Rehousing of Single Homeless People. Aldershot: Avebury. Fitzpatrick, S. (­2005) Explaining Homelessness: A Critical Realist Perspective. Housing, Theory and Society, 22(­1), p­p. ­1–​­17. Fitzpatrick, S. and Pleace, N. (­2012) The Statutory Homelessness System in England: A Fair and Effective ­R ights-​­Based Model? Housing Studies, 27(­2), p­p. ­232–​­251. Freeman, M. and Nelson, G. (­2008) Vicarious Vagrants: Incognito Social Explorers and the Homeless in England ­1860–​­1910. Lambertville, NJ: The True Bill Press. Gowan, T. (­2010) Hobos, Hustlers and Backsliders: Homeless in San Francisco. Minnesota: University of Minnesota Press. Higginbotham, P. (­2008) The Workhouse Cookbook Port. Stroud: The History Press. Kemp, P.A., Neale, J. and Robertson, M. (­2006) Homelessness among Problem Drug Users: Prevalence, Risk Factors and Trigger Events. Health and Social Care in the Community, 14(­4), p­p. ­319–​­328. Krugman, P. (­2020) Arguing with Zombies: Economics, Politics, and the Fight for a Better Future. New York: W. W. Norton & Company. Kuhn, R. and Culhane, D.P. (­1998) Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data. American Journal of Community Psychology, 26(­2), p­p. ­207–​­232. ­M acgregor-​­Wood, S. (­1976) Camberwell Reception Centre: A Consideration of the Need for Health and Social Services of Homeless, Single Men. Journal of Social Policy, 5(­4), p­p. ­389–​­399. McNaughton, C. (­2008) Transitions through Homelessness: Lives on the Edge. London: Springer. Meert, H. (­2005) Denmark 2005: Preventing and Tackling Homelessness: Synthesis Report. Brussels: European Commission, DG Employment, Social Affairs and Equal Opportunities. Neale, J. (­1997) Homelessness and Theory Reconsidered. Housing Studies, 12(­1), p­p. ­47–​­61.

33

Joanne Bretherton and Nicholas Pleace O’Flaherty, B. (­2010) Homelessness as Bad Luck: Implications for Research and Policy. In Ellen, I.G. and O’Flaherty, B. (­eds.) How to House the Homeless. New York: Russell Sage Foundation, p­p. ­143–​­182. O’Sullivan, E. (­2006) Pathways through Homelessness: Theoretical Constructions and Policy Implications. In Doherty, J. and Edgar, B (­eds.) In My Caravan, I Feel Like Superman. St Andrews: University of St Andrews, p­p. ­71–​­100. ­ usch-​­Geertsema, V. and Hrast, M.F. (­2020) Distorting TendenO’Sullivan, E., Pleace, N., B cies in Understanding Homelessness in Europe. European Journal of Homelessness, 14(­3), p­p. ­109–​­135. O’Sullivan, E. (­2020) Reimagining Homelessness for Policy and Practice. Bristol: Policy Press. Parsell, C. (­2018) The Homeless Person in Contemporary Society. London: Routledge. Pleace, N. (­2000) The New Consensus, the Old Consensus and the Provision of Services for People Sleeping Rough. Housing Studies, 15(­4), p­p. ­581–​­594. Pleace, N. (­2008) Effective Services for Substance Misuse and Homelessness in Scotland: Evidence from an International Review. Edinburgh: Scottish Government. Pleace, N. (­2016) Researching Homelessness in Europe: Theoretical Perspectives. European Journal of Homelessness, 10(­3), p­p. ­19–​­4 4. Pound, J. (­1971) Poverty and Vagrancy in Tudor England. London: Longman. ­R ibton-​­Turner, C.J. (­1887) A History of Vagrants and Vagrancy and Beggars and Begging. London: Chapman and Hall. Shinn, M. and Khadduri, J. (­2020) In the Midst of Plenty: Homelessness and What to Do about It. Hoboken: Wiley Blackwell. Snow, D.A and Anderson, L. (­1987) Identity Work among the Homeless: The Verbal Construction and Avowal of Personal Identities. American Journal of Sociology, 92(­6), p­p. ­1336–​­1337. Stephens, M. and Fitzpatrick, S. (­2007) Welfare Regimes, Housing Systems and Homelessness. How Are They Linked? European Journal of Homelessness, 1, p­p. ­201–​­212.

34

4 DEFINING AND COUNTING HOMELESSNESS Dan Treglia and Dennis Culhane

Introduction In February 2020, the United Nations Commission for Social Development called for a global effort to “­address homelessness,” a momentous recognition of a social and public health challenge impacting member states across the board (­United Nations Commission for Social Development, 2020). One of the first questions to be addressed in tackling homelessness: just how widespread is it? A “­definitive count of the size of the homeless population” is beyond realistic expectations. “­The best that one can hope for,” Wright and Devine wrote 30 years ago, “­is a more or less plausible count with known and hopefully small uncertainties attached to it” (­Wright & Devine, 1992). Even by this benchmark, the world is falling short. Not only do “­definitions and measurements” vary considerably across countries and regions, but so does the existence of operational definitions that allow for quantification and efforts to estimate the scope of homelessness. Between 3.8 and 216 million people meet official definitions of homelessness, a range too broad to offer meaningful guidance (­Tipple & Speak, 2009). Some argue against the measurement of homelessness as a distraction from efforts to address the problem. We, however, consider an assessment of a problem’s scope, causes, and characteristics as a necessary precondition for addressing the problem to, as Tipple and Speak wrote in 2009, facilitate “­investment” and enable “­lobbyists or officials to direct funding to address the problem.” The experience in the United States may provide guidance as the world seeks to “­harmonize measurement and collection of data on homelessness to enable national and global policymaking” (­United Nations Commission for Social Development, 2020). In contrast to the qualitative research traditions more prominent across Europe, the r­esults-​­driven governance style predominant in the United States has engendered an infrastructure and a subfield of homelessness research DOI: 10.4324/9781351113113-5

35

Dan Treglia and Dennis Culhane

devoted to its quantification that we think can, when examined critically, offer lessons as the world seeks to rise to the UN’s call to address this “­obstacle to human rights” and “­v iolation of human dignity” (­Culhane, Fitzpatrick, & Treglia, 2020; United Nations Commission for Social Development, 2020).

The Fight to Define Homelessness Counting homelessness is “­itself a controversial endeavor” (­Wasserman & Clair, 2009, ­p. 50), with debates among advocates, governments, and researchers on two planes: who to define as homeless and how to count them. A wide range of definitions emerged from American sociologists between the 1950s and the 1980s, with conceptualizations ranging from anyone with inadequate housing to those sleeping in “­literally homeless” ­settings  – ​­public or privately funded shelters and people sleeping on the streets or other areas not meant for human habitation (­Burt  & Cohen, 1989; Jencks, 1994; Lee, Tyler,  & Wright, 2010; Stern, 1984; Treglia, Montgomery, & Culhane, 2016). The U.S. government, dating back to its first official report on homelessness in 1984, has generally enumerated homelessness using a more restrictive ­definition –​ i­ ncluding as homeless individuals and households sleeping in shelters designated for “­the homeless” or unsheltered settings (“­places not meant for habitation”). Compared to others that are homeless by other definitions, they are the easiest to count and present the most extreme of housing instability and are therefore targeted for funding and services. Advocates and service providers, many of whom see financial and political interests in higher numbers, have traditionally argued for broader definitions that, in addition to those counted as homeless by the government, include people on the brink of homelessness or who are doubling up or couch surfing with friends or family. The research community has largely subscribed to the Department of Housing and Urban Development’s (­H UD) narrower ­definition –​ s­ometimes explicitly and in other instances confining their studies or estimates of homeless to those meeting the criteria of literal homelessness. Battles over definitions and measurements grew during the late 1970s into the 1980s as homelessness moved beyond “­skid row” neighborhoods and became a problem too large and geographically dispersed to politically ignore (­Hopper, 1992; Shlay & Rossi, 1992; Stern, 1984; Wright & Devine, 1992). The 1980 decennial census was the first systematic estimation of the extent of homelessness, including as homeless 23,000 people who listed a shelter as their permanent residence on the Census form ( ­Jencks, 1994). In the same year, Mitch Snyder, then the ­ on-​­Violence (­CCNV) and still, 30 years leader of the Community for Creative N after his death, among the most ­well-​­known of homelessness advocates, offered a very different assessment. Snyder called colleagues in a smattering of American cities and metropolitan areas and received their “­best guesses” of local homelessness. Data represented a variety of geographic units, time periods, and units of analysis and were “­unusable as a means of extrapolating the number of America’s homeless” (­Kondratas, 1991, ­p. 632). Despite this, the CCNV stated that 2.2 million Americans, or 1% of the 36

Defining and counting homelessness

population, were homeless. These estimates, though lacking in any semblance of methodological rigor, became conventional wisdom. This began a series of volleys between government officials and social ­scientists –​ t­wo groups with very different m ­ otivations  – ​­and advocates led by Snyder. The U.S. Department of Housing and Urban Development (­HUD) responded with a report to Congress in 1984; having surveyed its own list of homelessness experts and shelters directors in large cities, HUD estimated that between 250,000 and 350,000 people were experiencing homelessness, a conclusion corroborated by secondary analyses of their data by the National Bureau of Economic Research (­N BER) and ICF, Inc., and disavowed by Snyder, who sued HUD for negligence (­Burt & Cohen, 1989; Kondratas, 1991; Shlay & Rossi, 1992; Wright & Devine, 1992). Methodological advancement continued during the late 1980s along two tracks. On one, a series of studies built a consensus for a national homelessness best guess of between 500,000 and 1 million, or between 25% and 50% of Snyder’s earlier proclamation (­Burt  & Cohen, 1989; Kondratas, 1991; Wright  & Devine, 1992). At the same time, Peter Rossi and others developed and refined methodologies for local counts, particularly to enumerate hard to find street homeless populations. Rossi emphasized methods that reduced bias and quantified uncertainty, and the most credible estimates of street homeless still lean heavily on his work (­Rossi, 1991). These paths merged in the 1990 ­S -​­Night (­the “­S” representing “’shelter and street’”) Count, an effort to enumerate literally homeless individuals as part of the U.S.’s decennial census (­Shlay & Rossi, 1992; Wright & Devine, 1992). During the night of March 20, 1990, teams from the Census Bureau counted people in “­a ll known shelters” in five participating cities, and the following morning counted people in streets, abandoned buildings, and other unsheltered settings. The count ­ appened – ​­Mitch Snyder urged people experiwas controversial before it even h encing homelessness to avoid locations in which they might be counted, lest, he argued, they lend credence to an effort designed to underestimate homelessness for political purposes. Despite his attempted boycott, Snyder wrote in the Washington Post that ­S -​­Night “­needed no interference from me to doom it to failure” (­Snyder, 1990, p. D8). The effort produced an estimate of 228,621, or less than half of the likely range suggested by credible contemporary studies. No one, including the Census Bureau, considered this an authoritative enumeration, though it offered an opportunity to test relevant methodologies at scale and with high stakes. Generally, the shelter portion of the count ran smoothly, while street counts varied widely in their reliability. Perhaps the most notable methodological advancement of S­ -​ N ­ ight Count was the use of a “­­plant-​­capture” quality assurance mechanism, in which trained observers stationed in unsheltered geographies to be canvassed could record whether they’d been counted and, thus, assess the count’s exhaustiveness (­Hopper, 1992; Martin, 1992; Wright  & Devine, 1992). Snyder’s passing in the summer of 1990 meant that the S­ -​­Night result, even with Census Bureau’s caveats, lacked the robust advocacy response that the federal government could have counted on earlier. 37

Dan Treglia and Dennis Culhane

Though debates faded from the pages of national newspapers, researchers in the 1990s continued their efforts to more comprehensively and precisely estimate the scale of homelessness. Bruce Link and colleagues used phone surveys to establish ­five-​­year and lifetime prevalence rates in 20 large metropolitan areas (­Link et al., 1994). His survey of 1,507 U.S. residents found lifetime and fi ­ ve-​­year literal homelessness rates of 7.4% and 3.1%, respectively. A parallel development, at around the same time, was the rise of homeless management information systems (­H MIS) –​ a­ dministrative databases to track shelter usage and manage homeless services operations and procurement. New York City was the first to adopt such a system in 1986 and Philadelphia followed suit in 1990. By the end of the decade, 12 communities had a “­sufficient portion of shelters represented” to produce meaningful assessments of homelessness’ scope and prevalence. Culhane and colleagues were the first to use these data to assess homelessness prevalence; estimating ­point-­​­­in-​­time (­PIT), annual, and ­five-​­year prevalence rates in New York City and Philadelphia and producing rates similar to those found by Link (­Culhane, Delowski, Ibanez, Needham, & Macchia, 1994). Five years later, Metraux and colleagues conducted a similar exercise in nine communities (­Metraux et al., 2001). The federal government set its eye on ­national-​­level regular and standardized reporting, which required broad adoption of administrative databases. In 2001, Congress charged HUD with assisting communities in the development of HMIS and by 2005, 93% of communities had, or were in the process of implementing, one. In parallel with that development, some communities ran and published their own official estimates of homelessness, some of which went beyond those HMIS systems.

Mandated Homelessness Reporting In the ­m id-​­2000s, HUD began leveraging the billions of dollars it provides in homeless service funding to compel local data collection and reporting that could be rolled into a national report. In 2007, HUD released its first Annual Homeless Assessment Report (­A HAR) to Congress on a sample of 80 municipalities and, in the same year, mandated that all communities receiving federal homelessness dollars through the ­McKinney-​­Vento Act provide annual estimates of homelessness prevalence. These local estimates are provided by approximately 400 Continuums of Care (­CoCs), collectives of service providers and governments through which communities apply for and receive homelessness funding from HUD. They report two sets of estimates each year, which are then compiled in Parts 1 and 2 of HUD’s AHAR. The first is a measure of ­point-​­prevalence providing a “­­Point-­​­­i n-​­Time” (­PIT) estimate assessment of the number of people experiencing “­l iteral homelessness,” including “­sheltered homelessness,” meaning people living in emergency shelter and transitional housing, and “­u nsheltered homelessness” referring to people sleeping on the streets or in other areas unfit for human habitation. HUD mandates that each CoC produces a PIT estimate of homelessness reflecting a 38

Defining and counting homelessness

single night in the last ten days of January; the observation period is intended to standardize estimates and, by conducting the count in winter, maximize the number of people in sheltered settings, where they are easier to count than on the streets or in other spaces. Part 2 of the AHAR estimates annual prevalence of sheltered homelessness, providing an unduplicated count within each CoC of people accessing shelter and transitional housing from October ­1 – ​­September 30 (­m irroring the federal fiscal year). HUD is also developing the Longitudinal System Analysis (­L SA) reporting platform, which will go a step further. Rather than limiting estimates to prevalence and basic demographic characteristics, the LSA will, for the first time, provide ­national-​­level estimates of service use characteristics and trajectories of people experiencing homelessness.

Estimating the Number and Characteristics of Homelessness As was the case in the 1990 ­S -​­Night Count, enumerating sheltered homelessness is relatively straightforward. Given the HMIS mandates imposed by HUD, counts of those living in “­sheltered homelessness” settings, whether in emergency shelters, transitional housing, or ­low-​­demand shelters (­referred to as “­safe havens”), are generally pulled directly from administrative databases. Unsheltered homelessness is a very different story and was the subject of much of Peter Rossi’s experimentation in Chicago in the late 1980s. Systematically finding and counting people taking up quarters outside or in transit hubs, abandoned buildings, cars or Recreational Vehicles (­RVs) and other “­uninhabitable” settings is an arduous task, and HUD communities employ a range of methodologies that vary widely in their statistical rigor.

Measuring Unsheltered Homelessness These methodologies can be broadly divided into two categories: ­street-​­based and ­service-​­based counts. In ­street-​­based counts, outreach workers, often working alongside volunteers, fan out across a defined geography to find people sleeping unsheltered. They generally occur late at night or very early in the ­morning  –​ ​­ can take on many different forms. ­while people are still “­bedded down”  – and Some, like Philadelphia, PA, visit only homelessness “­hotspots”  – ​­specific areas with known homelessness often in downtown areas and other spaces known for concentrated homelessness (­ t rain stations, airports). These hotspot approaches, though they represent only a sample of a jurisdiction’s geography, do not include any statistical extrapolation to uncanvassed areas and no quantification of the uncertainty embedded in the sample, making these estimates relatively methodologically weak. Others, like Boston, MA, canvass their entire geography; while this eliminates the uncertainty and ad hoc nature of the hotspot approach, it is feasible only for small, urban geographies able to recruit a large number of enumerators. A third option is the geographically stratified probability sample. Here, communities divide their total geography into distinct and standardized areas, and then stratify those areas based on the likelihood of finding homeless individuals using 39

Dan Treglia and Dennis Culhane

information from prior counts and other institutional knowledge, like observations from street outreach teams, and a statistically valid random sample of areas is pulled from each stratum. Methodologies vary further within these categories. In New York City, which has received recognition from HUD for its methodological rigor, enumerators survey everyone they encounter about their housing status, regardless of their appearance. Other communities conduct “­w indshield surveys” in which they drive or walk assigned geographies without speaking with anyone, designating individuals as homeless based entirely on appearance. Such estimates are subject to the biases of the enumerators, many of whom are volunteers without relevant experience and less than an hour of training. ­Service-​­based counts are the other primary method of capturing the unsheltered homeless population. In this methodology, homeless, food assistance, case management, and other service providers likely to be frequented by homeless individuals ask service users about their housing status on a given night (­usually the previous night). HUD allows for communities to survey service users over a ­seven-​ d­ ay period after the designated night.

Limitations of ­HUD-​­Approved Methodologies Research has demonstrated notable shortfalls in these methods, limiting their exhaustiveness, reliability, and validity, and suggests that they may skew our understanding of who is experiencing homelessness at any given time (­Glynn, Byrne, & Culhane, 2018; Glynn & Fox, 2019; Schneider, Brisson, & Burnes, 2016; Williams, 2011). For one, levels of sheltered homelessness, and to some degree levels of unsheltered homelessness, are u ­ tilization-​­driven, meaning that those who cannot or choose not to avail themselves of services are excluded from estimation of homelessness. A shelter system at full capacity, for example, cannot register an increase in homelessness, regardless of demand. Second, as has been argued with respect to homelessness and poverty generally (­Bane & Ellwood, 1986), PIT estimates overrepresent chronic homelessness and underrepresent the ­short-​­term spells that categorize around 80% of all shelter stays (­Culhane & Kuhn, 1998; Culhane, Metraux, Park, Schretzman, & Valente, 2007). Another serious limitation of the ­one-​­night PIT is that it is extremely sensitive to ­single-​­night changes that could affect the number and location of people experiencing homelessness. Cold and rainy nights lead people who may normally be sleeping in public view to take refuge in a shelter, a temporary ­non-​­homeless accommodation like a hotel room or a friend’s couch, or an unsheltered location like an abandoned building that is more protective against the elements and farther from public view. Finally, regardless of weather, the unsheltered count can fail to find people who are out of sight or in areas unknown to homelessness officials. A 1990s survey of formerly homeless people, for example, found that 59% of people who experienced literal homelessness had spent time living in their cars and 25% were in other “­m akeshift housing” arrangements like boxcars or caves (­Williams, 2011), 40

Defining and counting homelessness

a finding corroborated by Hopper, Shinn, and colleagues’ 2005 survey conducted in conjunction with New York City’s inaugural citywide PIT (­Hopper, Shinn, Laska, Meisner, & Wanderling, 2008a). Another study, examining deaths among the street homeless population, found that many who died were in areas not routinely served by street outreach teams and, resultantly, were unknown to homeless support systems (­Metraux et al., 2016). These shortfalls are more likely to result in undercounts rather than overcounts, and researchers and local agencies responsible for their PIT counts have devised a range of strategies for incorporating that error into their assessments of homelessness prevalence. One, to our knowledge used only by New York City in the United States and Toronto in Canada, uses the ­plant-​­capture mechanism employed by the 1990 ­S -​­Night Count to estimate the undercount of the unsheltered PIT (­Hopper, 1992; Hopper, Shinn, Laska, Meisner, & Wanderling, 2008b; Wright & Devine, 1992). In this method, an outside agency places teams of “­decoy” homeless individuals into a sample of areas to be visited by enumerators, and they record whether they were approached by enumerators. A second strategy is a ­post-​­enumeration survey in which users of social service centers in the days following the count are asked about their housing status on the designated PIT night; those indicating homelessness are asked more detailed information about their location during the PIT, particularly focused on whether they would have been visible to enumerators. Both methods were tested by Hopper, Shinn, and colleagues (­2008) as part of New York City’s inaugural ­full-​­city unsheltered PIT in 2005. The p­ lant-​­capture method found that 22% of decoys were likely missed and, as a result, the final estimate was increased by the same amount. The p­ ost-​­enumeration survey, which provided only preliminary numbers, estimated that as few as 33% of unsheltered adults were definitely visible in some parts of the city, meaning that up to ­t wo-​­thirds of individuals unsheltered on the PIT night would likely have been counted. Looking to the Hopper study, Glynn and Fox (­2018) adjusted published unsheltered homelessness estimates upward by 40% in their study of urban homelessness dynamics. ­Population-​­based surveys are another method of working around the constraints of these HUD approval methods. The aforementioned Link’s study assessed homelessness across the general population and, in a recent analysis, Agans and colleagues used a telephone survey to ask about homeless individuals sleeping on private property likely out of view from enumerators (­Agans et al., 2014; Link et al., 1994). Others have used household surveys to assess prevalence of homelessness among youth, a group widely recognized to be underrepresented by traditional HUD methods (­Cutuli, Treglia, & Herbers, 2020; Morton et al., 2018). Healthcare records present additional opportunities for estimating homelessness prevalence, although these are limited to healthcare users. One method for doing this is through examination of diagnosis codes. The International Classification of Diseases (­ICD) system, used to document health conditions, includes a V60.0 code to indicate “­lack of housing” and which researchers have used as a record of homelessness. Madigan and colleagues’ (­2020) examination of hospital records in Illinois estimated steady increases in homelessness from 2011 to 2018, with somewhere between 15,815 and 23,758 people experiencing homelessness in the latest 41

Dan Treglia and Dennis Culhane

year (­Madigan, Forst, & Friedman, 2020). Montgomery and colleagues have derived estimates of veteran homelessness based on screening questions administered to Department of Veteran Affairs (­VA) healthcare facilities users (­Montgomery, Szymkowiak, Marcus, Howard, & Culhane, 2016).

Targeting Subpopulations The enumeration of specific subpopulations has received additional attention, some because they are disproportionately difficult to find and count; others because they are deemed extraordinarily worthy of being counted and served.

Veteran Homelessness Military veterans are among those in the latter category, considered “­deserving” because of their military service, and the annual PIT counts played a valuable tool in evaluating ­veteran-​­focused homeless services initiated and expanded during the Obama Administration. The VA made large investments in its permanent supportive housing program, H ­ UD-​­VASH, targeting veterans experiencing chronic homelessness, and created the Supportive Services for Veteran Families (­SSVF) to address ­short-​­term homelessness. In 2016, as President Obama’s second term was coming to an end, the administration pointed to a 47% decline in veterans’ homelessness, as measured by the national aggregation of annual PIT counts, as evidence of the effectiveness of its programs (­National Alliance to End Homelessness, 2021). Official data likely understate the VA’s success, as efforts to improve the identification of homeless veterans and expand homeless services that evolved under President Obama would, on their own, result in an increase in the number of identified homeless veterans. Estimates of veteran homelessness are also made complicated by difficulties in the identification of veterans accessing c­ ommunity-​­based homeless services. Veterans accessing ­community-​­based (­­non-​­VA) homeless services are generally identified through one or more questions about previous military service. Two studies comparing shelter records with military service and VA records found ­ on-​­VA shelters actually underidentified veterans. Metraux and colleagues that n (­Metraux, Stino, & Culhane, 2014) and Treglia (­Treglia, 2016) noted that fewer than t­wo-​­thirds of ­non-​­VA shelter users with a military discharge record were correctly identified as veterans in HMIS. Veterans who were younger and women were most likely to be missed, which could reflect either a reticence to reveal military experience, less comprehensive veteran screening among these groups, or questions poorly calibrated with operational definitions of veteran status.

Youth Homelessness Estimating the number of youth experiencing homelessness may be among the most challenging endeavors in defining, measuring, and addressing homelessness. Three operational definitions exist across federal agencies and legislation for the 42

Defining and counting homelessness

purposes of enumeration, varying in their age parameters, living circumstances, and time p­ eriods – ​­making comparisons impossible. HUD’s literal homeless definition applies to youth, and estimates are based on its PIT methodology. Homeless children include anyone in a family aged 17 years or younger and counts as “­unaccompanied youth” unaccompanied individuals under the age of 25. The Department of Education’s (­DOE) operationalization of homelessness is guided by the M ­ cKinney-​­Vento Act as it has been amended through the Every Student Succeeds Act (­ESSA). Though its measurements are limited to ­school-​­aged children, it includes as homeless “­individuals who lack a fixed, regular, and adequate nighttime residence,” which includes people living in d­ oubled-​­up living arrangements and “­­couch-​­surfing,” and provides estimates that span a school year, rather than a single night (­U.S. Interagency Council on Homelessness, 2018). The third piece of relevant legislation is the Federal Runaway and Homeless Youth Act (­R HYA), which is administered by the Department of Health and Human Services (­H HS). Unlike the ­McKinney-­​­­Vento-​­driven language guiding HUD and DOE, RHYA’s definition of youth homelessness is driven not by an individual’s specific sleeping location than it is by their general circumstances, defining as homeless anyone under the age of 21 “­for whom it is not possible to live in a safe environment with a relative, and who has no other safe alternative living arrangement” (­U.S. Interagency Council on Homelessness, 2018). Traditional enumeration methods are particularly likely to produce underestimates of homeless youth. Homeless youth, more than older adults, are likely to refuse homeless and other social services and resist being found and, even when asked, are less likely to identify as homeless. As a result, probably no domain of homelessness enumeration has been the beneficiary of as much innovation and effort. Some of these enhanced efforts are extensions of more traditional methods, such as extending the reach of PIT counts beyond traditional homeless service providers and extending the window in which providers survey and count potentially homeless youth from one day to seven. Surveys are also being used to identify and quantify youth homelessness. Morton and colleagues (­2018) surveyed a representative sample of 26,161 adults whose households included ­13–­​­­25-­​­­year- ​­olds to establish a ­one-​­year prevalence rate, finding that 3.4% of ­13–​­17 ­year-​­olds reported literal homelessness and 5.3% identified as homeless using broader definitions that included ­couch- ​­surfing. For ­18–­​­­25-­​ year-​­ olds, estimates were notably higher, 5.9% and 15.6%, respectively. Simi­­ larly, a number of studies have assessed youth homelessness prevalence through the Youth Risk Behavior Surveillance System (­Y RBSS), administered by the Centers for Disease Control and Prevention in partnership with states and local school districts to public high school students. Two studies using YRBSS data demonstrate the growth and standardization in ­housing-​­related questions that can identify homelessness prevalence using ­McKinney-​­Vento definitions; while only 8 states included relevant questions in their 2015 YRBSS, that number grew to 25 states and the District of Columbia in 2019. In a 2021 analysis of 24 states with representative housing data from 2019, the homelessness rate of 9.2% amounted to more than 500,000 homeless high school youth, exceeding DOE estimates 43

Dan Treglia and Dennis Culhane

by approximately 60% (­Cutuli, Treglia, & Herbers, 2020; Hatchimonji, Flatley, Treglia, & Cutuli, 2021).

Women and LatinX Homelessness The operational definitions and service utilization measures relied on to enumerate homelessness exclude some groups who may meet HUD and other conventional definitions of homelessness without meeting the criteria for inclusion in official counts. Susan Baker wrote of the “­Latino Paradox” in homelessness in 1996, documenting that though “­A frican Americans are overrepresented among the homeless, Latinos  … tend to be underrepresented in areas as diverse in Los Angeles, San Antonio, and New York” (­Baker, 1996, ­p. 132). Her study of 18 U.S. cities, reliant on primary data, found that Latinos were underrepresented among the homeless population by an average of 3.5 percentage points. This disparity, she argued, was due in large part to the strength of social support networks within the Latino community that allowed otherwise homeless members to avoid the shelter system, to which she points to the high overcrowding rate among Latinos as evidence. This is no longer true on a national level, as the LatinX homelessness rate is nearly on par with their share of the population, but localized research suggests that the phenomenon persists in some parts of the country (­Chinchilla & Gabrielian, 2019; Culhane, Metraux, Treglia, Lowman, & ­Ortiz-​­Siberon, 2019; Henry et al., 2019; Homelessness Policy Research Institute, 2019). Pleace (­2016), building on work from Burt (­2001) and ­Busch-​­Geertsema and colleagues (­­Busch-​­Geertsema, Benjaminson, Filipovic Hrast, & Pleace, 2014), wrote similarly about homelessness among women. They, more so than men, he argued, are likely to have a social support network from which they can obtain temporary but precarious accommodations that places them as technically homeless but outside of view of any system or surveyor who could reasonably count them.

Conclusion The last 40 years have been marked by changes in how we define and enumerate homelessness in the United States. Methodological innovations, combined with the advent of HMIS and mobile phones, mean that we have never had more tools at our fingertips to accurately assess the scope of homelessness in the United States. Yet, the fundamental challenges outlined by Wright and Devine in 1991 remain true. Governments and advocates continue to spar over homelessness estimates (­Coalition for the Homeless, 2020) and, despite advancements over the last 40 years, the number of people experiencing homelessness remains wildly uncertain. Sheltered homelessness has become far easier to enumerate with the advent and ubiquity of HMIS, but the uncertainty that pervaded the 1990 ­S -​­Night Count remains largely intact and, we have no doubt, will remain that way. There is no hiding from this fact, and transparency on the part of those administering, conducting, and publishing results from official counts is critical to the credibility of these estimates.

44

Defining and counting homelessness

References Agans, R. P., Jefferson, M. T., Bowling, J. M., Zeng, D., Yang, J., & Silverbush, M. (­2014). Enumerating the Hidden Homeless: Strategies to Estimate the Homeless Gone Missing from a ­Point-­​­­i n-​­Time Count. Journal of Official Statistics, 30(­2), ­215–​­229. https://­doi. org/­10.2478/­­jos-­​­­2014-​­0 014 Baker, S. G. (­1996). Homelessness and the Latino Paradox. In J. Baumohl (­Ed.), Homelessness in America (­p­­p. ­132–​­140). Phoenix: Oryx. Bane, M. J., & Ellwood, D. T. (­1986). Slipping Into and Out of Poverty: The Dynamics of Spells. The Journal of Human Resources, 21(­1), 1. https://­doi.org/­10.2307/­145955 Burt, M. R., & Cohen, B. E. (­1989). America’s Homeless: Numbers, Characteristics, and Programs that Serve Them. Washington, DC: Urban Institute. Burt, M. R. (­2001). Homeless Families, Singles, and Others: Findings from the 1996 National Survey of Homeless Assistance Providers and Clients. Housing Policy Debate, 12(­4), ­737–​­780. ­Busch-​­Geertsema, V., Benjaminson, L., Filipovic Hrast, M., & Pleace, N. (­2014). Extent and Profile of Homelessness in European Member States: A Statistical Update. Brussels: FEANTSA. Chinchilla, M.,  & Gabrielian, S. (­2019). Stemming the Rise of Latinx Homelessness: Lessons from Los Angeles County. Journal of Social Distress and the Homeless, 0(­0), ­1–​­5. https://­doi.org/­10.1080/­10530789.2019.1660049 Coalition for the Homeless. (­2020, August 17). Statement on HOPE S­ urvey – ​­Coalition for the Homeless. Retrieved June 28, 2021, from https://­w ww.coalitionforthehomeless. org/­press/­­coalition-­​­­for-­​­­the-­​­­homeless- ­​­­statement-­​­­on-­​­­hope-​­survey/ Culhane, D. P., Delowski, E. F., Ibanez, J., Needham, E.,  & Macchia, I. (­1994). Public Shelter Admission Rates in Philadelphia and New York City: The Implications of Turnover for Sheltered Population Counts. Housing Policy Debate, 5(­2), ­107–​­140. https://­doi. org/­10.1080/­10511482.1994.9521155 Culhane, D. P.,  & Kuhn, R. (­1998). Patterns and Determinants of Public Shelter Utilization among Homeless Adults in New York City and Philadelphia. Journal of Policy Analysis and Management, 17(­1), ­23– ​­43. https://­doi.org/­10.1002/(­SICI)­­1520​­6688(­199824)­17:13.0.CO;­2 -​­J Culhane, D. P., Metraux, S., Park, J. M., Schretzman, M., & Valente, J. (­2007). Testing a Typology of Family Homelessness Based on Patterns of Public Shelter Utilization in Four US Jurisdictions: Implications for Policy and Program Planning. Housing Policy Debate, 18(­1), ­1–​­28. ­ rtiz-​­Siberon, A. (­2019). Latinx Culhane, D. P., Metraux, S., Treglia, D., Lowman, K., & O Homelessness in Philadelphia: Rates of Services Use, Perceived Barriers and Assets, and Potential Opportunities for Leveraging City Reform Efforts to Address Service Gaps. Retrieved from https://­works.bepress.com/­dennis_culhane/­233/ Culhane, D. P., Fitzpatrick, S., & Treglia, D. (­2020). Contrasting Traditions in Homelessness Research between the UK and US. In L. Teixeira & J. Cartwright (­Eds.), Using Evidence to End Homelessness (­p­­p. ­99–​­124). Bristol: Bristol University Press. Cutuli, J. J., Treglia, D., & Herbers, J. E. (­2020). Adolescent Homelessness and Associated Features: Prevalence and Risk across Eight States. Child Psychiatry and Human Development, 51(­1), ­48–​­58. https://­doi.org/­10.1007/­­s10578-­​­­019-­​­­0 0909-​­1 Glynn, C., Byrne, T. H., & Culhane, D. P. (­2018). Inflection Points in C ­ ommunity-​­Level Homeless Rates. Retrieved from https://­works.bepress.com/­dennis_culhane/­228/ Glynn, C., & Fox, E. B. (­2019). Dynamics of Homelessness in Urban America. The Annals of Applied Statistics, 13(­1), ­573–​­605. Hatchimonji, D., Flatley, C., Treglia, D., & Cutuli, J. J. (­2021). High School Students Experiencing Homelessness: Findings from the 2019 Youth Risk Behavior Surveillance System (­Y RBSS). Children’s Health System. Retrieved from: https://­fi les.eric.ed.gov/­f ulltext/­ED616088. pdf

45

Dan Treglia and Dennis Culhane Henry, M., Mahathey, A., Morrill, T., Robinson, A., Shivji, A., & Watt, R. (­2019). Annual Homeless Assessment Report to Congress: Part I. Washington, DC: Housing and Urban Development (­H UD). Homelessness Policy Research Institute. (­2019). Latinx Homelessness in Los Angeles Executive Summary. Hopper, K. (­1992). Counting the Homeless: S­ -​­Night in New York. Evaluation Review, 16(­4), ­376–​­388. Hopper, K., Shinn, M., Laska, E., Meisner, M., & Wanderling, J. (­2008a). Estimating Numbers of Unsheltered Homeless People through ­Plant-​­Capture and Postcount Survey Methods. American Journal of Public Health. https://­doi.org/­10.2105/­AJPH.2005.083600 Hopper, K., Shinn, M., Laska, E., Meisner, M.,  & Wanderling, J. (­2008b). Estimating Numbers of Unsheltered Homeless People through ­Plant-​­Capture and Postcount Survey Methods. American Journal of Public Health, 98(­8), ­1438–​­1442. https://­doi.org/­10. 2105/­AJPH.2005.083600 Jencks, C. (­1994). The Homeless. Cambridge, MA: Harvard Univesity Press. Kondratas, A. (­1991). Estimates and Public Policy: The Politics of Numbers. Housing Policy Debate, 2(­3), ­629–​­647. https://­doi.org/­10.1080/­10511482.1991.9521067 Lee, B. A., Tyler, K. A., & Wright, J. D. (­2010). The New Homelessness Revisited. Annual Review of Sociology, 36, ­501–​­521. https://­doi.org/­10.1146/­­a nnurev- ­​­­soc- ­​­­070308-​­115940 Link, B. G., Susser, E., Stueve, A., Phelan, J., Moore, R. E., & Struening, E. (­1994). Life­ ive-​­Year Prevalence of Homelessness in the United States. American Journal of time and F Public Health, 84(­12), ­1907–​­1912. Madigan, D., Forst, L.,  & Friedman, L. S. (­2020). Comparison of State Hospital Visits with Housing and Urban Development Estimates of Homeless: Illinois, 2­ 011–​­2018. American Journal of Public Health. American Public Health Association Inc. https://­doi. org/­10.2105/­AJPH.2019.305492 Martin, E. (­1992). Assessment of the ­S -​­Night Street Enumeration in the 1990 Census. Evaluation Review1, 16(­4), ­418–​­438. Metraux, S., Culhane, D. P., Raphael, S., White, M., Pearson, C., Hirsch, E., … Gleghorn, J. S. (­2001). Assessing Homeless Population Size through the Use of Emergency and Transitional Shelter Services in 1998: Results from the Analysis of Administrative Data from Nine US Jurisdictions. Public Health Reports, 116(­4), ­344–​­352. Retrieved from http://­ www.embase.com/­s earch/­r esults?subaction=viewrecord&from=export&id=L34521 259%0Ahttp://­ucelinks.cdlib.org:8888/­s fx_ucsf ?sid=EMBASE&issn=00333549&id= doi:&atitle=Assessing+homeless+population+size+through+the+use+of+emergency+ and+transitional+shelter+s Metraux, S., Stino, M., & Culhane, D. P. (­2014). Validation of ­Self-​­Reported Veteran Status Among Two Sheltered Homeless Populations. Public Health Reports, 129(­February 2014), ­73–​­77. Retrieved from http://­offcampus.lib.washington.edu/­login?url=http://­search. ebscohost.com/­login.aspx?direct=true&db=a9h&AN=93601079&site=­ehost-​­l ive Metraux, S., Manjelievskaia, J., Treglia, D., Hoffman, R., Culhane, D. P.,  & Ku, B. S. (­2016). Posthumously Assessing a Homeless Population: Services Use and Characteristics. Psychiatric Services, 67, ­1334–​­1339. https://­doi.org/­10.1176/­appi.ps.201500388 Montgomery, A. E., Szymkowiak, D., Marcus, J., Howard, P., & Culhane, D. P. (­2016). Homelessness, Unsheltered Status, and Risk Factors for Mortality: Findings from the 100 000 Homes Campaign. Public Health Reports, 131(­6), ­765–​­772. https://­doi. org/­10.1177/­0 033354916667501 Morton, M. H., Dworsky, A., Matjasko, J. L., Curry, S. R., Schlueter, D., Chávez, R.,  & Farrell, A. F. (­2018). Prevalence and Correlates of Youth Homelessness in the United States. Journal of Adolescent Health, 62(­2018), 1­ 4–​­21. https://­doi.org/­10.1016/­j. jadohealth.2017.10.006 National Alliance to End Homelessness. (­2021). This Veterans Day, Let’s Prioritize Ending Veteran Homelessness.

46

Defining and counting homelessness Pleace, N. (­2016). Exclusion by Definition: The ­Under-​­representation of Women in European Homelessness Statistics. In P. Mayock & J. Bretherton (­Eds.), Women’s Homelessness in Europe (­p­­p. ­105–​­126). London: Palgrave Macmillan. Rossi, P. H. (­1991). Down and Out in America: The Origins of Contemporary Homelessness. Chicago, IL: University of Chicago Press. Schneider, M., Brisson, D.,  & Burnes, D. (­2016). Do We Really Know How Many Are Homeless?: An Analysis of the ­Point-­​­­In-​­Time Homelessness Count. Families in Society: The Journal of Contemporary Social Services, 97(­4), ­321–​­329. https://­doi.org/­10.1606/­­ 1044-​­3894.2016.97.39 Shlay, A.,  & Rossi, P. H. (­1992). Social Science Research and Contemporary Studies of Homelessness. Annual Review of Sociology. https://­doi.org/­10.1146/­a nnurev.soc.18.1.129 Snyder, M. (­1990, April 15). CCNV: Counts and Accounts. Washington Post, p. D8. Stern, M. J. (­1984). The Emergence of the Homeless as a Public Problem. Social Service Review, 58(­2), ­291–​­301. https://­doi.org/­10.1086/­644193 Tipple, G.,  & Speak, S. (­2009). The Hidden Millions: Homelessness in Developing Countries. London: Routledge. Treglia, D. (­2016). Identifying and Serving Veterans Accessing ­Community-​­based Homeless Services: A Study of Three U.S. Cities. Washington, DC: US Department of Veteran Affairs. Treglia, D., Montgomery, A. E.,  & Culhane, D. P. (­2016). Homelessness in the United States. In K. B. Anacker, A. Caswell, S. Kirby, & K. R. Tremblay (­Eds.), Introduction to Housing (­p­­p. ­183–​­195). Athens: University of Georgia Press. U.S. Interagency Council on Homelessness. (­2018). Key Federal Terms and Definitions of Homelessness Among Youth. Washington, DC: USICH. United Nations Commission for Social Development. (­2020). Report on the 58th Session. Retrieved from https://­u ndocs.org/­E/­CN.5/­2020/­L .5 Wasserman, J. A., & Clair, J. M. (­2009). At Home on the Street. Boulder, CO: Lynne Rienner Publishers. Williams, J. C. (­2011). “­Stand Up and Be Counted”: The Politics of a Homeless Enumeration. Poverty & Public Policy, 3(­3), ­1–​­27. https://­doi.org/­10.2202/­­1944-​­2858.1172 Wright, J. D., & Devine, J. A. (­1992). Counting the Homeless: The Census Bureau’s “­­S-​ ­Night” in Five U.S. Cities. Evaluation Review, 16(­4), ­355–​­364.

47

5 RESPONDING TO HOMELESSNESS Making the human right to housing a reality in Scotland? Isobel Anderson Introduction This chapter reflects on the continuing prevalence of homelessness in an era of increasingly sophisticated analysis of the drivers of homelessness and what works in responding to homelessness. Homelessness is defined in relation to home and to housing as a human right. Responding to homelessness is framed in terms of the actions of institutions and stakeholders within ­multi-​­level and networked governance and political structures. The example of Scotland, within the United Kingdom (­U K), is used to explore how responses to homelessness which address the complex combination of housing, health, social and economic circumstances underpinning individual homelessness experiences may be framed in relation to housing and human rights. A ‘­re’-​­turn to rigorous evidence has enhanced understanding of ‘­what works’ in responding to homelessness, but measures designed specifically to reduce and ultimately end homelessness do not yet fully address the wider and deeper societal conditions which create and sustain multiple forms of social exclusion, including homelessness. Embedding a human rights approach to homelessness and housing rights may further enhance the effectiveness of e­ vidence-​­based solutions.

Human rights and the governance of homelessness Our human right to housing recognises a basic need for shelter which is safe, secure, affordable and sufficient for the needs of a particular household (­Kenna, 2005; Donnelly, Finnerty and O’Connell, 2020). Responses to homelessness need to begin with a conception of home as more than a physical dwelling. Home is an essential social space from which to conduct life’s activities, which should provide security and comfort both in living accommodation and in neighbourhood. Most broadly, homelessness can be defined as ‘­being without a home’, conveying a lack of a 48

DOI: 10.4324/9781351113113-6

Responding to homelessness

secure, adequate, affordable, private space in which to live and flourish. Home can be realised through a constitutional right to housing or a justiciable right to housing through a legal framework, such as which exists in the UK (­A nderson, 2012). A human rights approach to housing and homelessness can equally be framed in an institutional analysis of welfare where multiple stakeholders utilise evidence and networks within m ­ ulti-​­level (­g lobal to local) structures of governance to shape and deliver responses to homelessness (­Kemp, 2015; Anderson, Dyb and Finnerty, 2016). Homelessness is a particular dimension of wider housing exclusion, which, in turn, reflects overlapping structural, institutional and individual mechanisms within the legal and policy framework for housing (­Preece and Bimpson, 2019, ­p. 7). The structures of housing markets and welfare systems, inequality and most notably the experience of poverty, are crucial drivers of homelessness (­Bramley and Fitzpatrick, 2017; Fitzpatrick and Davies, 2021; Anderson and Sim, 2011) and merit close attention in responding to homelessness. ­State-​­led responses to homelessness were influential in the UK in the second half of the 20th century (­A nderson, 2004). The UK homelessness legislation of 1977 placed duties on local housing authorities to intervene when homelessness occurred, typically by offering eligible households social housing (­rather than creating a right to housing). By the late 20th century, the welfare state was already conceptualised as shifting from government to governance, functioning as increasingly autonomous public/­private/­NGO networks, such that ‘­government’ was seen to be ‘­steering’ rather than directly commanding or delivering public services (­Stoker, 1988; Lowe, 2004). Lowe (­2004, ­p. 35) characterised the changing governance of housing as reflecting the ‘­hollowing out’ of the state within a neoliberal framework. After 1997 with the election of New Labour, an emphasis on networked governance and ­evidence-​­based policy (­Nutley, Walter and Davis, 2007) changed the UK’s responses to homelessness. Government continued to set policy, but implementation and service delivery increasingly involved local government and t­hird-​ s­ector actors (­Kennedy, Lynch and Goodlad, 2001). A collaborative discourse emerged in the UK homelessness and wider social policy which emphasised partnership, interagency working, joined up government and new networks, albeit within a marketised and ­contract-​­based system of service delivery (­Powell and Glendinning, 2002; Powell and Exworthy, 2002; Clarke and Glendinning, 2002). The early 2000s also saw progressive homelessness and housing policies (­Power, 2009; Anderson and Sim, 2011; Pleace, 2011; Tunstall, 2011; Fitzpatrick, Pawson and Watts, 2020). Ambitious integrated strategies to tackle homelessness emerged in a number of European countries (­Benjaminsen, Dyb and O’Sullivan, 2009) as network governance increasingly underpinned collaboration across housing, homelessness, health and social care organisations aiming to prevent and reduce homelessness (­A nderson, Dyb and Ytrehus, 2012). The shift to networked and ­multi-​­level governance presented both opportunities and challenges for realising housing rights in practice, not least in the light of devolution of government in the UK which created a Scottish Parliament with powers to make distinctive housing and homelessness policy. The impact 49

Isobel Anderson

of devolved governance makes the UK an interesting illustrative case of ­multi-​ l­evel governance and political diversity in responding to homelessness and framing housing as a human right.

Responding to ­homelessness – ​­policy trajectories towards housing as a human right? Scotland grasped an early opportunity for radical change with its Homelessness Task Force (­2000, 2002). Prior legislation restricted access to rehousing to specific ‘­priority need’ groups, mainly households containing dependent children and adults with high and complex needs that might be exacerbated by homelessness. This priority restriction which excluded some homeless groups was abolished from 2012 in a significant step towards a housing rights led approach where all homelessness was recognised (­A nderson and Serpa, 2013; Anderson, 2020). Scotland combined this wider definition of homeless people who were eligible for rehousing with a shift towards homelessness prevention (­Scottish Government and COSLA, 2009). Prevention policy was seen to help reduce homelessness without further legal change and to lessen pressure on systems which were working with a much more widely defined homeless population (­A nderson and Serpa, 2013, ­p. 31; Anderson, 2020). Despite the ­housing-​­led modernisation of homelessness law and policy in Scotland, evidence reviews in the ­m id-​­to late 2000s indicated that exclusion from support services contributed to the persistence of homelessness (­Rosengard et al., 2007; Pleace, 2008). A key challenge in operationalising a h ­ uman-­​­­rights-​­led approach to homelessness centred on coordinating the networks of government and ­non-​­government bodies that delivered the Scottish homelessness strategy. The 2000s also saw the application of quantitative methods (­in addition to an analysis of routine administrative data) to research on homeless people with multiple and complex needs (­McDonagh, 2011). This research confirmed a high degree of intersection between different socially excluded groups and the need to coordinate responses (­Fitzpatrick, Johnsen and White, 2011). The risks that people with multiple and complex needs were still ‘­falling through cracks’ in service provision and becoming ­long-​­term or repeatedly homeless reinforced the case for integrated responses to homelessness which have been adopted elsewhere in Europe and the USA (­Pleace et al., 2015). Following the 2008 Global financial crisis, social policies of the p­ ost-​­2010 right of centre UK government diverged from the Scottish ideal of a ­r ights-​­led integrated, ­multi-​­agency and multisectoral approach to homelessness (­Fitzpatrick, Pawson and Watts, 2020, ­p. 14). The ­U K-​­wide policies of financial austerity ran counter to the notion of human rights, curtailing welfare benefits in the Welfare Reform Act 2012 and impacting negatively on those at risk of or experiencing homelessness (­Batty et  al., 2015; Dwyer and Bright, 2016). By 2015, the extreme situation of destitution affected 1.2 million people in the UK from a population of 64 million (­Fitzpatrick et al., 2016). Structural poverty remained a universal characteristic of severe and multiple disadvantages, with mental health issues, social stigma and poor 50

Responding to homelessness

quality of life all common experiences associated with acute homelessness, including in Scotland (­Bramley et al., 2015; Bramley et al., 2019). Despite the negative impact of U ­ K-​­wide welfare reform on homelessness, Scotland persisted in pursuing a more progressive, r­ights-​­oriented response building an integrated, interagency and multidisciplinary network of services. Scotland avoided significant increases in homelessness in the p­ ost-​­2010 period, reflecting distinct policy choices, combined with somewhat less challenging housing market conditions (­Fitzpatrick and Davies, 2021). However, evidence also indicated that the Scottish reforms of the 2000s and 2010s had not adequately addressed rough sleeping and a new Ending Homelessness Action Plan was subsequently developed (­COSLA and Scottish Government, 2018; Anderson, 2019). Scotland’s ­r ights-​­based strategy was constrained by an ­ever-​­falling supply of social housing throughout the 2010s, with homelessness services increasingly turning to a private rented sector, which was lower quality, often more expensive and less secure, as a response to homelessness (­Prevention Review Group, 2021). These supply issues were addressed by an enhanced social housing building programme and preserved the remaining social rented stock by ending social tenant’s ‘­R ight to Buy’ their homes in the Housing (­Scotland) Act 2014 (­A nderson, 2020). Similarly, the Private Housing (­Tenancies) (­Scotland) Act 2016 reformed private tenancy terms with the aim of improving quality and security for tenants (­A nderson, 2020). Nevertheless, inadequate housing availability necessitated the continued use of ­poor-​­quality temporary accommodation for homeless people (­Watts and Blenkinsopp, 2022), reflecting wider evidence that sleeping rough was often a rational alternative to intolerable temporary accommodation (­Bowpitt, 2020; McMordie, 2021). Although Scottish housing authorities implemented Rapid Rehousing Transition Plans (­R RTPs) designed to minimise use of temporary accommodation, resources were reported as insufficient to deliver ‘­transformational’ reductions in temporary accommodation use (­A nderson, 2019; Dunn, 2020; Chartered Institute of Housing Scotland, 2021). From 2020, the coronavirus pandemic brought new pressures and Scottish Government introduced measures to prevent evictions and street homelessness (­The Social Housing Resilience Group, 2021). While homelessness applications and assessments declined with the onset of ‘­lock down’ restrictions, the number of people in temporary accommodation increased (­Scottish Government, 2021a). The period saw an increase in the proportion of households becoming homeless due to household disputes, reflecting household pressures during the pandemic and a decrease in the proportion of homelessness due to ‘­loss of accommodation’, including from a private rented tenancy, likely linked to increased regulation of private renting in Scotland (­Scottish Government, 2021a). Further innovation in networked governance saw the Everyone Home Collective (­2021) of more than ­ OVID-​ 30 ­third-​­and ­academic-​­sector organisations come together during the C ­19 pandemic to protect progress on homelessness policy and shape the next steps. Official homelessness statistics for the pandemic year April ­2020–​­March 2021 revealed some key impacts of COVID as well as ongoing measures to reduce homelessness. From a human rights perspective, widening access to assistance brought 51

Isobel Anderson

some important changes. Lone adults had fewer entitlements and faced more barriers to services under previous laws and regulation, but the numbers being assisted had increased, reflecting their stronger rights and better access to assistance (­Scottish Government, 2021a). Notwithstanding the pandemic pressures, Scottish Government consulted widely to develop its ­long-​­term policy statement on ‘­Housing to 2040’ (­Scottish Government, 2021b) and a separate Social Justice and Fairness Commission (­2021) set out five key housing policy proposals (­­p. 100): 1 Develop modernised aims of housing policy: a decent home for everyone at a price within their means that meets minimum energy efficiency, space and accessibility standards. 2 Seek to move ­owner-​­occupation back towards a means to manage housing costs over the life cycle, and away from expectations of asset appreciation. 3 Use the expanded social rented sector to set standards across the housing system. 4 Retain and reform housing allowances as poverty falls. 5 Modernise the existing stock. After 20 years of implicitly ­r ights-​­led policy, Scotland’s Social Justice and Fairness Commission (­2021) explicitly referred to guaranteeing the human right to a home: The Commission has therefore put housing at the heart of our considerations. Housing is a basic human right, and it is also a cornerstone right that enables the realisation of other rights. Social justice and fairness cannot be achieved if people don’t have a safe place to live. (­­p. 16) This express commitment to housing as a human right was also central to Scotland’s National Taskforce for Human Rights (­2021) which set out recommendations for a new human rights framework in Scotland, to reaffirm the civil and political rights in the European Convention on Human Rights and implement the full range of rights in the UN human rights treaties. The proposed framework explicitly includes the right to respect for private and family life, home and protection of property (­National Taskforce for Human Rights, 2021, ­p. 11) as well as the right to an adequate standard of living, including housing (­­p. 12). When the resultant Scottish Human Rights Bill becomes a law, it will embed the right to an adequate standard of living, including adequate housing, directly into Scots Law (­Newhaven Research, 2021, para 1; Scottish Government, 2021c). In preparation for the legal right to adequate housing, the Convention of Scottish Local Authorities (­COSLA) commissioned a detailed review of evidence in order to estimate and monitor access to adequate housing (­Newhaven Research, 2021). Estimates showed that approaches to measuring housing need were often too narrow and that unacceptable housing conditions faced by many households needed to be better acknowledged: 52

Responding to homelessness

Whilst it is the most extreme form of failing, homelessness is by no means the only human rights failing in terms of adequate housing. (­Newhaven Research, 2021, ­p. 2) Other challenges included poor energy efficiency, housing standards and affordability, mental health impacts of inadequate housing, issues facing disabled people and those experiencing domestic abuse, and achieving change in a ­m arket-​­led system where over 75% of households live in the private sector (­Newhaven Research, 2021, ­p. 3). The review concluded that Scotland had achieved more progress in relation to homelessness than in wider affordability and accessibility of housing (­­p. 3). A large majority of households were found to fall short of being adequately housed on just one element (­t ypically energy efficiency), while some 22% fell short for two or more reasons, with the risk of living in inadequate housing associated with living alone, renting in the private sector, living in a rural area and being out of work (­­p. 5, para 16). In a further review of homelessness, Scotland’s m ­ ulti-​­stakeholder Prevention Review Group (­2021) adopted three principles (­­p. 5): 1 the collective responsibility across public services to prevent homelessness 2 intervention to prevent homelessness should start as soon as possible 3 those at risk of homelessness should have choice in where they live and access to the same options as other members of the public. The recommendations of the Prevention Review Group (­2021; Table  5.1) were influenced by people with lived and frontline experience of homelessness and were taken forward in a government consultation, concluding in 2022, and with further legislative reform expected in 2023 (­Scottish Government and COSLA, 2021). While the proposals acknowledge the importance of ‘­progressive housing rights’ in Scotland (­Scottish Government and COSLA, 2021, ­p. 3), the enhancements to homelessness prevention could have been more firmly and explicitly framed in relation to the work of the Social Justice and Fairness Commission (­2021) and the National Taskforce for Human Rights (­2021).

The ‘­­re-​­turn’ to ­evidence – ​­prospects for a human ­rights-​­led response to homelessness? Policy stakeholders have access to a growing and diverse evidence base on what works in tackling homelessness. Global governance is represented by both the longstanding United Nations conventions on human rights and the more recent commitment to agenda 2030 and the sustainable development goals, with goal 11 focusing on sustainable, inclusive communities (­United Nations, 1948; 2015, 2022). FEANTSA and the Institute for Global Homelessness are examples of established and emerging research and practice networks with the ambition of European and worldwide influence (­FEANTSA, 2022; IGH, 2022). International learning from ‘­peer review’ of local homelessness services across Europe has also confirmed 53

Isobel Anderson ­Table 5.1  Five main goals of legislative change in Scotland (­f rom Prevention Review Group, 2021) 1 2

3 4

5

Integrate a duty to prevent homelessness in the main statutory framework, so that local authorities assist anyone threatened with homelessness within six months. Prescribe a range of reasonable steps to be used to prevent or alleviate homelessness, based on the existing Housing Options framework and a personalised housing and support plan that enhances applicants’ choice and control. Ensure the service meets the needs of groups at risk of homelessness by working across services and partners. Ensure people are assisted into accommodation which is available for a minimum of 12 months and suitable to their needs, with appropriate safeguards to ensure that homelessness does not reoccur. Provide clarity and accountability in the system, including effective rights of review.

a substantive role for local policy making and service delivery (­Gosme and Anderson, 2015). However, without a governing policy and ethical framework, strong local control of homelessness policy, for example, as implemented in England, can be inconsistent and even destructive, particularly when resources are limited (­Fitzpatrick, Pawson and Watts, 2020). NGO participation in the Scottish homelessness policy process is ­well-​­established (­A nderson, 2019; Homeless Network Scotland, 2021), including involving experts by experience through a c­o-​­ production model (­ Glasgow Homeless Network, 2018; Anderson, 2019). Although there remains a scope for more detailed research on the influence of NGOs, networked governance has created a context in which homelessness policy development, in innovative fields like Housing First, has been a collaborative process within a strategic and ethical framework increasingly focused on viewing housing as a human right. Early evaluative evidence from Scotland’s Housing First Pathfinder programme confirmed initial success in securing sustainable housing outcomes for homeless people with complex support needs ( ­Johnsen, Blenkinsopp and Rayment, 2021) with plans to scale up Housing First across Scotland over the subsequent ten years (­Homeless Network Scotland, 2022). Research and conceptual approaches from psychology and health have also become influential in responding to homelessness in Scotland. Evidence which could support a human rights approach includes recognition of the influence of Adverse Childhood Experiences (­ACEs) on homelessness in later life and the potential benefits of Psychologically Informed Environments (­PIEs) as a model of flexible service provision to meet particular needs (­Keats et al., 2012; Breedvelt, 2016). Public Health Scotland (­2021) emphasised the importance of poverty and housing affordability to health (­p­­p. ­2 –​­3), as well as the ‘­catastrophically poor health outcomes’ for those experiencing homelessness (­­p. 23). Linkage of Scottish health and homelessness administrative data sets has also demonstrated the need for a ­whole-​­systems approach to address severe and multiple disadvantage (­Public Health Scotland, 2021, ­p. 28). Training and development for homelessness workers is important in developing p­ erson-​­centred, integrated and c­ ross-​­sectoral responses 54

Responding to homelessness

to homelessness (­Galbraith, 2020). The right training and empowerment of homelessness workers can support a trajectory to delivering integrated, ­person-​­centred and ­r ights-​­oriented responses to homelessness. The r­ e-​­turn to evidence on what works on homelessness has also seen an emphasis on robust quantitative research and on systematic evidence reviews. For example, Mackie, Johnsen and Wood (­2 019) drew on more than 500 literature sources, supplemented by interviews with international experts to identify effective measures to tackle rough sleeping, highlighting ­housing-​­led, ­person-​­centred, integrated service models and strategies. Alongside this, Fitzpatrick and Davies (­2 021) have reviewed the UK’s homelessness laws and produced a framework for an ‘­ideal’ system, again emphasising an integrated, preventative, p­ erson-​­led and ­housing-​­led strategy. In an evidence review of a­ ccommodation-​­based interventions, those offering the highest levels of support alongside unconditional accommodation were more effective in improving housing stability (­Keenan et al., ­ ousing-​­led, ­person-​­centred approaches to 2020, ­p.  10). Scotland has pursued h homelessness through networked, integrated and interdisciplinary strategy and service models. While this can be (­a nd has been) interpreted as an increasingly human ­rights-​­oriented approach to homelessness, the question still arises as to the scope for an even more explicit commitment to housing as a human right to ensure more effective solutions to homelessness. For example, the opportunity exits to frame the new public s­ector-​­led homelessness prevention duties in terms of actions to realise housing and human rights to deliver a more radical platform for change.

Conclusion This chapter has drawn on frameworks of human rights, networked governance and evidence informed policy to reflect on developments in responding to homelessness in Scotland. A significant shift from central ­ state-​­ led government to ­multi-​­level networked governance of homelessness can be identified and has been influential in supporting a ‘­re’-​­turn to valuing robust evidence on effectiveness in responding to homelessness. The response to homelessness in Scotland has become characterised by three main strands, a wide definition of homelessness, combined with an increasingly ­human-​­rights influenced ethical framework, and working within a context where system integration across agencies and sectors is being actively encouraged. Scotland has gone further than many countries in pursuing a ­r ights-​­oriented strategy, defining homelessness in very broad terms and offering close to universal, extensive homelessness and homelessness prevention services. However, a potential criticism of Scottish policy centres on closely reflecting, but not consistently committing to, a policy ethos and legal framework explicitly viewing and responding to homelessness as a violation of the human right to housing. Proposals to enshrine the European Convention on Human Rights directly into Scottish law in the early 2020s have been associated with a new impetus for a legal right to adequate housing for all. Housing and support resources will also be required to ensure that the right becomes a reality. 55

Isobel Anderson

Research in the first two decades of the 21st century ­re-​­confirmed that underlying structural inequalities continue to explain the persistence of homelessness and the complex needs of an increasing proportion of homeless households. The evidence base on what works in responding to homelessness has strengths and offers considerable consensus on tackling many aspects of homelessness. That said, evaluation tends to focus on specialist initiatives such as Housing First, while less is known about the effectiveness of mainstream housing, health and support services in the public and NGO sectors which are the main source of assistance to the majority of those facing homelessness in Scotland. Pursuit of an integrated, preventative, ­r ights-​­based homelessness strategy in Scotland may require more evidence on what the correct mix of services should look like. There still needs to be a ‘­­re-​­turn’ to e­ vidence-​­led policy evaluation and monitoring. A question for the 2020s will be how to nurture the combined efforts of multiple stakeholders in the networked, ­multi-​­level governance of homelessness to deliver responses which achieve real progress towards ending homelessness within a human rights framework. Housing has long been characterised as a fundamental human right and evidence indicates that sustainable housing outcomes for excluded groups require access to adequate income, health care and other support, as well as housing. Fully integrating homelessness responses with the housing and human rights agenda may be the additional nudge which is required for the next step change in achieving more egalitarian and inclusive housing outcomes. This chapter has focused on Scotland in particular, but in all countries, homelessness is influenced by housing policy and housing interventions, irrespective of tenure structures. While implementing a right to housing is not without its own challenges, the longstanding United Nations convention on human rights and the contemporary agenda for sustainable development goals at least offer a transferable global framework for actioning the realisation of housing and human rights and for responding to homelessness through a vision of a right to housing for all.

References Anderson, I. (­2004) Housing, homelessness and the welfare state in the UK. European Journal of Housing Policy, 4(­3), p­p. ­369–​­389. Anderson, I. (­2012) Policies to address homelessness: R ­ ights-​­based approaches. In Susan J. Smith, Marja Elsinga, Lorna Fox O’Mahony, Ong Seow Eng, Susan Wachter, Suzanne Fitzpatrick (­eds), International Encyclopedia of Housing and Home, vol. 5. Oxford: Elsevier, p­p. ­249–​­254. Anderson, I. (­2019) Delivering the right to housing? Why Scotland still needs an ending homelessness action plan. European Journal of Homelessness, 13(­2), p­p. ­131–​­159. Anderson, I. (­2020) Devolution and the health of Scottish housing policy. In Bonnar, A. (­ed.), Local Authorities and Social Determinants of Health. Bristol: Policy Press, p­p. ­367–​­386. Anderson, I., Dyb, E. and Finnerty, J. (­2016) The ‘­a rc of prosperity’ revisited: Homelessness policy change in North Western Europe. Social Inclusion, 4(­4), p­p. ­108–​­124. Anderson, I., Dyb, E. and Ytrehus, S. (­2012) Meeting the Needs of Homeless People: Interprofessional Work in Norway and Scotland. Oslo: Norwegian Institute for Urban and Regional Research. Anderson, I. and Serpa, S. (­2013) The right to settled accommodation for homeless people in Scotland: A triumph of rational policy making? European Journal of Homelessness, 7(­1), p­p. ­13–​­39.

56

Responding to homelessness Anderson, I. and Sim, D. (­eds) (­2011) Housing and Inequality. Coventry: Chartered Institute of Housing and Housing Studies Association. Batty, E., Beatty, C., Casey, R., Foden, M., McCarthy, L. and Reeve, K. (­2015) Homeless People’s Experiences of Welfare Conditionality and Benefits Sanctions. London: Crisis. Benjaminsen, L., Dyb, E. and O’Sullivan, E. (­2009) The governance of homelessness in l­iberal and social democratic welfare regimes. European Journal of Homelessness, 3, p­p. ­23–​­51. Bowpitt, G. (­2020) Choosing to be homeless? Persistent rough sleeping and the perverse incentives of social policy in England. Housing, Care and Support, 23(­3/­4), p­p. ­135–​­147. Bramley, G. and Fitzpatrick, S. (­2017) Homelessness in the UK: Who is most at risk? Housing Studies, 33(­1), p­p. ­96–​­116. https://­doi.org/­10.1080/­02673037.2017.1344957 Bramley, G. and Fitzpatrick, S. with Edwards, J., Ford, D., Johnsen, S., Sosenko, F. and Watkins, D. (­2015) Hard Edges: Mapping Severe and Multiple Disadvantage (­England). London: Lankelly Chase Foundation. Bramley, G., Fitzpatrick, S., Wood, J., Sosenko, F., Blenkinsopp, J., Littlewood, M., Frew, C., Bashar, T., McIntyre, J. and Johnsen, S. (­2019) Hard Edges Scotland: New Conversations about Severe and Multiple Disadvantage. London: Lankelly Chase Foundation and The Robertson Trust. Breedvelt, J. (­2016) Psychologically Informed Environments: A Literature Review. London: Mental Health Foundation. Chartered Institute of Housing Scotland (­2021) Rapid Rehousing Transition Plans, Temporary Accommodation and Housing Options: A Survey of Scotland’s Local Authorities. Edinburgh: CIH Scotland. Clarke, J. and Glendinning, C. (­2002) Partnership and the remaking of welfare governance. In Glendinning, C., Powell, M. and Rummery, K. (­eds), Partnerships, New Labour and the Governance of Welfare. Bristol: The Policy Press, p­p. ­33–​­50. COSLA (­Convention of Scottish Local Authorities) and Scottish Government (­2018) Ending Homelessness Action Plan. Edinburgh: Scottish Government. Donnelly, D., Finnerty, J. and O’Connell, C. (­2020) The right to housing. In McCann, G. and Ȯ hAdhmaill, F. (­eds), International Human Rights, Social Policy and Global Development: Critical Perspectives. Bristol: Policy Press, p­p. ­209–​­221. Dunn, L. (­2020) Rapid Rehousing Transition Plans: A Scottish Overview. With Practice Examples and Ideas to Share. London: Crisis. Dwyer, P. and Bright, J. (­ 2016) Welfare Conditionality: Sanctions, Support and Behaviour Change. First Wave Research Findings. York: University of York. Everyone Home Collective (­2021) A ­Route-​­Map to Protect Homes and Communities across Scotland. Glasgow: Homeless Network Scotland. Online: https://­everyonehome.scot/ FEANTSA (­2022) Home (­feantsa.org). Fitzpatrick, S., Bramley, G., Sosenko, F., Blenkinsopp, J., Johnsen, S., Littlewood, M., Netto, G. and Watts, B. (­2016) Destitution in the UK. York: Joseph Rowntree Foundation. Fitzpatrick, S. and Davies, L. (­2021) The ‘­ideal’ homelessness law: Balancing ‘­r ights centred’ and ‘­­professional-​­centred’ social policy. Journal of Social Welfare and Family Law, 43(­2), p­p. ­175–​­197. DOI: 10.1080/­09649069.2021.1917712 Fitzpatrick, S., Johnsen, S. and White, M. (­2011) Multiple Exclusion Homelessness in the UK: Key Patterns and Intersections. Social Policy and Society, 10(­4), p­p. ­501–​­512. Fitzpatrick, S., Pawson, H., and Watts, B. (­2020) The limits of localism: A decade of disaster on homelessness in England. Policy and Politics, 48(­4), p­p.  ­541–​­561. https://­doi. org/­10.1332/­030557320X1585733894438 Galbraith, J. (­2020) Homelessness workers negotiating the relationship between identity and practice: How gender, age and background influence ­worker-​­service user relationship. Housing, Theory and Society, 37(­2), p­p. ­198–​­213. Glasgow Homeless Network (­2018) Can We Fix Homelessness in Scotland? Aye We Can. Final Report. Glasgow: Glasgow Homeless Network. https://­homelessnetwork.scot/­­wp-​ ­content/­uploads/­2019/­12/­­Aye-­​­­Report-­​­­August-​­2018.pdf

57

Isobel Anderson Gosme, L. and Anderson, I. (­2015) International learning as a driver of innovation in ­local-​ ­level policy making: Achievements and challenges from peer review of homelessness policies. European Journal of Homelessness, 9(­1), p­p.  ­37–​­59. http://­w ww.feantsaresearch. org/­spip.php?article377 Homeless Network Scotland (­2021) We Are All In: Our Impact January to June 2021. Glasgow: Homeless Network Scotland. ­Impact-­​­­Report-­​­­Jan-­​­­Jun-​­2021.pdf ( ­homelessnetwork. scot). ­ tart-​­Up and Homeless Network Scotland (­2022) Branching Out. A National Framework to S ­S cale-​­Up Housing First in Scotland ­2021–​­2031. Glasgow: Homeless Network Scotland. ­Branching-­​­­Out-­​­­Housing-­​­­First-­​­­National-­​­­Framework-​­v230622.pdf (­homelessnetwork. scot). Homelessness Task Force (­2000) Helping Homeless People: Legislative Proposals on Homelessness. Edinburgh: Scottish Executive. Homelessness Task Force (­2002) An Action Plan for Prevention and Effective Response. Homelessness Task Force Final Report. Edinburgh: Scottish Executive. Institute for Global Homelessness (­2022) Institute of Global Homelessness (­ighomelessness. org). Johnsen, S., Blenkinsopp, J. and Rayment, M. (­2021) Scotland’s Housing First Pathfinder Evaluation: First Interim Report (­Full Report). Edinburgh: Institute for Social Policy, Housing and Equalities Research (­­I-​­SPHERE), Heriot Watt University. Keats, H., Maguire, N., Johnson, R. and Cockersall, P. (­2012) Psychologically Informed Services for Homeless People. Good Practice Guide. Southampton: University of Southampton. Keenan, C., Miller, S., Hanratty, J., Pigott, T., Hamilton, J. and Coughlan, C. (­2020) ­Accommodation-​­Based Programmes for Individuals Experiencing or at Risk of Homelessness: A ­ eta-​­Analysis. Online: Centre for Homelessness Impact. Systematic Review and Network M Centre for Homelessness Impact. Kemp, P. (­2015) Private renting after the global financial crisis. Housing Studies, 30(­4), p­p. ­601–​­620. Kenna, P. (­2005) Housing Rights and Human Rights. Brussels: FEANTSA. Kennedy, C., Lynch, E. and Goodlad, R. (­2001) Good Practice in Joint/­­Multi-​­Agency Working on Homelessness. Scottish Executive Central Research Unit, Development Group Research Programme, Research Findings No. 130. Lowe, S. (­2004) Housing Policy Analysis: British Housing in Comparative and Cultural Context. Basingstoke: Palgrave Macmillan. Mackie, P., Johnsen, S. and Wood, J. (­2019) Ending street homelessness: What works and why we don’t do it. European Journal of Homelessness, 13(­1), p­p. ­85–​­96. McDonagh, T. (­2011) Tackling Homelessness and Exclusion: Understanding Complex Lives. York: Joseph Rowntree Foundation. McMordie, L. (­2021) Avoidance strategies: Stress, appraisal and coping in hostel accommodation. Housing Studies, 36(­3), p­p. ­380–​­396. National Taskforce for Human Rights (­2021) National Taskforce for Human Rights Leadership Report. Edinburgh: Scottish Government. National Taskforce for Human Rights: Leadership ­report – ​­gov.scot (­w ww.gov.scot). Newhaven Research (­2021) The Right to Adequate Housing: Are We Focusing on What Matters? A Discussion Paper. Edinburgh: Association of Local Authority Chief Housing Officers. The right to adequate housing: Are we focusing on what matters?: CaCHE (­housingevidence.ac.uk). Nutley, S., Walter, I. and Davies, H. (­2007) Using evidence: How Research Can Inform Public Services. Bristol: The Policy Press. Pleace, N. (­2008) Effective Services for Substance Misuse and Homelessness in Scotland: Evidence from an International Review. Edinburgh: Scottish Government Social Research. Pleace, N. (­2011) Homelessness and inequality. In Anderson, I. and Sim, D. (­eds), Housing and Inequality. Coventry: Chartered Institute of Housing and Housing Studies Association, p­p. ­187–​­204.

58

Responding to homelessness Pleace, N., Culhane, D.P., Granfelt, R. and Knutagård, M. (­2015) The Finnish Homelessness Strategy: An International Review. Helsinki: Ministry of the Environment. Powell, M. and Exworthy, M. (­2002) Partnerships, ­quasi-​­networks and social policy. In Glendinning, C., Powell, M. and Rummery, K. (­eds), Partnerships, New Labour and the Governance of Welfare. Bristol: The Policy Press, p­p. ­15–​­32. Powell, M. and Glendinning, C. (­2002) Introduction. In Glendinning, C., Powell, M. and Rummery, K. (­eds), Partnerships, New Labour and the Governance of Welfare. Bristol: The Policy Press, p­p. ­1–​­14. Power, A. (­2009) New Labour and unequal neighbourhoods, In Hills, J., Sefton, T. and Stewart, K. (­eds), Towards a More Equal Society? Poverty, Inequality and Policy since 1997. Bristol: The Policy Press, p­p. ­115–​­133. Preece, J. and Bimpson, E. (­2019) Forms and Mechanisms of Exclusion in Contemporary Housing Systems: An Evidence Review. UK Collaborative Centre for Housing Evidence. Prevention Review Group (­2021) Preventing Homelessness in Scotland: Recommendations for Legal Duties to Prevent Homelessness. Edinburgh: HARSAG Prevention Review Group. Public Health Scotland (­2021) Healthy housing for Scotland. Briefing Paper. Edinburgh: Public Health Scotland. Healthy housing for Scotland (­publichealthscotland.scot). Rosengard, A., Laing, I., Ridley, J. and Hunter, S. (­2007) Closing the Opportunity G ­ ap –​ ­Findings of a Literature Review on Multiple and Complex Needs. Edinburgh: Scottish Executive Social Research. Scottish Government and the Convention of Scottish Local Authorities (­COSLA) (­2009) Prevention of Homelessness Guidance. Edinburgh: Scottish Government. Scottish Government (­2021a) Homelessness in Scotland: 2020 to 2021. Edinburgh: Scottish Government Homelessness in Scotland: 2020 to ­2021 – ​­gov.scot (­w ww.gov.scot). Scottish Government (­2021b) Housing to 2040. Edinburgh: Scottish Government. Housing to ­2040 – ​­gov.scot (­w ww.gov.scot). Scottish Government (­2021c) New Human Rights Bill, 12 March announcement: New Human Rights Bill – ​­gov.scot (­w ww.gov.scot). Scottish Government and COSLA (­2021) Prevention of Homelessness ­Duties  – ​­A Joint Scottish Government and COSLA Consultation. Edinburgh: Scottish Government. Supporting ­documents – ​­Prevention of Homelessness Duties: ­Consultation – ​­gov.scot (­w ww.gov.scot). Social Justice and Fairness Commission (­2021) A Route Map to a Fair Independent Scotland. Edinburgh: Social Justice and Fairness Commission. ­Social-­​­­Justice-­​­­Fairness-­​ ­­Commission-­​­­Final-­​­­Report-​­.pdf (­socialjustice.scot). Stoker, G. (­1988) Governance as theory: Five propositions. International Social Science Journal, 50(­155), p­p. ­17–​­28. The Social Housing Resilience Group (­2021) The Impact of the C ­ OVID-​­19 Pandemic on the Social Housing Sector in Scotland and Comparisons with the Whole of the UK. Housemark Scotland and Scotland’s Housing Network. Tunstall, R. (­2011) Estate regeneration and social exclusion. In Anderson, I. and Sim, D. (­eds), Housing and Inequality. Coventry: Chartered Institute of Housing and Housing Studies Association, p­p. ­129–​­149. United Nations (­1948) Universal Declaration of Human Rights. Paris: United Nations General Assembly (­Resolution 217A). Universal Declaration of Human Rights|United Nations. United Nations (­2015) Transforming Our World: The 2030 Agenda for Sustainable Development. Geneva: United Nations. United Nations (­2022) UN Sustainable Development Goals. https://­sdgs.un.org/ Watts, B. and Blenkinsopp, J. (­2022) Valuing Control over one’s immediate living environment: How homelessness responses corrode capabilities. Housing, Theory and Society, 39(­1), p­p. ­98–​­115.

59

6 HOMELESSNESS AND WELFARE SYSTEMS Lars Benjaminsen

In the research literature, increased attention has been given to the role of welfare states in shaping patterns and profiles of homelessness. This chapter explores in depth the relationships between homelessness and welfare systems and examines variations in the extent and composition of homelessness across different types of welfare systems. This chapter also discusses how welfare and support systems may mediate and alleviate homelessness if they function well or may fail to do so if they do not provide adequate solutions and interventions.

The role of welfare states in shaping and alleviating homelessness Individual vulnerabilities (­i.e. mental illness and substance abuse problems) and structural barriers (­ i.e. poverty and housing affordability problems) are w ­ ell-​ d­escribed factors behind homelessness and housing exclusion. However, some evidence suggests that homelessness and housing exclusion are also closely associated with welfare systems and welfare policies. Homelessness arises in an interplay between structural, systemic, interpersonal and individual risk factors where the role of welfare states generally represents the systemic level (­Edgar & Meert, 2005; Fitzpatrick, 2005). Through social and housing policies, a ­well-​­functioning welfare system reduces the risk of homelessness for people who do not have the means to provide adequate housing for themselves through the market and by providing accommodation and support for individuals with complex needs. Welfare systems with sufficient benefits, provision of social housing, strong mental health systems and good integration of services (­housing, health, social services and related services in respect of homelessness like Criminal Justice systems) will tend to minimise homelessness because there are multiple, overlapping safety nets that each attends to different dimensions and aspects of human needs. However, each time a safety net is either absent or weakened and the greater the distance 60

DOI: 10.4324/9781351113113-7

Homelessness and welfare systems

between each safety net, the risk of homelessness occurring and being sustained increases. Yet, no matter how many overlapping safety nets there are, additional (­integrated) specialist systems will still be needed when the support needs of specific groups reach a point where mainstream welfare, health, housing and other systems cannot meet those needs. Thus, modern welfare systems have grown into complex systems and this complexity in itself may hinder to establish adequate and coherent responses to homelessness. In particular, the specialised and differentiated welfare systems, and the demands and requirements that are often attached to each subsystem can be conflicting and difficult for vulnerable people to navigate in.

Types of welfare systems and overall patterns of homelessness Whilst welfare systems generally play a crucial role in providing housing and support to l­ow-​­income and vulnerable individuals, different welfare systems attend to basic needs in different ways. Although E ­ sping-​­Andersen’s (­1990) typology of welfare systems did not have a specific focus on housing and health, his fundamental distinction between different welfare regimes (­i.e. the liberal, corporative and social democratic welfare regimes) provides a general understanding of why different welfare systems tend to show very different success in minimising the level of homelessness in society. Following ­Esping-​­Andersen’s typology, the different types of welfare systems vary in the extent to which they provide people with basic income, housing opportunities and social support if needed regardless of the individual’s position in the market. Whilst social democratic welfare systems tend to provide comprehensive benefits and services to their citizens on a widely universal basis, liberal welfare systems tend to provide benefits and services on a residual basis only to those who need them the most. Corporatist welfare systems tend to have ­insurance-​­based systems usually of a high quality for people included on the labour market, supplemented by residual services on a more modest level for people who are outside the labour market. Due to these fundamental differences, there is great variation across welfare systems in terms of the extent to which they provide benefits, housing and support services for l­ow-​­income and vulnerable groups and whether such measures are aimed at relatively broad segments of ­low-​­income groups or are mainly targeted at more narrow groups. Likewise, there is also great variation across welfare systems in the generosity and quality of these measures and services. To describe the relation between welfare policies and homelessness, Stephens and Fitzpatrick (­2007) have formulated a general hypothesis consisting of two parts. The first part of the hypothesis is that countries with extensive welfare systems and lower levels of poverty and social inequality tend to have lower levels of homelessness than countries with less extensive welfare systems and higher levels of poverty and inequality. The second part of the hypothesis is that in countries with extensive welfare systems and lower levels of poverty, homelessness is more likely to be concentrated amongst individuals with complex support needs, whereas in countries with less extensive welfare systems and higher levels of social inequality, homelessness is more likely to result from poverty and housing affordability 61

Lars Benjaminsen

problems. Similar hypotheses have been put forward by other scholars (­Shinn, 2007; Toro, 2007). However, an important challenge to testing this fundamental hypothesis is that there is a general lack of comparable data across countries to allow for strong and robust tests based on similar definitions of homelessness and comparable measurement of different homelessness situations (­i.e. rough sleeping, shelter use, staying with family and friends). Thus, only a few studies have examined the relationship between welfare regime types and pattern of homelessness empirically. Moreover, differences in definitions of homelessness across countries and welfare systems also make direct comparison difficult. For instance, some social democratic welfare systems are in countries with lower levels of homelessness but at the same time also have a broader definition of homelessness, including ‘­h idden homelessness’ (­e.g. people staying temporarily with family or friends due to the lack of housing). Other types of welfare systems, which have higher levels of homelessness at the same time, often have narrower definitions of homelessness that do not include such forms of hidden homelessness. Stephens et al. (­2010) conducted a comparative analysis of homelessness across EU countries. Due to the lack of comparable data amongst the European countries, the authors emphasised that robust ­cross-​­country comparisons were not possible (­­p. 195). Yet, their analysis on disparate and limited data sources concluded that welfare regimes were clearly associated with outcomes for homeless people. They found that the strongest mainstream protection to those at risk of homelessness was offered in the social democratic and the hybrid regimes (­Sweden and the Netherlands), whereas the weakest protection against the risk of homelessness was found in the Mediterranean regime (­Portugal) and even more so, according to the authors, in the transition regime (­Hungary) (­­p. 257). Another comparison of overall prevalence rates of homelessness was conducted by Toro et al. (­2007). Using telephone surveys in five countries, the authors concluded that the prevalence of ‘­lifetime homelessness’ in the USA and the UK was considerably higher than in Belgium, Germany or Italy. This finding was possibly attributable to the higher levels of poverty and income inequality in the USA and the UK compared to the continental European countries (­Fitzpatrick, 2012; Shinn, 2007; Toro, 2007). In a study by Benjaminsen and Andrade (­2015), a ­two-​­country comparison was conducted using shelter data from Denmark to mirror studies on shelter data in the USA (­Kuhn & Culhane, 1998; Metraux et al., 2001). Thus, the patterns of shelter use were contrasted in two very different types of welfare states, namely the archetypical social democratic welfare system in Denmark and the likewise archetypical liberal welfare system in the USA. The comparison showed that the overall level of shelter use in Denmark was less than a third of the level in the USA, adjusted for population size. However, at the same time the Danish study showed that the three distinct types of shelters ­users – ​­the transitional, episodic and chronic shelter users identified by Kuhn and Culhane (­1998) in the U ­ SA – ​­was also identified amongst Danish shelter users. Even the proportional size of each group was strikingly similar in both countries as the transitional group of shelter users 62

Homelessness and welfare systems

(­that only stayed for a short time once or twice in the shelter system) was by far the largest group also in Denmark, similar to the USA. According to Kuhn and Culhane (­1998), the transitional shelter users in the USA were characterised by a much lower share with mental illness or substance abuse problems than the episodic and chronic shelter users, and the transitional shelter users were more likely to be homeless due to poverty and housing affordability problems. Thus, at a first glance, it was surprising that the transitional group of shelter users was also found amongst shelter users in Denmark, a Scandinavian country with a more extensive welfare system and a much lower level of income poverty than in the USA. However, the Danish study also revealed that the profile amongst the transitional shelter users was markedly different from the USA. In Denmark, the percentage with mental illness and/­or substance abuse problems amongst the transitional shelter users was similar to the level amongst chronic shelter users and thus much higher than in the USA, suggesting that in a relatively strong welfare state like Denmark, even ­short-​ ­term homelessness is predominantly concentrated to people with complex support needs, as the likelihood of experiencing homelessness of any duration is very low amongst people without these risk factors. Thus, the findings in these few existing empirical studies of patterns of homelessness across different welfare systems are basically in line with the hypothesis by Stephens and Fitzpatrick, that in countries with lower levels of poverty and more extensive welfare systems, levels of homelessness tend to be lower and homelessness is more concentrated to people with complex needs compared to countries with higher levels of poverty and less extensive welfare systems where homelessness is more likely to also affect broader segments of poor people.

Changing welfare policies and consequences for homelessness Whilst the literature suggests a general relationship between the extent and profile of homelessness and the strength of welfare and support systems, this relationship is not linear and simple as the structural and systemic factors affecting patterns of homelessness are manifold and complex. Welfare systems are dynamic and under constant change, and in practice they often diverge from the general characteristics outlined in E ­ sping-​­Andersen’s ideal typology. Even within the same welfare cluster, considerable differences exist. Successive reforms of welfare systems have become the norm in most countries often arising from continuous battles over the financial sustainability of expensive welfare services. At the same time, the ongoing evolution in subsystems (­i.e. housing systems or social support systems) may have a considerable impact on the risks of social marginalisation and homelessness. Such changes emphasise the point that whilst welfare systems often display strong inertia due to their overall complexity, these systems at the same time undergo constant development that may either strengthen or weaken overall welfare protection measures for ­low-​­income and vulnerable people. An example of the complexity between homelessness and welfare systems and of how welfare systems are subject to change can be found amongst the Nordic countries (­Benjaminsen  & Dyb, 2008). Whilst the Nordic countries are all 63

Lars Benjaminsen

examples of the social democratic type of welfare system and still have some of most extensive welfare systems in the world, the Nordic countries are also under constant pressure to finance their generous welfare services and like many other countries, their welfare systems have all undergone continuous series of reforms. The turn towards ‘­workfare’-​­oriented labour market policies has taken place in all the Nordic countries aiming at motivating benefit receivers towards employment through lower benefits, sanctions, etc. Changes have also taken place in the field of housing policies which have increased divergence across the Nordic countries. Already at the outset, greater difference existed than one might expect within the social democratic welfare cluster and these changes have grown over time. Whilst homeownership has traditionally been more prevalent in Norway, which has only a small social housing sector, Denmark, Finland and Sweden developed relatively large public housing sectors. Even in Denmark, Finland and Sweden, the development of housing policies and systems has been diverse. Whilst Denmark and Finland have widely maintained a traditional ­non-​­profit public housing sector, housing policies in Sweden have undergone substantial transformation with ­ on-​­profit principle increased liberalisation and marketisation. For instance, the n (­previously a hallmark of public housing associations) has been widely replaced by ­for-​­profit principles and general housing queuing allocations mechanisms, as well as prioritised access systems aimed towards vulnerable people, have often been abolished in many Swedish municipalities. Instead, they have been replaced by the right of housing organisations to choose new residents more selectively, e.g. through their own application processes. These changes have generally introduced higher barriers of access to housing for the most disadvantaged as housing associations tend to prefer more resourceful new residents with employment and a steady income rather than people with social problems. Consequently, Sweden has seen the growth of a secondary housing market, where municipal social agencies rent flats from housing associations that rent them out to vulnerable people on ­second-​ h ­ and temporary contracts, often with behavioural conditions for the tenants (­e.g. regarding substance misuse) attached (­ibid.). As research has pointed out, this staircase system imposes strong barriers of access to permanent housing for homeless and marginalised people (­Sahlin, 2005). Whilst many factors may affect overall levels of homelessness, these changes in housing and social policies are a likely explanation why Sweden generally saw an increase in homelessness during recent decades and now has the highest level of homelessness relative to population size amongst the Nordic countries. By contrast, neighbouring Norway and Finland have both seen decreases in the level of homelessness due to targeted policies aimed at providing affordable housing to marginalised groups based on the Housing First principle. In Denmark, a traditional public housing sector has been widely maintained and a secondary housing market is generally absent in contrast to neighbouring Sweden. Albeit still at a lower level than in Sweden, homelessness in Denmark also showed an increase during the 2010s. Whilst Denmark did not liberalise its public housing sector, new construction of public housing was modest, and increased shortages of affordable housing in urban centres following strong ­re-​­urbanisation in combination with successive welfare 64

Homelessness and welfare systems

reforms, which reduced benefits, have put a strain on the housing opportunities of marginalised groups and young people on social benefits in particular. These examples from some of the world’s most extensive welfare systems in the Nordic countries illustrate how systemic factors and changes in welfare systems and changes in housing policies may affect patterns and profiles of homelessness in complex interplay with other structural factors such as urban growth. In other types of welfare systems, even stronger exclusion mechanisms exist. In general, the overall level of income poverty tends to be higher in liberal welfare states due to less extensive income redistributions schemes. A recent study in the UK documented a clear association between poverty (­only partially addressed by the increasingly limited welfare system in the UK) and the risk of homelessness (­Bramley & Fitzpatrick, 2018). Moreover, the provision of social housing is usually more limited within the liberal welfare states, if it exists at all. In some liberal welfare states, a considerable stock of social housing exists such as social housing in the UK. Yet, new construction of social housing in the UK has been very limited for many years and over recent decades, the UK has seen a shift from providing social housing for ­low-​­income groups towards private rented sector housing, with poor and vulnerable groups often being maintained in the cheapest private rented housing through the welfare (­housing benefit) system. Quite often, this housing is of a poor quality and with greater uncertainty regarding rent stability and tenancy rights (­R hodes & Rugg, 2018). In other liberal welfare systems such as the USA or Australia, social housing is only available on a much smaller scale. In combination with increasing income inequality and strongly rising property prices and rent levels in larger cities, the housing opportunities of l­ow-​­income and vulnerable groups in these countries are often very limited, leading to an increased risk of homelessness (­O’Flaherty, 1996). For example, examining policy changes in the UK and Australia, Fitzpatrick and Pawson (­2014) analysed how the use of ­open-​­ended social tenancies has gradually been phased out in both countries, leading to a general weakening of tenure security as temporary tenancies with conditionality requirements have increasingly become the norm. The authors argue how this policy development has led to a transition from social housing providing a general safety net for ­low-​­income and vulnerable groups to an ‘­a mbulance service’ where the tenancy term generally is tied to the duration of needs (­ibid., ­p. 611), although some proposals (­i.e. only offering time limited tenancies) to reduce social housing to such an ambulance role were later abandoned in the UK.

Complex needs and social support in the context of complex welfare systems An important role of welfare systems is to provide vulnerable people with the social support they need. Yet, the extent to which welfare systems manage to do so and the forms of support they provide varies greatly, not only between but also within countries. Whilst more extensive welfare systems generally tend to be better at providing homeless and marginalised people with support, even the most advanced 65

Lars Benjaminsen

welfare systems do not succeed fully with this task. Whilst adequate resources are a necessary condition to provide sufficient support services, organisational factors and the ability of welfare systems to incorporate new knowledge and implement new methods in social work are also important parameters in understanding how well welfare services are able to meet the support needs of homeless people and people at risk of homelessness. A particular challenge centres on how support systems can meet the multiple and complex needs, i.e. the subgroup of homeless people experiencing combinations of mental illness, substance abuse problems and/­or physical health problems. As previously mentioned, in the most advanced welfare systems, this group makes up a higher share of the overall homelessness population, although total levels of homelessness are generally smaller in these countries. Thus, meeting the complexity of needs in this group is crucial to reducing homelessness further in these countries. In countries with less extensive welfare systems, even more people with complex needs are likely to become homeless due to the generally weaker social protection systems in these countries. Yet, they make up a smaller proportion of the overall homelessness population as to a larger extent they are also joined by poor people who become homeless even without a high problem complexity. Thus, the challenge of meeting the support needs of homeless people with a high problem complexity exists across different types of welfare systems although this challenge may be amplified by weaker general welfare protection systems. A further challenge concerns the tendency for different parts of treatment and support systems to be highly specialised and operate in silos. A person experiencing homelessness presenting with a combination of multiple social and health problems at the same time is difficult for these separate subsystems to manage simultaneously. In particular, the combination of mental illness and substance abuse problems is often difficult to handle within either the psychiatric treatment system (­which is not able to deal with addiction) or the substance abuse treatment system (­which is not able to deal with mental illness). In most countries, psychiatric and addiction treatment systems are split into different treatment systems that may even be anchored at different administrative levels. In less extensive welfare systems, the primary problem may be people experiencing homelessness lacking access to any health services at all, such as in countries with largely privatised health systems or poorly developed services in general. In some countries, there may also be a tendency for high complexity, integrated systems to only be developed in major urban centres and to exist only to a limited scale or not at all in less populated areas. Within split treatment systems, the psychiatric system may be reluctant to provide assessment and treatment as long as a substance abuse problem is highly prevalent and it is difficult for the most vulnerable individuals with a chaotic substance abuse problem to follow psychiatric treatment steadily, in particular if they are also in a homelessness situation. At the same time, addiction treatment specialists may lack adequate competences and treatment opportunities to handle the underlying psychiatric symptoms behind a substance abuse problem. This is why Assertive Community Treatment (­ACT) teams integrating psychiatric support, substance abuse treatment and social support plays a prominent role in the most advanced 66

Homelessness and welfare systems

services for homeless people. In the original Pathways Housing First model, ACT is the key support component together with Intensive Case Management (­ICM) for those with less complex support needs (­Tsemberis, 2010). As it is difficult for homeless people with these complex problems to get the support they need from existing treatment and support systems, their rehousing is likely to fail without this intensive and flexible support from the ACT/­­ICM-​­team. However, in many countries and welfare systems, these highly specialised support services for homeless people such as ­ACT-​­or ­ICM-​­support are either not available at all or only on a relatively small scale, whereas less intensive forms of support (­or even no support) are often the standard option.

Mainstreaming new interventions into local welfare systems Differences in welfare systems not only exist across welfare states but also within countries, as there are often considerable differences across local welfare systems in response to homelessness and the provision of services. Thus, interplays between the national and local levels should also be given close attention when examining the role of welfare systems in relation to homelessness. In recent decades, general advancements have taken place in the understanding of homelessness interventions with the paradigm shift from ‘­Treatment First’ to ‘­Housing First’ (­Padgett et al., 2016). Research has shown the importance of stabilising the housing situation already at the onset of an intervention by providing access to secure, permanent housing and offering the social and ­health-​­related support that people need (­Tsemberis et al., 2004, Tsemberis, 2010). However, with only few exceptions, Housing First programmes in most countries and cities have been rather limited in scale. Significant barriers often hinder the upscaling of these interventions to larger parts of the homeless population and making the Housing First part of mainstream service provision. In this sense, ‘­m ainstreaming’ describes the process by which new and promising interventions that have been developed and tested in an experimental setting are incorporated into the general national and local welfare systems and become standard interventions. In practice, this is a complicated process where structural, systemic and organisational barriers may prevent the implementation of the new interventions. Examining experiences with implementing Housing First services in many countries, the difficulties broadly relate to the challenges faced by local welfare systems in providing the key components of the Housing First model, namely housing and support. A lack of affordable housing, alongside the absence of allocation systems, or even the lack of prioritisation of homeless people in social and affordable housing, may pose barriers for providing suitable housing. A general challenge is that homelessness policies (­a nd even Housing First programmes) are seldom linked to wider housing policies (­Baptista & Marlier, 2019). This can lead to discrepancies between the high expectations attached to new interventions supposed to ‘­solve’ homelessness, and the lack of actual achievements on aggregate level, due to unsolved societal, structural and systemic deficiencies. Thus, overall shortages of affordable housing and the lack of general policies 67

Lars Benjaminsen

addressing this issue may severely hamper the implementation of h ­ ousing-​­led interventions on a broader scale. As previously mentioned, barriers may also exist in the provision of the intensive and flexible forms of support that homeless people often need when rehoused. For instance, there may be a reluctance or the lack of financial means amongst local authorities to provide intensive interventions such as ACT or ICM. In particular, the costs of providing these intensive services can often be perceived as too high. However, in the end, it may be even more costly not to provide these services as ­long-​­term homelessness often brings many other costs such as long stays in shelters and increased costs for health services in the long run (­Pleace et al., 2013). Thus, the costs of providing homeless people with permanent housing and support may be outweighed or at least partially offset by savings in other services such as reduced use of shelters, health services and the Criminal Justice system. However, very few studies empirically examine the cost dimension of providing more adequate services. An exception is found in the Canadian Housing First study (­­At-​­home/­Chez Soi), which showed that when rehousing homeless people with the most complex needs, the costs of ­ACT-​­support were almost fully offset by reduced costs for other services, including a strong decrease in shelter stays in the intervention group compared to the control group. Yet, for the group with moderate needs receiving I­ CM-​­support, only a partial cost offset was documented (­Goering et al., 2014). The Canadian study underlines the importance of applying a broader perspective on costs across different sectors of welfare systems in understanding the actual costs of homelessness to welfare systems and societies. Thus, seen in an overall perspective, providing adequate solutions to homelessness may be a more effective way to spend the scarce resources of welfare systems, as these interventions are likely to reduce (­repeated) emergency service use and costs across broader parts of the welfare system. In this way, the implementation of more holistic programmes and interventions in the field of homelessness requires wider transitions of local welfare systems and organisations, which are often very complex processes. Failure in succeeding with these transformations may explain why new interventions often remain on a small scale that do not contribute to reductions of homelessness on a wider scale.

Conclusion Welfare systems shape patterns of homelessness by mediating and alleviating the impact of both structural and individual risk factors for homelessness. They do so by providing housing opportunities and support services for ­low-​­income and vulnerable groups and by providing broader layers of social protection such as health services and income support. Yet, different types of welfare systems attend to these matters in different ways. Some welfare systems only provide minimal access to affordable housing, income and social support for broader populations, and primarily target measures at the most needy. In these countries, homelessness tends not only to affect people with complex needs but also affect broader segments of ­low-​­income groups due to poverty and housing affordability problems. 68

Homelessness and welfare systems

By contrast, more extensive welfare states tend to provide access to housing and support on a broader scale for ­low-​­income and vulnerable groups. Yet, even in countries with relatively strong welfare systems, homelessness persists, although it is concentrated amongst people with complex support needs and affects wider ­low-​­income groups only on a limited scale. Moreover, welfare states are dynamic systems that undergo continuous change and reforms that either strengthen or weaken overall protection systems and more specialised subsystems for particular groups. Welfare systems are complex organisations and the provision of ­long-​­term solutions for homeless people often runs into structural, systemic and organisational barriers. In particular, providing access to permanent housing and adequate support involves overcoming both structural barriers such as the lack of affordable housing and organisational barriers such as providing social and health support across different sectors. These challenges also arise when trying to implement new and promising interventions such as Housing First, where upscaling and mainstreaming these interventions into existing local welfare systems have shown to be difficult to accomplish in practice (­­Busch-​­Geertsema, 2013). Changing local welfare systems and services into providing holistic solutions rather than acute responses typically will require extensive transformations that involve interlinked changes to the existing provision of housing, support and wider welfare services such as health services and income support. Difficulties in succeeding with such transformations help explain why homelessness prevails, even in the most advanced welfare states.

References Baptista, I.  & Marlier, E. (­2019) Fighting Homelessness and Housing Exclusion in Europe: A Study of National Policies. Brussels: European Commission, D ­ irectorate-​­ General for Employment, Social Affairs and Inclusion, Publications Office. Benjaminsen, L. & Dyb, E. (­2008) The effectiveness of homelessness policies: Variations among the Scandinavian countries. European Journal of Homelessness, 2, p­p. ­45–​­67. Benjaminsen, L. & Andrade, S. B. (­2015) Testing a typology of homelessness across welfare 2060 Urban Studies 53(­10) regimes. Shelter use in Denmark and the USA. Housing Studies 30(­6), p­p. ­858–​­876. Bramley, G. & Fitzpatrick, S. (­2018) Homelessness in the UK: Who is most at risk? Housing Studies, 33(­1), p­p. ­96–​­116. ­Busch-​­Geertsema, V. (­2013) Housing First Europe. Final Report. Bremen: GISS. Edgar, B. and Meert, H. (­2005) Fourth Review of Statistics on Homelessness in Europe. The ETHOS Definition of Homelessness. Brussels: FEANTSA. ­Esping-​­A ndersen, G. (­1990) The Three Worlds of Welfare Capitalism. Oxford: Polity Press. Fitzpatrick, S. (­2005) Explaining homelessness: A critical realist perspective. Housing, Theory and Society, 22(­1), p­p. ­1–​­17. Fitzpatrick, S. (­2012) Homelessness. In D. Clapham, W. Clark & K. Gibb (­Eds) The Sage Handbook of Housing Studies, p­p. ­359–​­378. London: Sage. Fitzpatrick, S. & Pawson, H. (­2014) Ending security of tenure for social renters: Transitioning to ‘­a mbulance service’ social housing? Housing Studies, 29(­5), p­p. ­597–​­615. DOI: 10.1080/­02673037.2013.803043 Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., Nelson, G., MacNaughton, E., Streiner, D.  & Aubry, T. (­2014) National at Home/­Chez Soi Final Report. Calgary: Mental Health Commission of Canada.

69

Lars Benjaminsen Kuhn, R. & Culhane, D. (­1998) Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: Results from the analysis of administrative data. American Journal of Community Psychology, 26(­2), p­p. ­207–​­232. Metraux, S., Culhane, D., Raphael, S., White, M., Pearson, C., Hirsch, E., Ferrell, P., Rice, S., Ritter, B. & Cleghorn, J. S. (­2001) Assessing homeless population size through the use of emergency and transitional shelter services in 1998: Results from the analysis of administrative data from nine US jurisdictions. Public Health Reports, 111, p­p. ­344–​­352. O’Flaherty, B. (­1996) Making Room: The Economics of Homelessness. Cambridge, MA: Harvard University Press. Padgett, D., Henwood, B., & Tsemberis, S. (­2016) Housing First. Ending Homelessness, Transforming Systems, and Changing Lives. New York, NY: Oxford University Press. Pleace, N., Baptista, I., Benjaminsen, L., & ­Busch-​­Geertsema, V. (­2013) The Cost of Homelessness in Europe. An Assessment of the Current Evidence Base. Brussels: EOH Comparative Studies on Homelessness. ­ ow-​­Income Households in the Private Rhodes, D. J. & Rugg, J. J. (­2018) Vulnerability amongst L Rented Sector in England. York: Centre for Housing Policy. Sahlin, I. (­2005) The staircase of transition: Survival through failure. Innovation, 18(­2), p­p. ­115–​­135. Shinn, M. (­2007) International homelessness: Policy, s­ocio-​­cultural, and individual perspectives. Journal of Social Issues, 63(­3), p­p. ­657–​­677. Stephens, M. & Fitzpatrick, S. (­2007) Welfare regimes, housing systems and homelessness. How are they linked? European Journal of Homelessness, 1, p­p. ­201–​­212. Stephens, M., Fitzpatrick, S., Elsinga, M., van Steen, G. & Chzen, Y. (­2010) Study on Housing Exclusion: Welfare Policies, Housing Provision and Labour Markets. Brussels: European Commission, Directorate General for Employment, Social Affairs and Equal Opportunities. Toro, P. A. (­2007) Toward an international understanding of homelessness. Journal of Social Issues, 63(­3), p­p. ­461–​­481. Toro, P. A., Tompsett, C., Philipott, P., Nachtergael, H., Galand, B. & Schlienz, N. (­2007) Homelessness in Europe and the United States: A comparison of prevalence and public opinion. Journal of Social Issues, 63, p­p. ­505–​­524. Tsemberis, S., Gulcur, L. & Nakae, M. (­2004) Housing first, consumer choice and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(­4), p­p. ­651–​­656. Tsemberis, S. (­2010) Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction. Minneapolis, MN: Hazelden Press.

70

7 ­ OVID-​­19 C Nicholas Pleace

Introduction This chapter looks at the impact of the ­COVID-​­19 pandemic on global homelessness. At the time of writing, mass vaccination programmes are being rolled out across the most economically prosperous countries but global distribution of the vaccines is highly uneven. There are also concerns that variants of the virus may emerge that prove resistant to the vaccines being used. Much of the world has been cycling in and out of periods of greater and lesser degrees of lockdown and it remains uncertain when and to what extent the pandemic will be contained. This chapter explores the extent to which the pandemic has changed attitudes and responses to homelessness, particularly with regard to people sleeping rough and people living in homeless shelters and other homelessness services that have ‘­shared air’ (­i.e. shared living and sleeping areas). Attempts made to contain the risks of ­COVID-​­19 for homeless people are also reviewed. This chapter concludes by considering the degree to which ongoing strategic changes in response to homelessness are likely to result from the pandemic.

A shift in attitudes By the Spring of 2020, it had become apparent that allowing certain forms of homelessness to persist in the face of the pandemic would deepen a public health crisis that was already running out of control. Someone living rough could catch the virus and not be able to s­elf-​­isolate, which raised the chances that they could infect other people. People sleeping rough also could not enter lockdown, because doing so required accommodation in which someone could sustain themselves. Homeless people living in shelters and other homelessness services with ‘­shared air’ environments, where several people shared the same room to sleep, eat or wash in, DOI: 10.4324/9781351113113-8

71

Nicholas Pleace

were also at a potentially heightened risk. There was soon evidence of what could happen if ­COVID-​­19 got into environments in which large groups of homeless people were breathing the same indoor air (­Culhane et al., 2020). The main strategic risk from homelessness centred on public health systems. The true struggle for governments was going to be keeping the virus sufficiently contained so that hospitals and wider health infrastructure did not collapse. Homeless people, particularly lone adults experiencing ­long-​­term and recurrent homelessness, can be more likely to have underlying or secondary conditions than the general population, which meant that they were more likely to develop acute and ­life-​­threatening symptoms. If all the people who were sleeping rough on a ­long-​ ­term and recurrent basis in any major city, like London, Dublin, Paris, New York or Tokyo, were likely to have an array of physical health problems, alongside high prevalence of addiction and severe mental illness caught ­COVID-​­19, it could potentially fill dozens of intensive care beds that were already under massive pressure from the general population. Getting homeless people off the streets and out of s­hared-​­air services could stop hundreds of hospital admissions and was integral to an effective strategy to keep hospitals and wider public health systems from being overwhelmed (­Lewer et al., 2020). In the UK, it was clear that new policy towards people living rough was being driven by the wider strategic concern that the public health system, the National Health Service (­N HS), must not be overwhelmed (­Majeed et  al., 2020). The risk from every possible contagion point had to be minimised, not least because, as had happened in the USA, the UK had, initially, badly underestimated the severity of the pandemic and was experiencing a cascade failure in public health policy. As Parsell et al. (­2020) note in relation to Australia, which was by no means atypical in suddenly intervening to reduce rough sleeping and change some homelessness service at an unprecedented scale, the motivation of governments around the world to reduce these forms of homelessness was hardly because they had suddenly seen the light and wanted to stop homelessness itself. Taking this observation as our point of departure, we suggest that the potential impact of the disease on the health of the homeless is not the sole driver of these drastic interventions; rather, it is the risk that their heightened vulnerability to contracting and spreading the disease poses to the health of the housed population. Using Australia’s response as a case study, we substantiate this claim by examining how homelessness is represented as a problem in the pandemic, comparing this to how homelessness is typically represented in policy discourse. (­Parsell et al., 2020, p­p. ­2 –​­3)

Containing the risk In the USA, homelessness services were using a mix of traditional and innovative approaches in 2020. Housing First services, that employed ordinary housing, such as private rented apartments scattered across a city or single site, provided homes in which someone could lock down and ­self-​­isolate. There were also congregate 72

COVID-19

Housing First services which, rather than having shared sleeping areas, kitchens and bathrooms, offered s­ elf-​­contained small (­studio or bedsitting room) apartments (­Padgett et al., 2016). In these Housing First services, the challenge was maintaining contact between people receiving support and those delivering support. The people using Housing First were still at some risk because they were likely to have high and complex support needs (­Padgett et al., 2006), including poor physical health, limiting illness and disability which could place them at a higher risk from C ­ OVID-​­19, but they were not in an inherently riskier situation than most of the population as the pandemic took hold. The same was not true for people experiencing homelessness in the extensive provision of homeless shelters and other communal homelessness services that still formed a significant part of the homelessness sector in the USA. Prevalence studies conducted early in the pandemic found infection rates in ­shared-​­air homelessness services between 17% and 66% of residents and in one shelter, 30% of staff were also found to be infected (­Mosites et al., 2020). In April 2020, around four months after the first cases of ­COVID-​­19 had been reported in the USA, a study of a large ­shared-​­air homelessness shelter in Boston, with 408 residents, reported that 36% of them had tested positive for S­ ARS-­​­­CoV-​­2 , the ­COVID-​­19 virus (­Baggett et al., 2020). Culhane et al. (­2020), working early in 2020, estimated that in order to contain the risk of an explosion of ­COVID-​­19 infection, hospitalisation and mortality among homeless people using ­shared-​­air homelessness services, capacity within each service ­would – ​­at the very ­least – ​­need to be halved in order to facilitate social distancing and ­self-​­isolation. Alongside this, the USA had also been experiencing higher levels of ‘­unsheltered’ homelessness, i.e. people living rough, in encampments and in cars. The ‘­unsheltered’ population faced all the risks associated with not being able to lock down or ­self-​­isolate because they lacked suitable accommodation. This meant a lot of emergency accommodation, that could facilitate at least basic infection controls, was going to be needed fast: Approximately 200,000 single adults were sheltered on a given night in January 2019 (­199,531; US HUD*, 2019). To reduce density by 50% while maintaining current capacity would require the addition of 100,000 units. 211,293 adults and persons in families were enumerated as unsheltered in 2019. Assuming a 40% undercount, approximately 300,000 beds are needed to provide accommodations to all unsheltered persons. (­Culhane et al., 2020, ­p. 8, *Federal Department of Housing and Urban Development (­H UD)) COVID-​­ 19 among people experiencing homelessness European experience of ­ was mixed. In some countries, such as Denmark, Finland, Ireland and the UK, the use of ­shared-​­air homelessness services, while it still occurred, was much less common than it had once been. Denmark and Finland had both shut down large communal shelters. Denmark had, initially, shifted towards smaller, better staffed 73

Nicholas Pleace

services offering people their own rooms, motivated by evidence that the larger, communal services had little effectiveness and, in the past decade, had also shifted towards the use of Housing First services. Finland had transitioned to what was termed a ‘­Housing First’ strategy from large, communal service provision, again led by evidence and experience. Finnish homelessness strategy included services that were similar to the American ‘­Housing First’ model, but within a wider, integrated, strategy that was centred around providing settled, ­self-​­contained housing as the response to homelessness, including an array of preventative, supported and ­housing-​­led services (­A llen et al., 2020). Both Ireland (­O’Sullivan, 2020) and the UK (­Pleace, 2021) were less far along the road to a largely ­housing-​­led strategy, but both had been moving away from the kind of provision seen in the USA, like the ­408-​­bed shelter in Boston (­Baggett et al., 2020) for decades. Again, both Ireland and the UK had initially shifted from larger, ­shared-​­air emergency shelters to congregate services offering people their own rooms or studio apartments/­flats and latterly to Housing First services, the latter modelled on the American rather than Finnish model. In the UK, the risks to people in Housing First services or the many homelessness services offering either individual rooms or individual small apartments were comparatively low. The challenges for the homelessness sector were logistical, i.e. ensuring staff had personal protective equipment (­PPE), difficult at first as the UK initially struggled even to provide this for its health services and that people using services could get access to food, prescription drugs and other necessities. Homelessness service providers were also having to put contingencies in place to keep providing support if there were significant outbreaks among their staff (­Pleace et al., 2021). This left the challenge of providing emergency accommodation for people sleeping rough in the UK, through a series of programmes, the biggest one of which was ‘­Everyone In’ in England, using a mix of hotels and other temporary accommodation. Alongside providing emergency accommodation for people sleeping rough, the ‘­Everyone In’ programme also enabled the ­shared-​­air services that were operational to close. In England, this included ‘­­No-​­Second Night Out’ shelters designed to immediately provide (­­short-​­term) emergency accommodation for anyone found living rough and informal, f­aith-​­based and other charitable activities focused on homeless people that were receiving little or no public funding. Alongside providing emergency accommodation like hotel rooms, ‘­Everyone In’ also included funding to provide a Housing First (­or Housing First like) housing solution to everyone helped by the programme, with the important exception of illegal migrants who had been living rough. By November 2020, 9,866 people were in emergency accommodation and 23,273 people had moved on into settled accommodation or supported housing (­own rooms/­apartments in services with ­on-​­site staffing) in England (­Cromarty, 2021). The nature of much of the homelessness sector in England enabled ‘­Everyone In’ to become highly effective. This was because the number of people experiencing homelessness in situations where they were at a heightened risk of the virus was already relatively small. In turn, this was because of the way in which 74

COVID-19

most homelessness services were structured, i.e. offering individual rooms/­small apartments or using ­housing-​­led/­Housing First services that employed ordinary housing. This enabled the streets and ­shared-​­air services to be quickly cleared. In December 2020, medical researchers estimated that England had avoided around 20,000 infections, 260 deaths, 1,100 hospital admissions and 340 ICU admissions among homeless people (­Lewer et al., 2020) because of ‘­Everyone In’. By contrast, ­shared-​­air services in some other parts of Europe were facing the same kinds of challenges being experienced in the USA. In some cases, Hungary being one example, homelessness shelters had reacted by closing themselves off and reorganising their internal space insofar as they could. Services that had been open ­ OVID-​­19 infeconly at night were now open all day but they sought to contain C tions by not allowing people in or out in unsupervised ways (­Pleace et al., 2021). In other cases, the virus had got into s­ hared-​­air homelessness services and taken hold; in June and July 2020, French medical researchers tested 818 people experienc­ OVID-​­19 (­Roederer et al., ing homelessness at 14 sites, reporting that 52% had C 2021). Belgian researchers, like those in the USA, found a high degree of variation between s­hared-​­air shelters, which suggested both an element of luck and that variations in the detail of how services organised themselves made a difference in the rates reported. However, within Belgian homelessness services, infection rates were still around 5% (­Roland et al., 2021). In North America, mass Canadian testing was finding a broad association between experience of homelessness and the risk of ­COVID-​­19 infection. As in the USA, Canada had a mix of Housing First services, which, because they were centred on mobile support delivered to ordinary housing, were relatively safe living environments and communal ‘­shared air’ homelessness services, such as shelters. The Canadian researchers reviewed tests for some 30,000 people with a history of homelessness and found higher rates than among the general population, including a much higher risk of hospitalisation (­R ichard et al., 2021). In the USA, some significant interventions to clear the streets of people living rough and experiencing other forms of unsheltered homelessness were rolled out. One example was ‘­Project Roomkey’ in California, which provided hotel and motel rooms to some 22,300 people, although unlike efforts in the UK and some other European countries, the intervention was only aimed at h ­ igher-​­risk groups within the unsheltered homeless population, rather than everyone living rough or in an unsheltered situation. Like the UK ‘­Everyone In’ programme, rather than returning people to unsheltered homelessness, Project Roomkey was designed to rehouse the people it assisted (­ca.gov, 2021).

Continuity and change after C ­ OVID-​­19 Sudden and in some cases unprecedented efforts to clear the streets of people living rough spurred a kind of relatively s­hort-​­lived ‘­COVID collectivism’, centring on the idea that the pandemic had shown what was actually possible if this form of homelessness was effectively reclassified as a public health challenge. One of the experiences from the pandemic was that public conceptualisations, and also 75

Nicholas Pleace

medical conceptualisations of ‘­homelessness’, were rather narrow, arguably reinforced by governments seeking to define homelessness as a relatively ­small-​­scale social problem. This meant that the ‘­homelessness’ being talked about as being ‘­ ended’ by ­ COVID-​­ 19 only actually encompassed some forms of unsheltered homelessness. This reflects a general, international, tendency to conflate homelessness with people living rough, rather than including everyone who lacks their own home (­O’Sullivan et al., 2020). The ‘­end’ of homelessness being talked about meant that people who were unsheltered and living rough had been put into hotels and in some instances also into programmes that would provide them with a settled home. In England, the ‘­Everyone In’ programme meant that rough sleeping levels, which had been rising since 2010, plummeted, dropping 43% compared to their 2017 peak (­4,751 people) to 2,688 people found living rough in the 2020 street count (­M HCLG, 2021). Levels were still higher than in 2010 (­1,768 people), when ‘­austerity’ policies had first begun a process that saw an estimated £5 billion in spending cut from the homelessness sector (­Thunder and ­Bovill-​­Rose, 2019). As was also the case in much of Europe (­FAP/­FEANTSA, 2021), Australia (­A BS, 2020) and America (­Culhane et al., 2020), however, the rough sleeping population was a small fraction of total homelessness. There had, p­ re-​­pandemic, been approaching 5,000 people sleeping rough reported by the annual street counts in England, b­ ut – ​­alongside ­this – ​­at any one point, some 40,000 people were in homelessness services and another 75,000 households, containing around 120,000 children, who had been found statutorily homeless (­eligible for assistance under the homelessness laws) were awaiting settled housing in temporary and emergency accommodation. One estimate is that there were at least 200,000 people experiencing homelessness in England in 2020 (­Fitzpatrick et al., 2021). The homelessness of people living in temporary accommodation, in homelessness services and in various, precarious situations of hidden homelessness, i.e. staying with relatives, friends and acquaintances because they had nowhere else to go, were not addressed by ‘­Everyone In’. In England, people staying with others because they had nowhere else to go, experiencing ‘­h idden homelessness’, who often lacked their own private and safe living space, had no legal security of tenure and could also be overcrowded, were not assisted. Homeless people living in homelessness services that did not use a s­hared-​­air model but offered people their own rooms or small apartments were also not assisted. Most homelessness was unaffected by the C ­ OVID-​­19 policies that temporarily ‘­solved’, or at least drastically reduced, the scale of rough sleeping, and to the limited extent that it applied, temporarily stopping the use of ­shared-​­air emergency shelters, in the UK (­Pleace, 2020). A bizarre effect began to be observed as a result of this situation. Within the homelessness services that were designed for lone adults with support needs, in ­housing-​­led and Housing First services, as well as among the people living rough who were accommodated in hotels, C ­ OVID-​­19 was contained (­Lewer et al., 2020; Pleace, 2021; Pleace et  al., 2021). In the meantime, ordinary people who were living in overcrowded conditions, who had homes but not the space in which 76

COVID-19

to ­self-​­isolate and practise social distancing, began to be infected and to experience mortality at higher rates than the general population. The Office of National Statistics reported that the risks of mortality from the pandemic were 1.9 times higher in the most deprived areas of the England compared to the most affluent areas (­ONS, 2021); one indicator of deprivation is overcrowded housing. Further analysis showed a correlation between overcrowding and COVID infections and mortality in England (­Barker, 2020). The line between overcrowding and a state of homelessness is not interpreted consistently (­Pleace and Hermans, 2020). While the homelessness laws have diverged with devolution to Scotland, Wales and Northern Ireland in the UK, extremes of overcrowding can also be defined as a state of ‘­homelessness’ under their laws and the homelessness laws in England. Having established that there is some need for caution when talking about responses to ­COVID-​­19 ‘­ending’ homelessness, as ­COVID-​­specific homelessness and public health policies have been largely intended for people sleeping rough and other unsheltered populations, alongside reducing use of ‘­shared air’ services, there is the question of whether ­COVID-​­19 will bring lasting policy change. In some European countries, the concern is that the measures introduced are designed and presented as temporary, as a response that will not last, with the (­often significant) additional resources that have been made available also being t­ ime-​­limited (­Pleace et al., 2021). In the UK and in some areas of the USA, ­COVID-​­19 is producing something beyond an ­emergency-​­only response, in that populations accommodated in hotels are not being returned to the street or other unsheltered living arrangements, but at least offered settled housing and support. The optics of returning homeless people to the street from hotels was probably one reason for not simply ‘­switching off’ these programmes and returning people to the street or other unsheltered forms of homelessness. In the UK, improvements in health, ­well-​­being and other metrics were reported among people sleeping rough and accommodated in hotels, showing that the ‘­Everyone In’ programme was having other positive effects beyond providing protection from ­COVID-​­19 (­Harrison, 2020; Neale et al., 2020). Government in England, which has around 80% of total UK population, announced that alongside the £105 million for s­ horter-​­term/­interim accommodation and immediate support to stop people living rough and enable them to move out of ­shared-​­air services, a further £161 million would be committed to deliver 3,300 units of ­longer-​­term, ­move-​­on accommodation and support (­Cromarty, 2021). Rather than attempt mass rehousing at a speed that would, in theory at least, allow the hotels to reopen as COVID restrictions are lessened, as in the UK, some American responses to the ongoing crises of unsheltered homeless people and C ­ OVID-​ 1­ 9 were rather more straightforward. California spent $800 million buying sites that would be converted into settled housing, which included buying some of the hotels that had been employed as emergency accommodation (­Dougherty, 2021). Elsewhere however, with Hungary being an example, shelter systems are being modified on a temporary, emergency basis, with the expectation being that there will be a reset to normal, assuming the pandemic is finally brought under control (­Pleace et al., 2021). In other cases, such as Germany, there was relatively 77

Nicholas Pleace

little adaptation of some existing services for homeless people in the face of the pandemic. In part, this was because there is use of s­elf-​­contained accommodation in homelessness services but there was no national equivalent of the ‘­Everyone In’ initiative, albeit that there were programmes to temporarily rent hotel rooms for people sleeping rough in some cities. Neither Germany and Denmark, which have relatively advanced and extensive homelessness sectors, were actively discussing any fundamental changes to homelessness services because of the virus (­Pleace et al., 2021). The pressure to ‘­reset to normal’ in all aspects of life and policy, dropping social distancing and masking as soon as possible, has been strong but several governments have tried to relax ­COVID-​­19 restrictions only to experience sudden and marked increases in infection. The future of s­ hared-​­air services may be dependent in part on how the pandemic progresses, as if progress in containing the virus stalls, the viability of ­shared-​­air responses to homelessness will be questioned, which may then lead to changes in practice. However, the virus is only one of the variables influencing the future direction of homelessness services. Evidence has been accumulating around the relative effectiveness of ­housing-​­led and Housing First services compared to more traditional ­ ousing-​­ready approach means taking ‘­housing ready’ responses to homelessness. A h someone out of homelessness, temporarily accommodating them in a building with ­on-​­site or visiting support staff (­either sharing air in communal buildings or living in their own room or small apartment) and making them ‘­housing ready’, for example, by ending addiction, ensuring compliance with psychiatric treatment and by teaching them the skills needed to manage in their own home. These h ­ ousing-​ r­ eady services appear to be broadly less effective in physically ending homelessness than is the case for Housing First (­Pleace and Bretherton, 2017) and while Housing First is not perfect, as no service model is, it appears to often deliver better outcomes in actually ending homelessness among people with complex needs at a comparable or sometimes lower cost than ­housing-​­ready services (­Padgett et al., 2016). The evidence about Housing First, combined with the successes of Finland (­A llen et  al., 2021) in developing a broadly ­housing-​­led strategy in response to homelessness, minimising the use of fi ­ xed-​­site supported services and maximising the use of ordinary housing and mobile support, was beginning to fuel a general movement away from ­shelter-​­based and ­housing-​­ready service strategies before the pandemic struck. Much of North Western Europe and individual OECD countries, in particular Canada (­Greenwood et al., 2018), were already moving towards ­housing-​­led and Housing First approaches by the late 2010s (­Pleace et al., 2018). The rise in homelessness prevention is another important development along similar lines. The UK has been something of a pathfinder here, shifting to a more ­prevention-​­led model in England in the ­m id-​­2000s, before taking the approach to another level with the significant legislative reforms that shifted local government service provision into a preventative stance in Wales (­Mackie et al., 2017), a strategic shift that was subsequently echoed in England. Prevention has also drawn policy attention in the USA (­Lee et al., 2021). Prevention centres on maintaining housing that someone already has and, where maintaining an existing home is not 78

COVID-19

possible, stopping an experience of homelessness before it can start by putting a new home in place to (­more or less) instantly replace one that is going to be lost. The highly successful Finnish ‘­Housing First’ approach, which, as noted, describes an entirely h ­ ousing-​­led integrated national strategy, rather than Housing First in the North American sense, also has prevention at its core (­A llen et  al., 2021). Temporary bans on eviction have also been part of the response to the pandemic but these are not the same as homelessness prevention, which is a system of active attempts to retain existing housing that will also rapidly rehouse ­someone – ​­where possible before homelessness actually o ­ ccurs – if ​­ existing housing is going to be lost (­Pleace et  al., 2021). Again, this shift away from reactive, s­helter-​­based and ­housing-​­ready models and towards a h ­ ousing-​­led, preventative approach was well underway in several countries before the pandemic arrived. The pandemic has acted on a lens on the limits of some forms of homelessness service provision and further highlighted some strategic and practical shortcomings in existing policy responses to homelessness. The experience of the pandemic has also acted as an accelerant, adding to existing pressures, led by evidence about better outcomes for homeless people and by research showing greater c­ ost-​ ­effectiveness, to reduce use of traditional, ­shared-​­air, emergency shelters and other ­fi xed-​­site services and towards a more preventative, h ­ ousing-​­led/­Housing First response to homelessness. How far different countries get down this road will be dependent in part on the course of the pandemic but, importantly, it will also depend on the resources countries have available, in economies that will have been damaged by the pandemic, and, crucially, on the political will that there is to end homelessness in the wake of the pandemic.

References Allen, M., Benjaminsen, L., O’Sullivan, E. and Pleace, N. (­2020) Ending Homelessness in Denmark, Finland and Ireland. Bristol: Policy Press. Australian Bureau of Statistics (­2020) Specialist Homelessness Services Annual Report. ABS: Sydney. Baggett, T.P., Keyes, H., Sporn, N. and Gaeta, J.M. (­2020) Prevalence of S­ ARS-­​­­CoV-​­2 infection in residents of a large homeless shelter in Boston. Journal of the American Medical Association, 323(­21), p­p. ­2191–​­2192. Barker, N. (­2020) The housing pandemic: Four graphs showing the link between ­COVID-​ 1­ 9 deaths and the housing crisis. Inside Housing, 25 May 2020. Ca.gov (­2021) Governor Newsom Announces Emergency Allocation of $62 Million to Local Governments to Protect People Living in Project Roomkey Hotels (­Press Release). https://­w ww. gov.ca.gov/­2 020/­11/­16/­­g overnor-­​­­newsom- ­​­­a nnounces- ­​­­emergency- ­​­­a llocation- ­​­­of- ­​­­62-­​ ­­m illion-­​­­to-­​­­local-­​­­governments-­​­­to-­​­­protect-­​­­people-­​­­l iving-­​­­i n-­​­­project-­​­­roomkey-​­hotels/ Cromarty, H. (­2021) Coronavirus: Support for rough sleepers (­England). House of Commons Briefing Paper, Number 09057, 14 January 2021. Culhane, D.P., Treglia, D., Steif, K., Kuhn, R. and Byrne, T. (­2020) Estimated Emergency and Observational/­Quarantine Capacity Need for the US Homeless Population Related to ­COVID-​­19 Exposure by County; Projected Hospitalizations, Intensive Care Units and Mortality. Phila­ delphia: University of Pennsylvania. http://­works.bepress.com/­dennis_culhane/­237/ Dougherty, C. (­2021) One way to get people off the streets: Buy hotels. The New York Times, 17 April 2021.

79

Nicholas Pleace FAP/­F EANTSA (­2021) Fifth Overview of Housing Exclusion in Europe 2020. Brussels: FEANTSA. Fitzpatrick, S., Watts, B., Pawson, H., Bramley, G., Wood, J., Stephens, M. and Blenkinsopp, J. (­2021) The Homelessness Monitor: England 2021. London: Crisis. Greenwood, R.M., Bernad, R., Aubry, T. and Agha, A. (­2018) A study of programme fidelity in European and North American housing first programmes: Findings, adaptations, and future directions. European Journal of Homelessness, 12(­3), p­p. ­275–​­298. Harrison, J. (­2020) Manchester Emergency Accommodation Evaluation: Interim Report (­R iverside). https://­w ww.riverside.org.uk/­­w p- ​­content/­uploads/­2 020/­0 6/­R iverside_MCREmergency_Accommodation_FINAL.pdf Lee, B.A., Shinn, M. and Culhane, D.P. (­2021) Homelessness as a moving target. The Annals of the American Academy of Political and Social Science, 693(­1), p­p.  ­8 –​­26. Doi: 10.1177/ ­0 002716221997038. Lewer, D., Braithwaite, I., Bullock, M., Eyre, M.T., White, P.J., Aldridge, R.W., Story, A. and Hayward, A.C. (­2020) ­COVID-​­19 among people experiencing homelessness in England: A modelling study. The Lancet Respiratory Medicine, 8(­12), p­p.  ­1181–​­1191. https://­w ww.thelancet.com/­action/­showPdf ?pii=­S2213-​­2600%2820%­2930396-​­9 Mackie, P.K., Thomas, I. and Bibbings, J. (­2017) Homelessness prevention: Reflecting on a year of pioneering Welsh legislation in practice. European Journal of Homelessness, 11(­1), p­p. ­81–​­107. Majeed, A., Maile, E.J. and Bindman, A.B. (­2020) The primary care response to ­COVID-​ ­19 in England’s National Health Service. Journal of the Royal Society of Medicine, 113(­6), p­p. ­208–​­210. MHCLG (­2021) Rough sleeping snapshot in England: Autumn 2020. London: MHCLG. Mosites, E., Parker, E.M., Clarke, K.E., Gaeta, J.M., Baggett, T.P., Imbert, E., Sankaran, M., Scarborough, A., Huster, K., Hanson, M. and Gonzales, E. (­2020) Assessment of ­SARS-­​­­CoV-​­2 infection prevalence in homeless s­ helters—​­four US cities, March ­27–​ ­April 15, 2020. Morbidity and Mortality Weekly Report, 69(­17), ­p. 521. Neale, J. et al. (­2020) Experiences of Being Housed in a London Hotel as Part of the ‘­Everyone In’ Initiative Part 1: Life in the Hotel. London: King’s College London. Office for National Statistics (­2021) Deaths Involving ­COVID-​­19 by Local Area and Socioeconomic Deprivation: Deaths Occurring between 1 March and 31 July 2020. London: ONS. O’Sullivan, E. (­2020) Reimagining Homelessness for Policy and Practice. Bristol: Policy Press. O’Sullivan, E., Pleace, N., ­Busch-​­Geertsema, V. and Hrast, M.F. (­2020) Distorting tendencies in understanding homelessness in Europe. European Journal of Homelessness, 14(­3), p­p. ­109–​­135. Padgett, D.K., Gulcur, L. and Tsemberis, S. (­2006) Housing First services for people who are homeless with c­ o-​­occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(­1), p­p. ­74–​­83. Padgett, D.K., Henwood, B.F. and Tsemberis, S. (­2016) Housing First: Ending Homelessness, Transforming Systems, and Changing Lives. Oxford: Oxford University Press. Parsell, C., Clarke, A. and Kuskoff, E. (­2020) Understanding responses to homelessness during ­COVID-​­19: An examination of Australia. Housing Studies, p­p. ­1–​­14. Pleace, N. and Bretherton, J. (­2017) What do we mean by housing First? Considering the significance of variations in housing First services in the European Union. In J. Sylvestre, G. Nelson and T. Aubry (­eds) Housing for People with Serious Mental Illness: Theory, Research, Practice and Policy. Oxford: Oxford University Press, p­p. ­287–​­299. Pleace, N., Baptista, I., Benjaminsen, L. and ­Busch-​­Geertsema, V. (­2018) Homelessness Services in Europe. Brussels: FEANTSA. Pleace, N. (­2020) Homelessness, Bad Housing, and the Virus: A Decent Home Should Be Every Citizen’s Right. LSE BPP Blog. https://­blogs.lse.ac.uk/­politicsandpolicy/­­homelessness-­​­­ and-​­covid19/

80

COVID-19 Pleace, N. and Hermans, K. (­2020) Counting all homelessness in Europe: The case for ending separate enumeration of ‘­h idden homelessness’. European Journal of Homelessness, 14(­3), p­p. ­35–​­62. ­ OVID-​­19 on People Sleeping Rough: An Overview Pleace, N. (­2021) Minimising the Impact of C of UK and Global Responses. IPPO. https://­covidandsociety.com/­­m inimising-­​­­i mpact-­​ ­­covid-­​­­19-­​­­people-­​­­sleeping-­​­­rough-­​­­overview-­​­­u k-­​­­g lobal-​­responses/ Pleace, N., Baptista, I., Benjaminsen, L., ­Busch-​­Geertsema, V., O’Sullivan, E. and Teller, N. (­2021) European Homelessness and COVID 19. Brussels: FEANTSA. Richard, L., Booth, R., Rayner, J., Clemens, K.K., Forchuk, C. and Shariff, S.Z. (­2021) Testing, infection and complication rates of C ­ OVID-​­19 among people with a recent history of homelessness in Ontario, Canada: A retrospective cohort study. CMAJ Open, 9(­1), p. E1. Roederer, T., Mollo, B., Vincent, C., Nikolay, B., Llosa, A.E., Nesbitt, R., Vanhomwegen, J., Rose, T., Goyard, S., Anna, F. and Torre, C. (­2021) Seroprevalence and risk factors of exposure to ­COVID-​­19 in homeless people in Paris, France: A ­cross-​­sectional study. The Lancet Public Health, 6(­4), p­p. ­202–​­209. Roland, M., Ben Abdelhafidh, L., Déom, V., Vanbiervliet, F., Coppieters, Y. and Racapé, J., (­2021) S­ ARS-­​­­CoV-​­2 screening among people living in homeless shelters in Brussels, Belgium. Plos One, 16(­6), p.e0252886. https://­journals.plos.org/­plosone/­a rticle?id=10.1371/ ­journal.pone.0252886 ­ ovill-​­Rose, C. (­2019) Local Authority Spending on Homelessness: Understanding Thunder, J. and B Recent Trends and Their Impact. London: Homeless Link and St Mungo’s.

81

SECTION 2

Homelessness across different disciplines

8 CRIME, PUNISHMENT AND HOMELESSNESS Eoin O’Sullivan

Introduction The relationship between homelessness and institutional systems designed to punish, police, deter and segregate is a longstanding tradition in homelessness research. Until the early 20th century, homelessness or ‘­vagrancy’ and associated activities such as begging were in themselves punishable offences in all advanced industrial countries and their colonies arising from various vagrancy statutes enacted and ­re-​ ­enacted since the Middle Ages (­­Ribton-​­Turner, 1887; Chambliss, 1964; Beier and Ocobock, 2008). Over the course of the 20th century, in the majority of advanced industrial countries, responses to homelessness had gradually moved from the punitive, based on an understanding of vagrancy as a source of disorder and criminality and that indiscriminate alms giving threatened the labour or charity contract, to largely inclusive welfare responses based on an understanding of homelessness as a form of residential instability exacerbated by a varying balance of personal and structural deficiencies in particular contexts. Even where Vagrancy Acts were still on the statute books, by the m ­ id-​­20th century, they were largely redundant, particularly in Europe, and constitutional challenges in the United States formally dismantled ­state-​­level vagrancy legislation by the late 1960s, albeit that concerns over homelessness were not the key driver of these changes (­Goluboff, 2016). Despite this broadly ‘­inclusive turn’, certain cities in the United States, from the early 1980s, began passing laws that prohibited sleeping in public, begging, loitering and other public space restrictions. These enactments, in large part, reversed the constitutional rulings between 1965 and 1975 that limited the powers of urban authorities to criminalise vagrancy and begging. The number of cities in the United States that have laws prohibiting camping, begging sitting down and lying down, sleeping in public and other restrictions has

DOI: 10.4324/9781351113113-10

85

Eoin O’Sullivan

grown over the past 20 years according to the National Law Center on Homelessness and Poverty (­2019). This ­so-​­called ‘­punitive turn’ was less pronounced in Europe, but Hungary is an outlier, where in 2018 an amendment to the Constitution has banned ‘­habitual residence in a public space’ (­Faragó et al., 2020). Given that responses to homelessness, by State and n ­ on-​­state actors, were largely fixated on regulating, reforming and restraining vagrancy due to a ­deep-​­seated belief in the inherent deviancy of the vagrant, it is not surprising that criminology as a discipline with the ‘­conditions of possibility’ for its emergence originating in large part with the ‘­birth of the prison’ (­Foucault, 1977) in the early to ­m id-​ 1­9th century has had a historical and contemporaneous interest in researching vagrancy, particularly those working within the political economy tradition of criminology/­penology. Furthermore, policing and penal policies evolved in part through responses to vagrancy in Europe and North America (­O’­Brassill-​­Kulfan, 2019; Lawrence, 2004). Vagrancy was also a staple topic of discussion of the periodic meetings of International Penitentiary Congress which had its first meeting in Frankfurt in 1846 (­A lthammer, 2014) and the annual American based National Conference of Charities and Correction which had its first meeting in 1874 (­Bruno, 1948). These discussions on responding to vagrancy were developing in a context where criminology was emerging as a discipline, where developments included the principles of individualisation and differentiation, and with the application of these principles, ‘­criminology arrives as the distinctive “­criminal character”’ (­Garland, 1985, ­p. 124). Early empirical researchers interested in vagrancy also followed these principles of individualisation and differentiation to classify vagrants, in the case of Alice Solenberger in her study of 1,000 homeless men in Chicago to identify the salvageable from the irredeemable, the parasitical from the deserving (­1911, p­ . 10). Edwin Sutherland (­better known for pioneering work on ­white-​­collar crime) and Harvey Locke (­1936, p­p. ­66–​­77) in their study of 20,000 shelter using men, also ­ on-​­hobohemians, with the in Chicago, distinguished between hobohemians and n hobohemians being the ‘­old homeless’ who ‘­have been a social problem for decades’, with the ‘­new homeless’ of skilled and unskilled tradesmen and labourers, including ­white-​­collar workers in the ranks of the n ­ on-​­hobohemians.

Research Strands The recent literature on homelessness and various forms of coercion can be usefully divided into five strands, albeit with a significant number of overlaps. The first strand of this research has highlighted that the experience of homelessness, specifically those living on the streets or utilising emergency shelters, was inherently criminogenic, either through engagement in survivalist crimes such as shoplifting, begging and larceny, or by virtue of the fact that in many countries, homelessness or vagrancy in itself was until relatively recently, or is currently criminalised, which could result in various sanctions being imposed by the criminal justice system, including imprisonment. 86

Crime, punishment and homelessness

A second strand of this research was that the institutions of the criminal justice system, particularly jails and other closed institutions could be viewed as part of an extended institutional circuit that the homeless traversed which, in addition to jails, included shelters, clinics, psychiatric facilities, missions, casual wards, hostels, etc. A third strand has explored whether imprisonment was a cause of homelessness, in addition to being an outcome of homelessness. In other words, while homelessness could lead to incarceration, increasingly incarceration in prisons and jails was contributing to homelessness through inadequate preparation for discharge and the difficulty in obtaining accommodation for ­ex-​­offenders. A fourth strand has explored the policing of homelessness. Classic studies of the policing of skid row’s in the United States in the 1960s were supplemented by an increasing number of studies exploring the policing of public spaces, which had a substantial effect on those literally homeless, following the adoption of various forms of ­zero-​­tolerance/­public order type policing in the 1980s. Finally, a fifth, and relatively recent strand of research that critically accesses many of the claims in the dystopic literature noted in strand four, providing detailed qualitative data that has resulted in a more nuanced understanding of the various interventions, by the Police and others, in the lives of the literally homeless, particularly in England and the United States. Three caveats are required in relation to research on this topic. Firstly, as the reader will quickly observe, much of the research cited in this chapter is from the United States, and to a lesser degree the UK and the Antipodes. This reflects the strength and sophistication of homelessness research in these countries relative to others, but these are also countries with some of the highest incarceration rates in the world, with the United States having the highest rate, and England/­Wales and Australia having ­m id-​­ranking populations ­world-​­wide, but significantly higher than the majority of Western European countries (­Walmsley, 2018) and have been to the forefront in rolling out ­public-​­order type policing (­Harcourt, 2001). Thus, the reach of the criminal justice and particularly the penal system is more extensive in these countries, particularly the United States (­Garland, 2020) and people experiencing homelessness are more likely to be ensnared in the criminal justice systems in these countries than they would in other Western Europe countries, such as the Nordic countries who have both comparatively low prison populations (­Pratt and Eriksson, 2013) and low numbers experiencing homelessness (­Benjaminsen et al., 2020) thus skewing the possible impact of the criminal justice systems on those experiencing in general. Secondly, much of the research on homelessness and the criminal justice systems has focused on the experience of those who are literally or experiencing street homeless. This is not particularly surprising as the interaction between, for example, policing and those experiencing homelessness is likely to occur at street level, but it requires careful interpretation. Those 87

Eoin O’Sullivan

who are literally homeless are a small, distinct and not representative cohort of those who experience homeless either at a point in time, or more importantly over a period of time. Hence the reason for caution when describing ‘­policing the homeless’ or punishing or criminalising homelessness. They are therefore a particularly distinctive ­s ub-​­set of the overall population who experience homelessness over time, but also the group that the general population think of as ‘­t he homeless’. Thus, when describing, for example, the ‘­c riminalisation of homelessness’, the majority of the studies discussed below are in fact referring to the ‘­c riminalisation of the chronic homeless’. Thirdly, and related to the point above, data from shelter usage and rough sleeping enumerations in Europe, North America and the Antipodes all highlight that men are more likely to experience rough sleeping than women, and that women’s experience of all forms of homelessness are likely, but not exclu­ on-​­recurrent The reasons for this, that females sively, to be s­hort-​­term and n are more likely to be in ‘­h idden homeless’ situations, etc. (­Pleace, 2016) than on the streets need not detain us here, but rather to note that l­ong-​­term homelessness and rough sleeping is more likely to be visibly experienced by men rather than women, and hence much of the literature is in fact discussing the interaction between a relatively small cohort of males experiencing ­long-​ ­term homelessness and the institutions and agencies of the criminal justice system.

Strands of Research: Situational Offending and Victimhood The first research strand identified sees the situation of homelessness, specifically literal or street homelessness as inherently criminogenic, in that the very status of being homeless may result in prosecution, through the criminalisation of vagrancy, or that allied activities linked to the absence of private accommodation such as consuming alcohol in a public place, begging or performing ablutions in public may be in themselves a criminal offence well documented in a series of ethnographic studies from the late 1960s to the present, particularly in North America (­see, for example, Huey, 2007; Nimmer, 1971; Snow and Anderson, 1993; Spradley, 1970; Stuart, 2016; Wiseman, 1970). Other activities, such as their ‘­d aily routines and idiosyncratic appearance and behavior of many of the homeless bring them to the attention of the police’ (­Snow, Baker and Anderson, 1989, ­p. 546), or other various coping and survival strategies such as drug consumption, which tend to increase with the length of time on the street, leading to an elevated risk of prosecution (­McCarthy and Hagan, 1991). For Snow, Baker and Anderson (­1989, ­p.  539), ‘­while homeless males are arrested more frequently than ­non-​­homeless males, most of their offenses are relatively minor and victimless’. Indeed, rather than the homeless being simply perpetrators of crime, they are highly at risk of being victims of crime, in particular, vulnerable to robbery and assault while on the streets (­see Ellsworth, 2019 for a review). Thus, those experiencing the most extreme forms of residential instability, literal or street homelessness, find 88

Crime, punishment and homelessness

themselves more likely to both engage in relatively trivial and/­or victimless crime to survive on the streets, to fall foul of a range of ordinances and laws that penalise their routine street activities and are also more likely to become victims of more serious crimes due to their vulnerability to various crimes from violence, sexual and physical to theft on the streets (­Menih, 2020), in some cases from fellow homeless street users (­Moran and Atherton, 2019), but also from the general public ( ­Ballintyne, 1999).

Strands of Research: The Institutional Circuit Starting with the pioneering work of Kuhn and Culhane (­1998), researchers have applied cluster analyses to time series data on shelter admissions in welfare contexts as diverse as the United States, Australia, Canada, Denmark and Ireland. Their results showed a clear and consistent pattern whereby approximately 80% of emergency shelter users were transitional users, in that they used shelters for very short periods of time or a single episode, and did not return to homelessness. A further 10% were episodic users of shelters, in that they used emergency shelters on a regular basis, but for short periods of time, and the remaining 10% were termed chronic or ­long-​­term users of emergency shelter services. For those single persons experiencing chronic and episodic homelessness, note how they traverse through a range of different residential institutions, from emergency accommodation to prisons and psychiatric hospitals, in an endless loop through an ‘­institutional circuit’ (Hopper et al, 1997) of congregate facilities ostensibly with distinct functions such as correcting, rehabilitating or resocialising, but actually all serving similar functions in maintaining single marginal men and women in a perpetual state of residential instability. The ‘­institutional circuit’ contains more than the institutions of the criminal justice system, but over the past 50 years, the numbers contained and detained in various asylums and refuges with ostensibly therapeutic functions have declined, and the role of the criminal justice system, particularly with the growth in penal populations, has assumed greater significance on the institutional circuit in recent decades (­Harcourt, 2006). Although the significance of the different institutions that make up the ‘­institutional circuit’ has varied over the past 100 years, contemporary shelters for those experiencing homelessness continue to operate alongside, particularly for ­long-​­term shelter users, a range of other institutional sites, with penal institutions in the ascendency by the beginning of the 21st century. It is the interactions between these penal sites and homelessness that is the focus of the next section of this chapter.

Strands of Research: Homelessness and Imprisonment The growing rate of incarceration in many Western countries in recent decades, allied to an increasing number experiencing literal homelessness, alongside a punitive shift in their management, at least in North America and in parts of Europe, 89

Eoin O’Sullivan

has resulted in a wealth of research exploring the relationship between homelessness and penal incarceration. Although there are a number of exceptions, prison populations grew in the majority of advanced industrial states in the closing decades of the 20th century and beginning of the 21st century. One of many questions posed by researchers aiming to understanding this development was the degree to which this growth in prison populations, particularly in the liberal ­A nglo-​­Saxon countries, was as a consequence of a shift towards managing marginal populations, such as those experiencing homelessness, from inclusive welfarist interventions to exclusionary punitive models. As we will discuss below, the literature on policing the homeless and the introduction of new forms of public order ordinances would lead us to expect an increase in the number of homeless people entering jails and prisons. Two ­sub-​­strands of research are evident. Those who explored homelessness as a risk factor for incarceration and those who explored incarceration as a risk factor for homelessness. ­ eta-​­analysis of research into homelessness during the 1980s, Shlay and In their m Rossi (­1992, p­p. ­139–​­140) suggest that ‘­on average 18% of the population of homeless persons had served time in prison after being convicted of a felony, and about one third of the population of homeless persons had been jailed on misdemeanour charges, An average of 41% of the population of homeless persons experienced some form of incarceration within the criminal justice system’. In a detailed study in New York, which matched prison and jail records with those resident in public shelters for the homeless on December 1st 1997, Metraux and Culhane (­2006) showed that nearly o ­ ne-​­quarter of the shelter residents had been incarcerated in New York prison or jail in the previous 24 months. More recently, the experience of imprisonment has been examined as an institution that contributes to an exacerbation of homelessness rather than an outcome of homelessness. In other words, while homelessness could lead to incarceration, increasingly incarceration was contributing to homelessness (­Metraux and Culhane, 2004, 2006). Baldry et al. (­2006) in Australia demonstrate that in their sample of those released from prison, homelessness increased from 18% who were homeless ­pre-​­prison to 21% ­post-​­release. In addition, being homeless after prison increased the likelihood of further incarceration. Metraux and Culhane (­2004) came to a similar conclusion in the United States showing that the likelihood of reincarceration is intensified for those who had a history of homelessness before initial incarceration, as did Dyb (­2009) in her survey of prisoners in Norway. The most sophisticated research on the relationship between homelessness and incarceration was conducted by Moschion and Johnson (­2019) in Australia utilising the Journey’s home d­ ata – ​­a comparatively unique and sophisticated longitudinal data set. They concluded that, in the Australian case at any rate, ‘­homelessness does not increase the risk of incarceration and that incarceration does increase the probability an individual will become homeless, but not immediately’ (­2019, ­p. 855). Rather, the risk increases after six months, which they suggest is a consequence of ­post-​­prison supports ending. The significance of this research cannot be overstated. Because of the unique sample employed in the study, including adults with experience of homelessness and those ‘­at risk’, it avoids the methodological biases of 90

Crime, punishment and homelessness

much of the existing research that sample either former prisoners about their experience of homelessness or homeless people about their experience of incarceration.

Strands of Research: Policing Homelessness on Skid Row The policing of homelessness, particularly in the United States, is a particularly fruitful area of the fusion between criminology and homelessness. The policing of homelessness shifted in the 1950s, as the homeless increasingly clustered in the urban enclaves known as ‘­skid row’. A key objective of the policing of skid row was to contain the homeless within these urban spaces and to ensure the observance of certain basic rules. Inhabitants of skid row were seen as chronic alcoholics, and arrests for their public drunkenness formed a key part of their policing in North America in particular (­Schneider, 1988). In his classic study of the policing of skid row, Bittner in his classic study outlined why the inhabitants of skid row required such intensive policing: ‘­From the perspective of society as a whole, ­skid-​­row inhabitants appear troublesome in a variety of ways. The uncommitted life attributed to them is perceived as inherently offensive; its very existence arouses indignation and contempt. More important, however, is the feeling that persons who have repudiated the entire ­role-​­status casting system of society, persons whose lives forever collapse into a succession of random moments, are seen as constituting a practical risk. As they have nothing to forsake, nothing is thought safe from them’ (­Bittner, 1967, ­p. 706). Those who patrolled skid row displayed a degree of paternalism in their dealings with the homeless men and women who inhabited skid row, interspersed with abuse of their power or as described by Wiseman in her ethnography of Skid Row Alcoholics, the police officers ‘­operate with a rare mixture of almost paternal indulgence, strictness and ad hoc ­decision-​­making not found elsewhere in the city’ (­1970, ­p. 65). Skid rows survived until the early 1970s, but were gradually destroyed as business interests sought to acquire the valuable sites on which skid rows tended to be situated (­Metraux, 1999). It is not clear to what degree skid rows existed outside of the United States and Canada. What some authors described as skid rows were scattered derelict areas where a very small number of rough sleepers tended to congregate, usually attracted by soup kitchens, rather than specific residential areas of a city as was the case in London and Dublin (­Edwards et al., 1966; Kearns, 1984). The absence of these skid row zones in most cities in Europe may explain in part the later and more muted punitive response to homelessness than that experienced in North America.

Coercive Care Scholars and activists in the United States have from the beginning of this century noted that the public policy was ‘­annihilating public space’ and, as a consequence, a disproportionate representation of homeless people in the criminal justice system (­Mitchell, 2020). DeVerteuil et al. (­2009) argue that while there is ample evidence of punitive responses to those experiencing homelessness, other more inclusive responses 91

Eoin O’Sullivan

are also evident and that this is particularly the case when the focus shifts from the United States to other jurisdictions. The motivation for the ‘­punitive shift’ was explored by Johnsen and Fitzpatrick (­2010) who concluded that coercive policies towards the homelessness were in part motivated by the desire to assist ­service-​­resistant rough sleepers who were engaging in ­self-​­destructive behaviour, rather than simply vengeful actions against the powerless. Forms of urban surveillance, such as CCTV, rather than only acting to police and exclude the homeless from public spaces may also provide a degree of security to some vulnerable homeless people (­Huey, 2012). Furthermore, in the majority of accounts of the punitive responses to homelessness, those who are the recipients of those actions are strangely silent and passive; yet, Snow and Mulcahy (­2001, ­p.  165) argue that ‘­homeless individuals, for the most part, are not unwitting, passive actors but relatively active agents in negotiating and reacting to the spatial and political constraints they encounter. Some may exit the situation, others may adapt by modifying their subsistence repertoire, still others may persist in what they have been doing, and yet others my exercise their voice by engaging in collective protest’. The perspective and voices of homeless people themselves are also heard in a series of innovative research projects in the United States (­Stuart, 2016; Herring, 2021), Australia (­Clarke and Parsell, 2020) and the UK, particularly in England ( ­Johnsen and Fitzpatrick, 2010; Johnsen, Fitzpatrick and Watts, 2018; Watts, Fitzpatrick and Johnsen, 2018). For example, these accounts acknowledge the impact of enforcement strategies on the lives of rough sleepers, but suggest a more nuanced interpretation rather than such strategies been interpreted as wholly punitive and repressive. Those that aim to trace the impact of neoliberal urban structuring at the ­m acro-​ l­evel are undoubtedly correct to draw attention to the implications of this restructuring on urban space and those marginal households that inhabit this space (­M itchell, 2020), but these detailed qualitative studies across the Global North suggest that interactions between social services providers, police and those on the street exhibit degrees of compassion, support, access to secure housing in addition to enforcement and coercion.

Conclusion Over the past two centuries, we can trace a relationship between elite perceptions of homeless people and the broad State response. From beginning of the 19th century until the ­post-​­war second world period, the elite view of homeless people was that they were ­d angerous – ​­a danger to compliance with the needs of industrial ­capitalism  – ​­and thus requiring resocialisation in labour colonies to ensure participation in the labour market. Coinciding with the growth of welfare states, in the ­post-​­war period, the elite view of homelessness was of ­d isaffiliation – ​­homeless people being mildly deviant and undersocialised, but small in number and corralled in declined skid row areas or festering in casual wards and other remnants of the institutions of the great confinements of the 19th century, and requiring the intervention of ­welfarist-​­type agencies, bolstered, if necessary, by the truncheon of the neighbour cop. From the early 1970s, as visible homelessness increased, 92

Crime, punishment and homelessness

the dominant view of the homeless was that they were d­ isturbed – ​­based on an assumption that they were discharged from various psychiatric institutions and the response was to place them in shelters. This perception of the homeless as disturbed and the relatively benign response of placing them in shelters was gradually replaced with a view that homeless people were either disorderly in themselves or else that they contributed to a disorderly environment that was detrimental to public safety and economic revitalisation. Whatever the motivation of these statutes, it is clear that punitive vagrancy and ­anti-​­begging legislation and policies are not novel but rather have a long history.

References Althammer, B. (­ 2014) Transnational Expert Discourse on Vagrancy around 1900. In Althammer, B., Gestrich, A. and Grundler, J. (­Eds.) The Welfare State and the ‘­Deviant Poor’ in Europe, ­1870–​­1933, p­p. ­103–​­125 (­Basingstoke: Palgrave Macmillan). Ballintyne, S. (­1999) Unsafe Streets: Street Homelessness and Crime (­L ondon: Institute for ­Public Policy Research). Baldry, E., McDonnell, D., Maplestone, P. and Peeters, M. (­2006) ­Ex-​­prisoners, homelessness and the state in Australia. Australian & New Zealand Journal of Criminology 39(­1), p­p. ­20–​­33. Beier, A.L. and Ocobock, P. (­Eds.) (­2008) Cast Out: Vagrancy and Homelessness in Global and Historical Perspective, p­p. ­1–​­34 (­Athens: Ohio University Press). Benjaminsen, L., Dhalmann, H., Dyb, E., Knutagård, M. and Lindén, J. (­2020) Measurement of Homelessness in the Nordic Countries. European Journal of Homelessness 14(­3), p­p. ­159–​­180. Bittner, E. (­1967) The Police on ­Skid-​­Row: A Study of Peace Keeping. American Sociological Review 32(­5), p­p. ­699–​­715. Bruno, F.J. (­1948) Trends in Social Work, as Reflected in the Proceedings of the National Conference of Social Welfare, ­1874–​­1946 (­New York: Columbia University Press). Chambliss, W.J. (­1964) A Sociological Analysis of the Law of Vagrancy. Social Problems 12 (­1), p­p. ­67–​­77. Clarke, A. and Parsell, C. (­2020) The Ambiguities of Homelessness Governance: Disentangling Care and Revanchism in the Neoliberalising City. Antipode 52(­6), p­p. ­1624–​­1646. DeVerteuil, D., May, J. and von Mah, J. (­2009) Complexity Not Collapse: Recasting the Geographies of Homelessness in a ‘­Punitive’ Age. Progress in Human Geography 33(­5), p­p. ­646–​­666. Dyb, E. (­2009) Imprisonment: A Major Gateway to Homelessness. Housing Studies 24(­6), p­p. ­809–​­824. Edwards, G., Hawker, A., Williamson, V. and Hensman, C. (­1966) London’s Skid Row. The Lancet 287(­7431), p­p. ­249–​­252. Ellsworth, J.T. (­2019) Street Crime Victimization among Homeless Adults: A Review of the Literature. Victims & Offenders 14(­1), p­p. ­96–​­118. Faragó, L., ­Ferenczy-​­Nyúlb, D., Kende, A., Krekób, P. and Gurálye, Z. (­2020) Criminalization as a Justification for Violence against the Homeless in Hungary. The Journal of Social Psychology 162(­2), pp.­216–​­230. Foucault, M. (­1977) Discipline and Punish: The Birth of the Prison (­L ondon: Penguin). Garland, D. (­1985) The Criminal and His ­Science – ​­A Critical Account of the Formation of Criminology at the End of the Nineteenth Century. British Journal of Criminology 25(­2), p­p. ­109–​­137. Garland, D. (­2020) Penal Controls and Social Controls: Toward a Theory of American Penal Exceptionalism. Punishment and Society 22(­3), p­p. ­321–​­352.

93

Eoin O’Sullivan Goluboff, R. (­2016) Vagrant Nation: Police Power, Constitutional Change, and the Making of the 1960s (­Oxford: Oxford University Press). 2001) Illusion of Order: The False Promise of Broken Windows Policing Harcourt, B.E. (­ (­Cambridge: Harvard University Press). Harcourt, B.E. (­2006) From the Asylum to the Prison: Rethinking the Incarceration Revolution. University of Texas Law Review, Symposium Issue on Crime and Punishment, 84 Texas Law Review, p­p. ­1751–​­1786. Herring, C. (­2021) Complaint Oriented “­Services”: Shelters as Tools for Criminalizing Homelessness. The Annals of the American Academy of Political and Social Science 693(­1), p­p. ­264–​­283. Hopper, K., Jost, J., Hay, T., Welber, S. and Haugland, G. (1997) Homelessness, Severe Mental Illness, and the Institutional Circuit, Psychiatric Services 48(5) pp.659–664. Huey, L. (­2007) Negotiating Demands: The Politics of Skid Row Policing in Edinburgh, San Francisco and Vancouver (­Toronto: University of Toronto Press). Huey, L. (­2012) Invisible Victims: Homelessness and the Growing Security Gap (­Toronto: University of Toronto Press). Johnsen, S. and Fitzpatrick, S. (­2010) Revanchist Sanitisation or Coercive Care? The Use of Enforcement to Combat Begging, Street Drinking and Rough Sleeping in England. Urban Studies 47(­8), p­p. ­1703–​­1723. Johnsen, S., Fitzpatrick, S. and Watts, B. (­2018) Homelessness and Social Control: A Typology. Housing Studies 33(­7 ), p­p. ­1106–​­1126. Kearns, K.C. (­1984) Homelessness in Dublin: An Irish Urban Disorder. American Journal of Economics and Sociology 43(­2), p­p. ­217–​­233. Kuhn, R. and Culhane, D.P. (­1998) Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data. American Journal of Community Psychology 26(­2), p­p. ­207–​­232. Lawrence, P. (­2004) Policing the Poor in England and France, ­1850–​­1900. In Emsley, C., Johnson, E. and Spierenburg, P. (­Eds.), Social Control in Europe, ­1800–­​­­2000 – ​­Volume 2, p­p. ­210–​­225 (­Columbus: Ohio State University Press). Locke, H.J. (­1936) Twenty Thousand Homeless Men: A Study of Unemployed Men in the Chicago Shelters (­Chicago: J. B. Lippincott). McCarthy, B. and Hagan, J. (­1991) Homelessness: A Criminogenic Situation? British Journal of Criminology 31(­4), p­p. ­393–​­410. Menih, H. (­2020) ‘­Come ­Night-​­time, It’s a War Zone’: Women’s Experiences of Homelessness, Risk and Public Space. British Journal of Criminology 60(­5), p­p. ­1136–​­1154. Metraux, S. (­1999) Waiting for the Wrecking Ball: Skid Row in Postindustrial Philadelphia. Journal of Urban History 25(­5), p­p. ­690–​­715. Metraux, S. and Culhane, D.P. (­2004) Homeless Shelter Use and Reincarceration Following Prison Release: Assessing the Risk. Criminology & Public Policy 3(­2), p­p. ­139–​­160. Metraux, S. and Culhane, D.P. (­2006) Recent Incarceration History among a Sheltered Homeless Population. Crime & Delinquency 52(­3), p­p. ­504–​­517. Mitchell, D. (­2020) Mean Streets: Homelessness, Public Space, and the Limits of Capital (­Athens: University of Georgia Press). Moran, P. and Atherton, F. (­2019) The Philosophy of Homelessness: Barely Being ( ­L ondon: Routledge). Moschion, J. and Johnson, G. (­2019) Homelessness and Incarceration: A Reciprocal Relationship? Journal of Quantitative Criminology 35(­4), p­p. ­855–​­887. National Law Center on Homelessness and Poverty (­2019) Housing Not Handcuffs 2019: Ending the Criminalization of Homelessness in U.S. Cities. Washington, DC: National Law Center on Homelessness and Poverty). Nimmer, R.T. (­1971) Two Million Unnecessary Arrests: Removing a Social Service Concern from the Criminal Justice System (­Chicago: American Bar Foundation). O’­Brassill-​­Kulfan, K. (­2019) Vagrants and Vagabonds: Poverty and Mobility in the Early American Republic (­New York: New York University Press).

94

Crime, punishment and homelessness Pleace, N. (­2016) Exclusion by Definition: The ­Under-​­Representation of Women in European Homelessness Statistics. In Mayock, P. and Bretherton, J. (­Eds.) Women’s Homelessness in Europe, p­p. ­105–​­126 (­L ondon: Palgrave Macmillan). Pratt, J. and Eriksson, A. (­2013) Contrasts in Punishment: An Explanation of Anglophone Excess and Nordic Exceptionalism (­L ondon: Routledge). ­R ibton-​­Turner, C.J. (­1887) A History of Vagrants and Vagrancy and Beggars and Begging (­L ondon: Chapman and Hall). Schneider, J. (­1988) The Police on Skid Row: A Historical Perspective. Criminal Justice Review 13(­2), p­p. ­15–​­20. Shlay, A.B. and Rossi, P.H. (­1992) Social Science Research and Contemporary Studies of Homelessness. Annual Review of Sociology, p­p. ­129–​­160 Volume 18. Snow, D., Baker, S.G. and Anderson, L. (­1989) Criminality and Homeless Men: An Empirical Assessment. Social Problems 36(­5), p­p. ­532–​­549. Snow, D.A. and Anderson, L. (­1993) Down on Their Luck: A Study of Homeless Street People (­Berkeley: University of California Press). Snow, D.A. and Mulcahy, M. (­2001) Space, Politics, and the Survival Strategies of the Homeless. American Behavioral Scientist 45(­1), p­p. ­149–​­169. Solenberger, A.W. (­1911) One Thousand Homeless Men: A Study of Original Records (­New York: Russel Sage Foundation). Spradley, J.P. (­1970) You Owe Yourself a Drunk: An Ethnography of Urban Nomads ( ­Boston: Little Brown and Co.). Stuart, F. (­2016) Down and Out and Under Arrest: Policing and Everyday Life in Skid Row (­Chicago: University of Chicago Press). Walmsley, R. (­2018) World Prison Population List, 12th edition (­L ondon: Institute for Criminal Policy Research). Watts, B, Fitzpatrick, S. and Johnsen S. (­2018) Controlling Homeless People? Power, Interventionism and Legitimacy. Journal of Social Policy 47(­2), p­p. ­235–​­252. Wiseman, J.P. (­1970) Stations of the Lost: The Treatment of Skid Row Alcoholics (­Hoboken: ­Prentice-​­Hall).

95

9 HOMELESSNESS AND SOCIAL WORK Current challenges and future opportunities Susanne Gerull Introduction At a time of growing housing shortages in almost every European country, homelessness has become a focus of politics, the housing industry and social sciences. Although the economic crisis in 2008 “­has created a ‘­perfect storm’ for our services” (­Brünjes, 2014, p­ . 4 [emphasis in original]), social workers have to “­a rticulate more clearly the potential for social work support to improve outcomes for people at risk of homelessness or with experience of it” (­Manthorpe et al., 2015, p­ . 587). The marginalisation of people experiencing homelessness places a critical light on professionals. In addition, in interdisciplinary teamwork, doctors, psychologists or social scientists usually have the lead. The needs of people experiencing homelessness are also changing with new groups, such as EU citizens, LGBTQI and families appearing and demanding new approaches and concepts. The ­COVID-​­19 pandemic has also created additional challenges in supporting homeless people. A systematic literature search covering research from 2013 onwards revealed many articles describing homeless assistance, but few analyses and debates on the specific role of social work in this field of work. One exception is the discussion about the Housing First approach, which has led to a paradigm shift in homeless assistance. In this chapter, the role of social work(­ers) in the assistance for homeless people is questioned: What are their specific tasks and responsibilities? Which skills and knowledge enable them to work with homeless people and support them in a way other professions are not capable of? What are the current challenges and what are the future opportunities for social workers in the field of homelessness care? In the following, the terms “­social work” and “­homelessness” are defined, target groups in the homeless care are identified, the role of social workers in this field is discussed and the paradigm shift from deficit to ­strengths-​­based approaches is described. The chapter ends with conclusions. 96

DOI: 10.4324/9781351113113-11

Homelessness and social work

Social Work The global definition of social work has been developed by the International Federation of Social Workers (­IFSW). The current version is from July 2014: Social work is a ­practice-​­based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing. (…) (­IFSW, 2014) Speaking about social work in this chapter, I refer to this definition to draw a distinction between trained social workers and volunteers and workers, without an academic degree of social work, providing homelessness care (­not to devalue people contributing to homeless care in this way).

Homelessness There is no universal definition of homelessness. Even in a specific country the term can be used in different ways; and only a few official definitions are found in the European context (­for an overview, see Hansen Löfstrand and Quilgars, 2016, p­p.  ­51–​­54). The most widely adopted definition is the European Typology of Homelessness and Housing Exclusion (­ETHOS) which was developed by FEANTSA’s researchers. ETHOS uses four conceptual categories (­roofless, houseless, insecure and inadequate housing), which are differentiated in more specific operational categories and living situations (­FEANTSA, 2005; cf. Amore et  al., 2011). For all homeless people in the listed living s­ ituations – from public space to ​­ transitional supported accommodation to overcrowded d­ wellings – ​­social workers could or should (­depending on regional or national rules) be responsible for offering professional support.

Target Groups As mentioned above, social workers support homeless people and people threatened by homelessness in very different living situations. Their tasks differ due to the specific living situations, but also to the needs and wants of people experiencing or at risk of homelessness: When a household is living under the threat of eviction due to rent arrears, social workers may check the possibility of ensuring the rental agreement by assuming responsibility for the rent arrears and finding a way to pay them off. Someone living rough can also apply for supported accommodation to overcome her*his complex needs with the help of a social worker. Since Housing First approaches spread in the USA, Canada and the European Union, 97

Susanne Gerull

ensuring ­re-​­housing in the form of secure rental contract agreements is more and more a duty of social workers. In the following section, the tasks of social workers in the context of prevention, accommodation and ­re-​­housing are described. The last paragraph addresses how social work can help some of the new groups experiencing, or at risk of, homelessness that have appeared in recent years, via professional homeless care.

Prevention of Homelessness The biggest target group in the context of preventive measures is households threatened by evictions (­ETHOS, insecure housing, category 9, rented and owned housing). Rent arrears are the most common reason for evictions (­Stenberg et al., 2011). A comparative analysis of evictions (­Gerull, 2014) showed the variety of legal frameworks, regional and national strategies in the examined 14 EU countries. One of the findings was t­hat – ​­besides structural and legal ­regulations – ​­personal support is a key measure in preventing homelessness. In some countries, the law guarantees a ­so-​­called “­protection period”, i.e. repaying the rent arrears makes the notice to quit legally void. In other countries, negotiations with the landlord to ensure the rental contract are possible. Therefore, (­often) social workers try to help the persons concerned to repay their rent arrears after getting a notice to quit. As rent arrears often only represent the tip of the iceberg, social workers have to examine if other structural disadvantages or individual problems are underlying reasons for the arrears. Due to their professional expertise, social workers are important stakeholders in the prevention of evictions. Nevertheless, a comparative report of the European Observatory on Homelessness (­EOH, 2018) reports that: [p]revention is in its early stages in much of Europe. Most services are focused on managing financial problems that lead to rent arrears and possible eviction, with only a minority of the 16 countries having integrated systems that combine housing advice, debt counselling, mediation and support services. (­EOH, 2018, ­p. 95) Apart from the specialists in homeless care, the prevention of homelessness is a task for every social worker. A multivariate analysis, based among others on a longitudinal data set, presents the social distribution of homelessness in the UK: Bramley and Fitzpatrick (­2018) disproving the prejudice that “­we are all two pay cheques away from homelessness” (­ibid., ­p.  96). Quite the contrary, homelessness is not ​­ the odds experiencing homelessness “­a re randomly distributed in the ­U K – and outside the control of those directly affected” (­ibid., ­p. 112). The most relevant predictors found in the data are the experience of (­childhood) poverty and (­w ith less explanatory power) “­a range of health and support needs and behavioural issues, particularly in the teenage years” (­ibid.). The authors don’t mention social workers’ support but it is obvious that social work assistance for families can play an important role in the prevention of homelessness in view of the above. 98

Homelessness and social work

Accommodation of and Social Support for Homeless People Social workers are also involved in the accommodation of homeless people ­a nd –​ ­ ore ­often – ​­in their social support (­w ithin the ETHOS categories of roofless and m houseless people). Across the EU member states, the involvement of social workers differs, as well as there being variation in offered homelessness services in general. A comparative study of the European Observatory on Homelessness (­EOH, 2018) found that emergency accommodation is the most frequently offered service for homeless people, and only ­low-​­intensity support is offered in most of these services. By comparison, ­housing-​­focused support constitutes a minority of homelessness services in EU countries, with only some countries having significant levels of ­housing-​­led/­Housing First services and making less use of transitional supported accommodation or emergency shelters (­ibid., ­p. 95). Hence, probably most of the professional social work support occurs in the context of transitional supported accommodation (­staircase/­housing ready services). In Germany, for example, a special legal regulation (§§ ­67–​­69 Social Security Code XII) guarantees a legal right of social workers’ support for people with particular social difficulties that is used mostly for homeless people. In most of the cases, the support is combined with an accommodation like single living, group living or in transitory shelters. In recent years, this legal norm has also been increasingly used for “­­family-​­supporting assistance to overcome social difficulties” (­BAG W, 2021). An emphasis on the s­ o-​ ­called “­housing readiness” (­see paragraph ‘Shift from Deficit to Strengths-Based Approaches in the Homeless Care’) is mostly expected in these services. Depending on the regional and national approaches, also other forms of accommodation offered with social worker support are sometimes reserved for women, families, young people, people with mental health problems, etc. This demands a specialisation of the social workers for particular “­target” groups of people experiencing homelessness (­Dries et al., 2016, ­p. 198 for homeless women) and interdisciplinary teamwork.

­Re-​­housing Homeless People ­ e-​­housing homeless people is primarily the responsibility of the housing market R and politics. However, due to growing housing shortages and thereby the increase of homelessness in almost every EU member state (­see Abbé Pierre Foundation and FEANTSA, 2021), social workers are more and more involved in r­ e-​­housing homeless people, even though this is still not the case in every European country. ­Housing-​­focused support services include h ­ ousing-​­led and Housing First services. Housing First is being implemented in more and more European countries. In a review paper, Tim Aubry (­2020, ­p.  13) found Housing First “­effective in ending homelessness, producing minimal negative effects, generating cost offsets, relatively easy to implement, and adaptable to different communities and clients subgroups”. The approach involves, among other professions, social workers for supporting homeless people to sustain a secure rental contract. The paradigm shift from a “­housing readiness” approach that first has to be established, to focus support on understanding of housing as a human right, is discussed below. 99

Susanne Gerull

New Target Groups In recent years, new groups of people have been requiring homeless care, e.g. vulnerable EU citizens or homeless LGBTQI people. Other subgroups like homeless families, which we have not seen for years in some countries, are back. Although it is important to note that the people mentioned above do not represent homogeneous groups, they can present complex challenges for homelessness services: The assistance for homeless people is not very flexible in most of the countries and systems are often slow to adapt to changing needs. Consequently, this means that a lot of homeless people are falling through the net. In the case of vulnerable EU citizens, Reichenbach (­2018, ­p.  41) argues “­that ­intra-­​­­EU-​­migration … is regulated by national law, and that it produces specific legal constellations and life circumstances. As seen, this creates urgent needs for the person affected”. FEANTSA, beyond that, constantly criticises breaches to the EU law in different countries like “­restrictions in the access to social benefits and the systematic verification of residence rights” for EU citizens living in other EU countries (­FEANTSA, 2018, ­p. 1). This leads to lots of roofless EU citizens with special support needs that social workers cannot always meet. Social workers cannot change national laws and their interpretation by judges, but they can use their political mandate for social change. S­ taub-​­Bernasconi (­2012, ­p.  34), who developed the idea of a triple mandate for social workers, argues as follows: Beside the mandates given by their clients (­help) and by the society (­control), the third mandate comes from the profession itself based on scientific knowledge and the professional code of ethics. However, in the case of mobile EU citizens, Reichenbach elaborates that social workers in the field of homelessness can also become stuck in “­colonial” thinking and therefore argues that “­social work needs to reflect critically its own position and actions” (­Reichenbach, 2018, p­ . 56). ​­ ­young – LGBTQI ​­  people. Among peoA second new target group i­s – mostly ple experiencing homelessness, they are often ­over-​­represented. Forge et al. (­2018) state for the USA: When compared to their heterosexual, cisgender counterparts, a greater percentage of youth who are LGBTQ had been kicked out of their homes, had been homeless for more than one year, reported being abused as a child, were victimized while they were homeless, indicated a mental health problem, and identified adult friends or a professional contact (­rather than family members) as a source of support. (­ibid., p­p. ­47–​­48; cf. Aguiniga and Bowers, 2018, ­p. 379) This points to the need for adequate social work approaches to be developed for LGTBQI people experiencing/­at risk of homelessness. A recent European survey of homelessness service providers found that “[m]ore than half of organisations surveyed reported working with LGBTQI youth, although findings reveal there is no systematized procedure for collecting the sexual orientation and gender identity of service users” (­Shelton et al., 2020, ­p. 9). As pointed out in above, prevention 100

Homelessness and social work

of homelessness must start already at the very beginning: Focusing on preventing LGBTQI youngsters becoming homeless in the future, Forge et  al. (­2018, ­p.  63) indicate the “­complex challenges presented to child welfare professionals when engaging with families who reject their child based on their sexual orientation or gender identity”. These multifaceted problems also implicate the need for interdisciplinary support solutions. In addition, Aguiniga and Bowers (­2018, ­p. 382) demand that students of social work should “­address the social justice issue of … transgender youth homelessness”. As it was the case for a long time regarding homeless women, social work must avoid an androcentric perspective also on transgender people: Homelessness affects men, women and transgender persons differently, and homeless men should no longer be the “­standard” norm for how social work meets support needs of homeless people. Another group experiencing more homelessness are families including homeless mothers. In several countries, families represent the fastest growing portion of the homeless on the whole (­for the USA: Sheller et al., 2018, p­ . 1247). They are more likely to be exposed to a myriad of interpersonal and contextual stressors, i.e., interpersonal and community violence; economic and housing distress; maternal depression and other psychiatric disorders; parental substance use; inadequate educational, social, and health resources. (­ibid., ­p. 1248) In many European countries, the number of homeless families has increased and most of them are headed by single (­lone) women (­Dries et al., 2016, p­p. ­180–​­181). Like single women, homeless mothers often stay invisible and live with friends or family (­experience “­h idden homelessness”). But as Dries et al. state, “­large numbers will access shelter or other homelessness accommodation simply because these informal living arrangements are generally not sustainable in the medium or longer term” (­ibid., ­p. 200). This demonstrates the need to develop precisely tailored support ­offers  – ​­without assuming that all homeless families have limited social resources. Also, for families experiencing or at risk of homelessness, social workers must reflect on the “­structural factors, particularly related to circumstances within housing markets, … that result in heightened vulnerability” (­ibid.).

The Role of Social Workers in Homeless Care There is no shared understanding among social workers about their role in relation to people experiencing or at risk of homelessness: ­Self-​­attributions of social workers vary from carers and protectors, to advocates and lobbyists to facilitators and partners working alongside people experiencing homelessness. Accordingly, theories and approaches like Clinical Social Work (­d iagnosis and treatment) and Social Work as a Human Rights Profession (­referring to human rights) are distinct from each other. Based on the international definition of social work and the specific problems and needs of homeless people, one can nevertheless identify some dimensions and aspects that describe the role of social workers in homeless care. 101

Susanne Gerull

Due to the limited space in this chapter, two key components are elaborated in the following: The social workers’ role in the context of social exclusion as well as ­inter-​­ and transdisciplinarity.

The Role of Social Workers in the Context of Social Exclusion Social exclusion, in brief, means “­inadequate social participation, lack of social integration and lack of power” (­Littlewood and Herkommer, 1999, ­p. 7). Von Mahs (­2013, ­p.  121) identifies three distinct trajectories of social exclusion concerning homeless people: “… immediate survival strategies to generate income (­legal exclusion) and find shelter and housing (­service exclusion) as well as their l­ong-​­term exit strategies to find residential stability and economic ­self-​­sufficiency (­market exclusion)”. In this context, many authors refer to the concept of intersectionality (­Baker Collins et al., 2018, regarding homelessness and disability; Cameron et al., 2016, regarding homeless women). Zufferey (­2017) proposes an intersectional approach in the field of homelessness that “­is consistent with social work ethics and values about social change, and working to upholding social justice and human rights” (­ibid., ­p. 147). ­A nti-​­homeless policies like the criminalisation of loitering in public spaces influence the living situation of people experiencing homelessness. It is obvious that homeless people are affected disproportionately by these exclusionary measures (­Aykanian and Lee, 2016, ­p. 183). As “[s]ocial work prioritizes serving the most oppressed and marginalized populations” (­ibid., ­p. 184), they “­must promote the recognition and protection of the human rights of people experiencing homelessness” (­ibid.). These tasks include a need to “­educate business leaders about the causes of homelessness and the effects of a­ nti-​­homeless laws” (­ibid.). This implies a requirement to act as an advocate or lobbyist (­see above). In this context, von Mahs (­2013, ­p. 47) points to successful lawsuits in the USA against exclusionary practices. Besides exclusionary measures in public spaces and the dimensions von Mahs (­2013) identifies, homeless people are often discriminated and stigmatised by “­­group-​­focused enmity” from society which can manifest as acts of violence in the form of hate crimes (­Gerull, 2021). On the other side, “[s]ocial work is itself exclusionary. It cannot engage in integration and inclusion because its innate functions involve labelling and marginalising people” (­Sheppard, 2006, ­p. 27). This means that social work itself excludes homeless people by identifying them as needy “­t arget group”. Reflecting this paradox, social workers have to rethink their view to homeless people: Especially roofless (­i.e. visible) people living rough who are suffering from ­multi-​­layered problems, including social exclusion, but first and foremost they don’t have a rental contract agreement or residential property. Labelling them as people with low skills, respectively, other resources in the first place cannot do justice to them.

­Inter-​­and Transdisciplinarity in Homeless Care Due to the multifaceted individual problems of many homeless people, support and help often require the involvement of several p­ rofessions – ​­beside social workers 102

Homelessness and social work

e.g. doctors, psychologists, psychotherapist, and (­for homeless children) educators and teachers. Other specialists are needed to tackle structural problems like housing shortages and unemployment. To avoid building up parallel structures and/­or working against each other, coordination (­e.g. via case managers) or teamwork (­e.g. in the case of mental health problems) is necessary. Interdisciplinary and transdisciplinary work with homeless people means simultaneously involving professionals from multiple branches of knowledge: Interagency teams work closely together and complement one another (­interdisciplinarity) and solutions can be sought where the knowledge of a single discipline is not sufficient (­t ransdisciplinarity). What sounds inspirational at first hearing can be very complex and complicated in practice. In the hierarchy of professions, in particular in the health system, social workers are not in the highest position in some countries (­especially when they work with homeless people). Their special skills and knowledge are not always recognised and some doctors are astonished that one has to study some years to become a social worker (­cf. ­Geißler-​­Piltz and Gerull, 2009). Therefore, new professional strategies for the benefit of people experiencing homelessness have to be developed.

Shifting from Deficit to S ­ trengths-​­Based Approaches in Homeless Care Social work methods and approaches are not set in stone. Society and people experiencing homelessness are all subject to continual change, professional concepts, skills and strategies. In recent years, we have experienced a shift from deficit to ­strengths-​­based approaches in the homeless care: And so the most fundamental changes we can make are to share more power with our service users, to transform our role from ‘­fi xer’ to ­facilitator – ​­and to transform the perception of our service users as passive recipients of services into one where they are equal partners with assets, not just problems or needs. (­Brünjes, 2014, ­p. 5) So we need more participation (­in the spirit of users taking part in d­ ecision-​­making processes) and empowerment instead of social workers taking over the homeless care process. One of the prerequisites is a “­safe, supported open dialogue between service users and frontline staff” (­Carr, 2007, ­p. 273). The ­prejudice – also ​­ of social ­workers  – ​­that homeless people don’t want to and/­or are not able to participate in their own support and care has been rejected in several empirical studies. In a Canadian study, Paradis (­2016) found out that ­self-​­determination was more important for the interviewed homeless women than basic material provision. Field research in Germany (­Gerull, 2018) also confirmed that homeless people are able and willing to take part in ­decision-​­making processes. The other side of the coin is that social workers have to give up (­partly) their power, which can lead to feelings of anxiety and uncertainty (­ibid.). Taking a “­deficit” (­rather than ­strength-​­based) perspective on people experiencing homelessness also affects the discussion about the right to housing which 103

Susanne Gerull

has been the subject of more debate in the last years: Do we have to make people experiencing homelessness “­housing ready” before we can arrange a rental contract? In many countries, the s­o-​­called staircase models dominated (­and partly still dominates) the idea of r­e-​­housing homeless people. Step by step, these must show that they are able to live independently, that they are (­or become) sober and that they are willing to get treatment and social workers’ support: “­In these types of homelessness service, housing happens ‘­last’” (­Pleace, 2016, ­p. 12). In contrast to this concept of “­housing readiness”, the Housing First approach shows that homeless people can be successfully ­re-​­housed if they are offered (­simultaneously) intensive social support on a voluntary basis (­Aubry, 2020; cf. B ­ usch-​­Geertsema, 2013). The underlying idea is the human right to housing.

Conclusions Social work for people experiencing homelessness seems to involve a constant balancing act between empowerment and care. Another challenge is the necessity of a permanent shift in services towards lasting h ­ igh-​­impact solutions and away from ­emergency-​­led ad hoc solutions (­cf. Bezunartea Barrio, 2014). The paradigm shift to more ­strength-​­based approaches confronts social workers with the people’s experiencing homelessness demands for more power and participation. Certainly, it helps to find more adequate solutions: Just ask the homeless people about their needs and include them in defining their problems and resources! This also includes new “­target” groups of people experiencing or at risk of homelessness who are a challenge for often inflexible homelessness systems. Due to the heterogeneity of homeless people, i­nter-​­and transdisciplinary approaches have to be developed. Especially when supporting people with special needs or multiple problems, social workers have to routinely cooperate with other professions. This must happen without social workers undervaluing themselves. Social workers have a holistic approach: In contrast to other professions, they always check individual and structural problems as well as resources. They take into account ­socio-​­spatial connections and are trained to use a variety of communication techniques as well as to think in political and economic contexts. However, there are of course limits to social work, which create the need for teamwork with other professions. In order to do justice to these tasks, social work has to become more ­research-​ ­ inded: The profession (­ m not only the academic discipline) needs more s­elf-​ c­ ontained, systematic practice research. First, this includes evaluations, including the effectiveness of existing homelessness services. Social workers must “­contribute to privileging and oppressing social processes, making invisible inequalities and constituting who remains marginalised” (­Zufferey, 2017, ­p. 57). Second, social work research should cover a wide range of empirical studies about problems and needs of people experiencing homelessness. In this context, “­­self-​­contained research” means ­co-​­produced work involving social workers and the homeless people themselves and the development of specific research questions and methods.

104

Homelessness and social work

Finally, social work in the field of homelessness must always fulfil its political mandate to contribute to social and political change. Otherwise, social work risks focusing on the symptoms and stabilising social inequality.

References Abbé Pierre Foundation and FEANTSA (­2021). 6th Overview of Housing Exclusion in Europe. Available  at:  https://­w ww.feantsa.org/­en/­r eport/­2 021/­0 5/­12/­­t he- ­​­­6 th- ­​­­overview- ­​­­of­​­­housing-­​­­exclusion-­​­­i n-­​­­europe-​­2021 [Accessed June 2021] Aguiniga, D. M. and Bowers, P. (­2018). Teaching N ­ ote—​­Partnering Macro Social Work Students and Agencies Addressing Youth Homelessness: A Model for Service Learning. Journal of Social Work Education, 54(­2), p­p. ­379–​­383. DOI: 10.1080/­10437797.2017.1336138. Amore, K., Baker, M. and ­Howden-​­Chapman, P. (­2011). The ETHOS Definition and Classification of Homelessness: An Analysis. European Journal of Homelessness, 5(­2), p­p. ­19–​­37. Aubry, T. (­2020). Analysis of Housing First as a Practical and Policy Relevant Intervention: The Current State of Knowledge and Future Directions for Research. European Journal of Homelessness, 14(­1), p­p. ­13–​­26. Aykanian, A. and Lee, W. (­2016). Social Work’s Role in Ending the Criminalization of Homelessness: Opportunities for Action. Social Work, 61(­2), p­p. ­183–​­185. DOI: 10.1093/ ­sw/­sww011. BAG W: Bundesarbeitsgemeinschaft Wohnungslosenhilfe e. V. [Federal Association for Assistance to the Homeless]. 2021. Familienunterstützende Hilfe zur Überwindung sozialer Schwierigkeiten nach §§ 67 ff. SGB XII in Wohnungsnotfällen [­Family-​ ­supporting assistance to overcome social difficulties according to §§ 67 ff. SGB XII in housing emergencies]. wohnungslos, 63(­1), p­p. ­15–​­17. Baker Collins, S., Schormans, A. F., Watt, L., Idems, B. and Wilson, T. (­2018). The Invisibility of Disability for Homeless Youth. Journal of Social Distress & the Homeless, 27(­2), p­p. ­99–​­109. DOI: 10.1080/­10530789.2018.1480892. Bezunartea Barrio, P. (­2014). Social Workers: Challenges and Contributions to Housing First Support Programmes. Homeless in Europe, 13(­2), p­p. ­14–​­15. Bramley, G. and Fitzpatrick, S. (­2018). Homelessness in the UK: Who Is Most at Risk? Housing Studies, 33(­1), p­p. ­96–​­116. DOI: 10.1080/­02673037.2017.1344957. Brünjes, M.-​­A. (­2014). From Fixer to ­Facilitator – ​­A New Role for Social Workers? Homeless in Europe, 13(­2), p­p. ­4 –​­5. ­Busch-​­Geertsema, V. (­2013). Housing First Europe Final Report. Bremen; Brussels: GISS e.V. Cameron, A., Abrahams, H., Morgan, K., Williamson, E. and Henry, L. (­2016). From Pillar to Post: Homeless Women’s Experiences of Social Care. Health and Social Care in the Community, 24(­3), p­p. ­345–​­352. DOI: 10.1111/­h sc.12211. Carr, S. (­2007). Participation, Power, Conflict and Change: Theorizing Dynamics of Service User Participation in the Social Care System of England and Wales. Critical Social Policy Ltd, 27(­2), p­p. ­266–​­276. DOI: 10.1177/­0261018306075717. Dries, L. v. d., Mayock, P., Gerull, S., van Loenen, T., van Hulst, B., Wolf, J. (­2016). Mothers who Experience Homelessness. In P. Mayock and J. Bretherton (­Eds), Women’s Homelessness in Europe. Basingstoke: Palgrave Macmillan, p­p. ­179–​­208. EOH: European Observatory on Homelessness (­2018). Homelessness Services in Europe. EOH Comparative Studies on Homelessness. Brussels: EOH. FEANTSA (­2005). ­ETHOS -​­European Typology on Homelessness and Housing Exclusion. Available at:s https://­w ww.feantsa.org/­download/­ethos2484215748748239888.pdf [Accessed 25 February 2019]. FEANTSA (­2018). Reports on Transposition of EU Free Movement Rules Stress the Need to Protect the Rights of Destitute Mobile EU Citizens. Press release 10 September 2018. Brussels: FEANTSA.

105

Susanne Gerull Forge, N., ­Hartinger-​­Saunders, R., Wright, E. and Ruel, E. (­2018). Out of the System and onto the Streets: ­LGBTQ-​­Identified Youth Experiencing Homelessness with Past Child Welfare System Involvement. Child Welfare, 96(­2), p­p. ­47–​­74. ­Geißler-​­Piltz, B., Gerull, S. (­Eds). (­2009). Soziale Arbeit im Gesundheitsbereich. Wissen, Expertise und Identität in multiprofessionellen Settings [Social Work in the Health Care. Knowledge, Expertise and Identity in Multiprofessional Settings]. Opladen and Farmington Hills: Budrich UniPress Ltd. Gerull, S. (­2014). Evictions Due to Rent Arrears. A Comparative Analysis of Evictions in 14 Countries. European Journal of Homelessness, 8(­2), p­p. ­137–​­155. Gerull, S. (­2018). Spaghetti oder Reis? Partizipation in der Wohnungslosenhilfe [Spaghetti or Rice? Participation in the Homeless Care]. Berlin; Milow; Strasburg: Schibri Verlag. Gerull, S. (­2021). Obdachlosenfeindlichkeit. Von gesellschaftlicher Stigmatisierung bis zu Hasskriminalität [Homeless Hostility. From Social Stigmatisation to Hate Crime]. In H. Amesberger, J. Goetz, B. Halbmayr and D. Lange (­Eds), Kontinuitäten der Stigmatisierung von,Asozialität’ [Continuities of the Stigmatisation of “­A sociality”]. Springer VS: Wiesbaden, p­p. ­135–​­148. Hansen Löfstrand, C. and Quilgars, D. (­2016). Cultural Images and Definitions of Homeless Women: Implications for Policy and Practice at the European Level. In P. Mayock and J. Bretherton (­Eds), Women’s Homelessness in Europe. Basingstoke: Palgrave Macmillan, p­p. ­41–​­73. IFSW: International Federation of Social Workers (­2014). Global Definition of Social Work. Available  at:  https://­w ww.ifsw.org/­­what-­​­­i s-­​­­social-​­work/­­g lobal-­​­­definition-­​­­of-­​­­social-​ ­work/ [Accessed 25 February 2019]. Littlewood, P. and Herkommer, S. (­1999). Identifying Social Exclusion. In P. Littlewood, I. Glorieux, S. Herkommer and I. Jönsson (­Eds), Social Exclusion in Europe. Problems and paradigms. Vermont/­USA: Ashgate Publishing Ltd, p­p. ­1–​­21. Mahs, J. v. (­2013). Down and Out in Los Angeles and Berlin. The Sociospatial Exclusion of Homeless People. Philadelphia: Temple University Press. Manthorpe, J., Cornes, M., O’Halloran, S. and Joly, L. (­2015). Multiple Exclusion Homelessness: The Preventive Role of Social Work. British Journal of Social Work, 45(­2), p­p. ­587–​­599. Paradis, E. (­2016). Outsiders Within: Claiming Discursive Space at National Homelessness Conferences in Canada. Social Inclusion, 4(­4), p­p. ­97–​­107. DOI: 10.17645/­si.v4i4.670. Pleace, N. (­2016). Housing First Europe Guide. Available at: https://­housingfirstguide.eu/­ website/­­w p-​­content/­uploads/­2016/­0 6/­HFG_full_Digital.pdf [Accessed 28 February 2019]. T. (­ 2018). Homelessness of Mobile ­ EU-​­ citizens as One Effect of a Reichenbach, M.-​­ ­National-​­European Conflict. Insights Into an Ethnography of Participation in Europe Using the Example of Germany. European Journal on Homelessness, 12(­1), p­p. ­41–​­60. Sheller, S. L., Hudson, K. M., Bloch, J. R., Biddle, B. and Krauthamer Ewing, E. S. (­2018). Family Care Curriculum: A Parenting Support Program for Families Experiencing Homelessness. In Maternal and Child Health Journal, 22(­9), p­p. ­1247–​­1254. Shelton, J., Stakelum, R. and Dodd, S. J. (­2020). Perceptions. Findings from a Survey of FEANTSA Membership Organisations. Available at: https://­w ww.feantsa.org/­public/­user/ ­Resources/­reports/­Youth_Homelessness_in_European_Context_v5.pdf [Accessed 1 May 2021]. Sheppard, M. (­2006). Social Work and Social Exclusion. The Idea of Practice. Aldershot; Burlington: Ashgate. ­Staub-​­Bernasconi, S. (­2012). Human Rights and Their Relevance for Social Work as Theory and Practice. In L. M. Healy and R. J. Link (­Eds), Handbook of International Social Work: Human Rights, Development, and the Global Profession. Oxford: Oxford University Press, p­p. ­30–​­36.

106

Homelessness and social work Stenberg, S.-​­A., van Doorn, L. and Gerull, S. (­2011). Locked Out in Europe: A Comparative Analysis of Evictions Due to Rent Arrears in Germany, the Netherlands and Sweden. European Journal of Homelessness, 5(­2), p­p. ­39–​­61. Zufferey, C. (­2017). Homelessness and Social Work. An Intersectional Approach. London; New York: Routledge.

107

10 HOMELESSNESS IN HUMAN GEOGRAPHY Jessie Speer

Those who experience homelessness are faced with the profoundly spatial problem having no safe, stable place in the world. Geographers have long been troubled by this spatial dilemma and have contributed to an important set of debates on the subject. This chapter provides an overview of these conversations, as they appear in ­English-​­language academic texts, paying special attention to recent developments and overlooked analyses. This chapter is loosely organised into three primary areas of concern: public space, institutional space, and private space. These categories are fluid and overlapping, and collectively cover a range of crucial issues such as mobility, gender, race, embodiment, labour, emotion, and displacement.

Public space People without access to housing or accommodation are forced to use public space for a range of private purposes, such as resting, making love, cooking, sleeping, and washing. Public space also enables opportunities for panhandling and socialising that can be essential for the survival of unsheltered people (­Rowe and Wolch, 1990). Yet, governments have long struggled to regulate such n ­ on-​­normative uses of space. In the US, as rates of unsheltered homelessness skyrocketed in the 1980s alongside the declining welfare state and ‘­rollback’ neoliberalism, local governments began funnelling resources for homelessness into aggressive arrest campaigns and property sweeps (­M itchell, 1997). Cities also developed architecture to prevent unsheltered people from sleeping or sitting and implemented programmes to bus homeless residents out of town entirely (­Mair, 1986). This process continues today as cities compete to attract investment. Mitchell (­2003) argues that the criminalisation of unsheltered homelessness has effectively annihilated the public sphere, which historically functioned as a shared resource for all urban residents and a 108

DOI: 10.4324/9781351113113-12

Homelessness in human geography

springboard for political struggle. Such measures also force people without shelter into a condition of perpetual movement, hearkening back to colonial banishment laws that framed ‘­vagrants’ as outsiders untethered to society (­Herbert and Beckett, 2010). They further function to push people into marginal city spaces, exposing women to the threat of violence and harassment (­Rowe and Wolch, 1990), and preventing people from accessing crucial social services (­Wolch, Rahimian and Koegel, 1993). In this way, unsheltered people are forced to navigate the exclusions and prohibitions of private property, without holding any of its privileges ( ­Blomley, 2006). Geographers have also examined how such a­nti-​­homeless policies have travelled, as cities look to each other for ideas on how to regulate unsheltered people’s use of public space. In Ecuador, the city of Guayaquil hired a former New York City Police Commissioner to implement an urban regeneration strategy that included harsh fines for begging (­Swanson, 2007). Elsewhere, punitive practices have often merged with discourses of compassion. Galvis (­2017) argues that the widespread praise of Bogota’s inclusive and liveable urban planning initiatives obscured the city’s aggressive ­anti-​­homeless policies. Gothenburg, Sweden similarly implemented a series of ‘­soft’ ­anti-​­homeless laws to create an attractive central business district for tourists and investors (­Thörn, 2011). Authorities banned street music, removed public toilets, converted a public park into a seating area for an adjacent cafe, and hired private security guards to patrol the streets. While these initiatives did not explicitly target homelessness, Thörn (­2011) argues that they nonetheless resemble the exclusionary dynamics of American a­ nti-​­homeless policy. Many countries in East Asia implemented similar policies after homelessness increased in the wake of the Asian Debt Crisis of 1997. In South Korea, the national government rolled out neoliberal welfare reforms that drew a clear distinction between ‘­deserving’ and ‘­undeserving’ poor, where only employable men were considered deserving of welfare and employment opportunities. Under pressure from the IMF and World Bank, the government devolved responsibility for the crisis to the municipal level and cities began to criminalise sleeping on the streets (­Song, 2011). In Japan, rising homelessness after the 1990s represented a rupture in the nation’s vision of a right to livelihood. Hayashi (­2013) argues that as cities instituted increasingly punitive reforms, they became autonomous sites for homelessness governance marked by the denial of national rights. Taken together, East Asian ­a nti-​­homeless policies can be seen as part of a larger global trend towards neoliberal modes of punitive poverty management and the increased reliance on privatised social services (­see also Kornatowski, 2008). In Russia and Eastern Europe, rising rates of homelessness after the rapid shift towards capitalism corresponded with similar shifts. In St. Petersburg, deregulation initially allowed for the existence of a ‘­refuse economy’ where unsheltered people could make a living informally and find unpoliced places to sleep. When urban renovation swept the city, it transformed these sites into ‘­prime spaces’ from which unsheltered people were displaced. At the same time as lodging opportunities for unhoused people vanished, social services remained limited only to those with ­propiska—​­registration at a permanent address (­Höjdestrand, 2011). In 109

Jessie Speer

Hungary and Romania, where socialist governments invested heavily in housing and public services, homelessness was framed as the aberrant result of personal pathologies rather than a failure of social services. Such ideologies resulted in a lasting stigma against homelessness that continued even after the fall of state socialism (­O’Neill, 2010; Udvarhelyi, 2014). In Hungary, this stigma contributed to intensive criminalisation culminating in national level legislation and a constitutional amendment that marked unsheltered homelessness as an illegal obstruction of public space (­Udvarhelyi, 2014). The policing of public space has also impacted unsheltered children. Much of the geographic literature on homelessness in Africa, Latin America, and Southeast Asia has tended to examine the unique experiences of street children, who are subjected to state regulation for their use of public space. In Ecuador, the policing of street children manifested as part of a racialised project of blanqueamiento or ‘­whitening.’ As neoliberal policies made agricultural livelihoods ever more tenuous, many rural indigenous people were forced to abandon their plots of land and relocate to cities to engage in informal labour. At the same time, cities sought to sell themselves as sites for tourism and upper income consumption by cracking down on informality and begging. Policies targeting poor rural migrants, including children, were profoundly steeped in racial and colonial ideologies that privileged whiteness (­Swanson, 2007). In Uganda, street children pushed out of prime urban areas moved to marginal niches in the city centre so they could continue to engage in survival strategies such as begging, window washing, and stealing, which required the presence of dense urban crowds. Young (­2003) argues that such ­spaces—​­trash heaps, underground drainage tunnels, and parking lot rooftops, for e­ xample—​­are not geographic peripheries on the urban outskirts, but culturally produced peripheries in the heart of the city. In Ethiopia, childhood begging practices are necessary for the survival of poor urban households, many of whom came to the city after their rural livelihoods became untenable (­Abebe, 2008). In stark contrast to homeless youth in the US who often have severed or strained family ties (­Gibson, 2011), street children in Ethiopia often framed begging as a crucial avenue through which to gain economic security for their families (­Abebe, 2008). While very little work has examined the geographies of homelessness in Africa, Asia, and Latin America, these studies all highlight a distinct geography of homelessness marked by rural i­n-​­migration and large numbers of ­people—​­including ­children—​­who rely on public space as a source of urban livelihood (­see also Shamshad and Chaplot, 2017; Roy and Siddique, 2018).

Institutional space Cultural geographers have sought to push back against the tendency in urban geography to ­over-​­emphasise the punitive nature of homelessness management. DeVerteuil, May, and Von Mahs (­2009) argue that much of the emphasis on militarised urban space is based on the assumption that American dynamics are universal. Instead, they argue, the situation in the UK must be examined on its own terms, as homelessness services often foster genuine relationships of care and compassion 110

Homelessness in human geography

that are crucial to the everyday lives of homeless residents. Laurenson and Collins (­2007) similarly found that support systems in New Zealand outweighed punitive ­a nti-​­homeless measures. Many geographers have conceptualised homelessness management as a blurring of compassionate and punitive approaches. In San Francisco, city authorities promoted a ‘­gentler’ approach to homelessness by redeveloping ­single-​­room occupancy hotels into supportive housing. Yet, Murphy (­2009) argues that this new mode of ostensibly compassionate assistance effectively removed some of the only super ­low-​­income housing from the market and made it available only to those enrolled in a strict and paternalistic programme. Studies have also revealed that the architectural design of shelters and service providers can be coercive, aiming to recreate hegemonic domestic ideals of individualism and private ownership (­Veness, 1994; Datta, 2005). As Lancione (­2016) argues, institutional settings in Italy are often hostile to difference and promote normative visions of proper homelessness. Rusenko (­2020) shows how a similarly paternalistic, ­Janus-​­faced approach to homelessness has predominated in Japan for decades, emerging out of its history of imperial governance. Shelters and other homelessness services have also faced the external pressure of NIMBYism. In many US cities, zoning measures prevent shelters from locating anywhere except marginalised neighbourhoods (­Brinegar, 2003). As a result, entire neighbourhoods have been carved out as ‘­­service-​­dependent ghettos’ marked by the clustering of services. Over time, the closure of institutional support systems led to spatial fragmentation that imposed increasingly complex demands on unhoused people’s daily mobility (­Dear and Wolch, 1987). In Hong Kong, the government sought to maintain the aesthetic draw of touristic areas by only funding shelters in undesirable i­ nner-​­city neighbourhoods (­Kornatowski, 2008). Takahashi (­1998) argues that such forms of NIMBYism are not simply the result of public or government attitudes towards homelessness but are the product of capitalist patterns of urban underdevelopment, revitalisation, and displacement. In their study of rural homelessness, Cloke, Milbourne, and Widdowfield (­2002) argue that weak service infrastructures in rural areas often create a pressing need for housing and services. For First Nations people in Canada, the majority of reserves are not situated near markets or services and have been subject to more than a century of disinvestment, resulting in poor housing quality and provision. Peters and Robillard (­2009) found that unhoused First Nations’ people moved frequently every year, often because services or jobs were not available on the reserve. This colonial legacy renders the reserve simultaneously a space of trauma, poverty, isolation, and poor housing, as well as family, social cohesion, and belonging, a tension which produces a ‘­circulation’ mobility pattern of constant movement between cities and reserves (­see also Christensen, 2017). Seeking to address some of the problems of emergency services, a range of agencies in North America and Europe have implemented new programmes aimed at providing rental housing for people who experience l­ong-​­term homelessness. As is described throughout this volume, Housing First ends requirements that people are ‘­housing ready’ before being rehoused. Yet, Housing First in the US has been 111

Jessie Speer

critiqued as a neoliberal strategy aimed largely at reducing the visibility of homelessness in the public sphere, lowering the cost of homeless services, and forcing people into exploitative rental relations (­Hennigan, 2017). In Canada, Housing First has presented a range of challenges for women in particular, as residents who previously lived in violent homes often struggle with the high degree of surveillance and regulation associated with Housing First. Many women also emphasise the need for connection and community to combat isolation and stigma; yet, permanent housing programmes are often based on an isolated model of individual or family residence with few spaces to foster communal connection (­K lodawsky, 2009; Fotheringham, Walsh, and Burrowes, 2014). Geographers have also examined how unhoused people’s movements are constrained and delimited by service infrastructures. Jackson (­2012) argues that unsheltered people can become ‘­fi xed’ in a condition of mobility as a result of institutional rules and regulations. She shows how homeless youth in London were often forced to leave day centres early in the evening and sleep on buses overnight, making mobility an ­ever-​­present fact of their daily lives. In Athens, service institutions often push unsheltered people into continual movement in efforts to ‘­mobilise’ them into responsible citizenship. Paradoxically, Bourlessas (­2018) argues, such enforced mobility produces the sense of passively drifting through and between institutional and public spaces, rather than actively shaping one’s own daily movements. Jocoy and Del Casino (­2010) write that unsheltered people depend on public transportation to a much greater degree than the general ­public—​­as a place to sleep or simply be during the ­d ay—​­yet are often unable to qualify for subsidised bus passes, making their mobility more tenuous. By contrast, homelessness management also fixes people in place. Dozier (­2019) argues that the entire Skid Row neighbourhood of Los Angeles has become a carceral space where unhoused people are contained and subjected to racialised ­hyper-​­policing. Across the US, jails, prisons, and other carceral institutions constitute a largely ­under-​­acknowledged site for homelessness management. Particularly when homeless encampments have been ­co-​­opted and governed by local authorities, carceral models of poverty management have become enmeshed with service provision, with shelter residence often linked to ­state-​­mandated jail diversion programmes (­Speer, 2018). In this way, homelessness can reproduce a paradoxical tension between continual displacement and containment.

Private space Geographers are increasingly moving beyond the public and institutional sphere to examine private space as crucial to the experience of homelessness (­Sparks, 2010). While homelessness is often framed as the result of unemployment and low wages, it is also a problem of housing and domesticity. Homelessness not only results from eviction and high rental costs, but from huge shortfalls in affordable housing supply in most OECD countries. In the US, policymakers often disallow the informal home spaces that poor people create, such that families living in shanties or crowded apartments are evicted and forced to live in the shelter system (­Veness, 112

Homelessness in human geography

1992). Aman and Yarnal (­2010) argue that a growing number of mobile home squatters in the US experience a kind of ­quasi-​­homelessness or housing exclusion. In Western Australia, policy understandings of what constitutes a home are based on urban, colonial assumptions that are often irrelevant to rural contexts, resulting in increased rates of housing condemnation and homelessness among Aboriginal communities (Zufferey and Chung, 2015). In Hong Kong, soaring housing costs have led to the creation of an entire class of ‘­cage sleepers’ who reside in spaces only large enough to fit a single bed. At the same time, the official tolerance of such housing has contributed to relatively low levels of visible, unsheltered homelessness (­Kornatowski, 2008). In Buenos Aires, the incidence of squatting has increased rapidly in recent years, alongside rising housing costs. Muñoz (­2018) describes how squatters living in hotels in Buenos Aires, many of whom are migrants from surrounding countries, face the constant threat of sudden eviction and must continually negotiate the use of shared domestic resources. Altogether, such precarious forms of l­ow-​­income, illegal, and insecure housing highlight the blurred boundary between housing exclusion, hidden homelessness, and rough sleeping. Geographers have also examined how unsheltered people form alternative kinds of domestic spaces. For many who experience homelessness, public city streets or town squares function as homelike sites of belonging, as they are places to return to, to meet friends, and from which to venture forth (­Robertson, 2007; Ursin, 2011). Libraries can also become crucial spaces for leisure and shelter during the day (­Hodgetts et al., 2008). For young people in Sydney, homelessness is often associated with traumatic relationships with past homes and the ongoing struggle to find safe spaces. Yet, social connections with others on the street can enable young people to ­re-​­establish a sense of home (­Robinson, 2011). In the US, an increasing number of people reside in their cars. W ­ ehman-​­Brown (­2 016) argues that the mobile nature of motor vehicles paradoxically enables car dwellers to find moments of stillness and stability during which they can evade ­anti-​­homeless policing. Such experiences recall the ‘­homeless vehicles’ project developed in New York City in which artists outfitted shopping carts with ­built-​­in sleeping pods, storage space, and washbasins. Smith (­1992) argues that such mobile shelters challenged the construction of scale itself, as people without homes used their residential mobility to expand the scale at which they moved about in the city. In many ways, homelessness also collapses the scales of the body and the home. As housing is an arrangement of space designed to protect the body and provide privacy for intimate bodily functions, unsheltered people experience extreme bodily exposure. For unsheltered men in Cape Town, South Africa, managing the ­body—​­its movements, comforts, pains, and ­v isibility—​­was central to the experience of homelessness, and a lack of bodily autonomy took a daily emotional toll (­Daya and Wilkins, 2013). In turn, certain bodies are more often identified as appropriate subjects of violence and exploitation. May (­2015) writes that young unsheltered men of colour who resided in downtown in Toronto often characterised suburban neighbourhoods as sites of intense racial scrutiny in which their bodies were sorted and judged. At the same time, the body can become a primary 113

Jessie Speer

line of resistance to stigmatising discourses. Beazley (­2003) shows how unsheltered homeless boys in Indonesia engaged in shared bodily ­practices—​­dress codes, masculine sexual posturing, drug use, and body ­modification—​­to counter the enormous stigma they faced in society, particularly as they became teenagers viewed as criminals rather than children deserving of protection. In addition to establishing homelike spaces in public, unsheltered people also develop informal communities of private, ­self-​­made dwellings. In Los Angeles, homeless encampments during the 80s and 90s offered respite from the violence of the streets, as community members provided security and protection for each other (­Rowe and Wolch, 1990). Ruddick (­1996) shows how such communities actively seek out invisible spaces as a strategy to bypass city policy. For unsheltered people who are often subjected to invasions of privacy and have few opportunities to be free from the public gaze (­Langegger and Koester, 2016; Goldfischer, 2018), camping provides a modicum of ­much-​­needed private space (­Sparks, 2010). Outside of city centres, unsheltered people often camp in p­ eri-​­urban park spaces, often framing their livelihoods as a form of rugged wilderness survival (­Rose and Johnson, 2017). In South Africa, informal s­tructures—​­including those without doors, locks, walls, or r­oofs—​­often constitute ‘­home’ for many people living in communal shack settlements (­Meth, 2003). Those who create informal dwellings thus challenge market property as the primary building block of urban society and subvert notions of domestic space as belonging only to s­elf-​­contained nuclear families (­see also Lancione, 2020). Indeed, unsheltered homeless collectives more broadly have been found to play an active role in reshaping urban space through creative ­place-​­making tactics (­Aufseeser 2018; Dozier 2019). But informality is by no means a solution to the problems of homelessness. In the US and elsewhere, residents of informal settlements are faced with the everyday reality of having no access to running water, trash pickup services, or bathroom facilities (­Speer, 2016) and being disproportionately exposed to environmental hazards (­Goodling, 2020). In the absence of the encampment, homelessness often becomes invisible. In the UK, hidden homelessness among women and Black and minority ethnic groups is often undercounted (­May, Cloke, and Johnsen, 2007; Deverteuil, 2011). In India, ­large-​­scale ­m igration—​­both of rural migrants and of refugees from neighbouring a­ reas—​­constitutes one of the leading causes of pavement dwelling (­Roy and Siddique, 2018; Shamshad and Chaplot, 2017). Yet because of the large and shifting nature of the problem, state census data is incredibly difficult to obtain. In Germany, the state historically refused to collect statistics on homelessness on the grounds that it was impossible to acquire accurate data. As Marquardt (­2016) argues, homelessness in this case represented the limit of state knowledge. These studies reveal the importance of making homelessness more visible, in all its dynamics, and moving away from simplistic, numerical models for assessing the scale and nature of the problem. Knowledge about homelessness is crucial not only to make the problem more visible, but to advance a narrative that more accurately reflects the voices and experiences of people of who actually experience it (­Schmidt and Robaina, 2017; Speer, 2021). 114

Homelessness in human geography

Conclusion Altogether, geographers have shown how unsheltered people are presented with a fundamentally spatial set of problems. Across the globe, unsheltered people share the common experience of struggling for freedom of movement in the face of ­anti-​­homeless policies, navigating between institutional resources to survive, and securing a modicum of privacy in the absence of stable housing. Geographers have further highlighted how homelessness challenges the smooth functioning of capitalist markets, such that increasingly neoliberal urban governments seek to address the issue through the ‘­geographic fix’ of continual displacement and containment. Yet, there is much room for further analysis in the field. In today’s world of rising nationalism, race, nationality, and migration status all profoundly shape the experience of homelessness in ways that are poorly understood in geography. More broadly, it is crucial to research the ways in which homelessness manifests at the intersection of multiple forms of inequality and discrimination, including ableism and heteronormativity. Geographers can produce a clearer picture of the dynamics of homelessness by researching more expersssiences outside of Europe and North America and examining homelessness through a more intersectional lens.

References Abebe, T. (­2008). Earning a living on the margins: Begging, street work and the socio-­ spatial experiences of children in Addis Ababa. Geografiska Annaler: Series B, Human Geography, 90(­3), ­271–​­284. Aman, D. and Yarnal, B. (­2010). Home sweet mobile home? Benefits and challenges of ­mobile home ownership in rural Pennsylvania. Applied Geography, 30(­1), ­84–​­95. Aufseeser, D. (­2018). Challenging conceptions of young people as urban blight: Street ­children and youth’s ambiguous relationship with urban revitalization in Lima, Peru. Environment and Planning A: Economy and Space, 50(­2), ­310–​­326. Beazley, H. (­2003). Voices from the margins: street children’s subcultures in Indonesia. Children’s Geographies, 1(­2), ­181–​­200. Blomley, N. (­2006). Editorial: Homelessness and the delusions of property. Transactions of the Institute of British Geographers, 31(­1), ­3 –​­5. Bourlessas, P. (­2018). ‘­These people should not rest’: Mobilities and frictions of the homeless geographies in Athens city centre. Mobilities, 13(­5), ­746–​­760. Brinegar, S. J. (­2003). The social construction of homeless shelters in the Phoenix area. Urban Geography, 24(­1), ­61–​­74. Christensen, J. (­2017). No Home in a Homeland: Indigenous Peoples and Homelessness in the Canadian North. Vancouver: University of British Columbia Press. Cloke, P., Milbourne, P. and Widdowfield, R. (­2002). Rural Homelessness: Issues, Experiences and Policy Responses. Bristol: Policy Press. Datta, A. (­2005). ‘­Homed’ in Arizona: The architecture of emergency shelters. Urban Geography, 26(­6), ­536–​­557. Daya, S. and Wilkins, N. (­2013). The body, the shelter, and the shebeen: An affective geography of homelessness in South Africa. Cultural Geographies, 20(­3), ­357–​­378. Dear, M. J. and Wolch, J. R. (­1987). Landscapes of Despair: From Deinstitutionalization to Homelessness. Princeton: Princeton University Press. DeVerteuil, G. (­2011). Survive but not thrive? Geographical strategies for avoiding absolute homelessness among immigrant communities. Social  & Cultural Geography, 12(­8), ­929–​­945.

115

Jessie Speer DeVerteuil, G., May, J. and Von Mahs, J. (­2009). Complexity not collapse: Recasting the geographies of homelessness in a ‘­punitive’ age. Progress in Human Geography, 33(­5), ­646– ​­666. Dozier, D. (­2019). Contested development: Homeless property, police reform, and resistance in skid row, LA. International Journal of Urban and Regional Research, 43(­1), ­179–​­194. Fotheringham, S., Walsh, C. A. and Burrowes, A. (­2014). ‘­A place to rest’: The role of transitional housing in ending homelessness for women in Calgary, Canada. Gender, Place & Culture, 21(­7 ), 8­ 34–​­853. Galvis, J. P. (­2017). Planning for urban life: Equality, order, and exclusion in Bogota’s lively public spaces. Journal of Latin American Geography, 16(­3), ­83–​­105. Gibson, K. E. (­2011). Street Kids: Homeless Youth, Outreach, and Policing New York’s Streets. New York: New York University Press. Goldfischer, E. (­2018). ‘­­Peek-­​­­a-​­boo, we see you too’: Homelessness and visuality in New York City. Environment and Planning D: Society and Space, 36(­5), ­831–​­848. Goodling, E. (­2020). Intersecting hazards, intersectional identities: A baseline Critical Environmental Justice analysis of US homelessness. Environment and Planning E: Nature and Space, 3(­3), ­833–​­856. Hayashi, M. (­2013). Times and spaces of homeless regulation in Japan, ­1950s–​­2000s: Historical and contemporary analysis. International Journal of Urban and Regional Research, 37(­4), ­1188–​­1212. Hennigan, B. (­2017). House broken: Homelessness, housing first, and neoliberal poverty governance. Urban Geography, 38(­9), ­1418–​­1440. Herbert, S. and Beckett, K. (­2010). ‘­This is home for us’: Questioning banishment from the ground up. Social & Cultural Geography, 11(­3), ­231–​­245. Hodgetts, D., Stolte, O., Chamberlain, K., Radley, A., Nikora, L., Nabalarua, E. and Groot, S. (­2008). A trip to the library: Homelessness and social inclusion. Social & Cultural Geography, 9(­8), ­933–​­953. Höjdestrand, T. (­2011). Good relationships, ­m icro-​­entrepreneurship, and permissive spaces: ‘­Transitional’ homelessness in St. Petersburg, Russia. Urban Geography, 32(­7 ), ­957–​­971. Jackson, E. (­2012). Fixed in mobility: Young homeless people and the city. International Journal of Urban and Regional Research, 36(­4), ­725–​­741. Jocoy, C. L., and Del Casino Jr., V. J. (­2010). Homelessness, travel behavior, and the politics of transportation mobilities in Long Beach, California. Environment and Planning A: Economy and Space, 42(­8), ­1943–​­1963. Klodawsky, F. (­2009). Home spaces and rights to the city: Thinking social justice for chronically homeless women. Urban Geography, 30(­6), ­591–​­610. Kornatowski, G. (­2008). The reconceptualization of homelessness policy and the social welfare response of ­non-​­governmental organizations in Hong Kong. Japanese Journal of Human Geography, 60(­6), ­533–​­556. Lancione, M. (­2016). Racialised dissatisfaction: Homelessness management and the everyday assemblage of difference. Transactions of the Institute of British Geographers, 41(­4), ­363–​­375. Lancione, M. (­2020). Radical housing: On the politics of dwelling as difference. International Journal of Housing Policy, 20(­2), ­273–​­289. Langegger, S., and Koester, S. (­2016). Invisible homelessness: Anonymity, exposure, and the right to the city. Urban Geography, 37(­7 ), ­1030–​­1048. Laurenson, P., and Collins, D. (­2007). Beyond punitive regulation? New Zealand local governments’ responses to homelessness. Antipode, 39(­4), ­649–​­667. Mair, A. (­1986). The homeless and the ­post-​­industrial city. Political Geography Quarterly, 5(­4), ­351–​­368. Marquardt, N. (­2016). Counting the countless: statistics on homelessness and the spatial ontology of political numbers. Environment and Planning D: Society and Space, 34(­2), ­301–​­318. May, J. (­2015). Racial vibrations, masculine performances: Experiences of homelessness among young men of colour in the Greater Toronto Area. Gender, Place & Culture, 22 (­3), ­405–​­421.

116

Homelessness in human geography May, J., Cloke, P., and Johnsen, S. (­2007). Alternative cartographies of homelessness: Rendering visible British women’s experiences of ‘­v isible’ homelessness. Gender, Place and Culture, 14(­2), ­121–​­140. Meth, P. (­2003). Rethinking the ‘­domus’ in domestic violence: Homelessness, space and domestic violence in South Africa. Geoforum, 34(­3), ­317–​­327. Mitchell, D. (­1997). The annihilation of space by law: The roots and implications of ­a nti-homeless laws in the United States. Antipode, 29(­3), ­303–​­335. Mitchell, D. (­2003). The Right to the City: Social Justice and the Fight for Public Space. New York: Guilford Press. Murphy, S. (­2009). ‘­Compassionate’ strategies of managing homelessness: Post-revanchist geographies in San Francisco. Antipode, 41(­2), ­305–​­325. Muñoz, S. (­2018). Precarious city: ­Home-​­making and eviction in Buenos Aires, Argentina. Cultural Geographies, 25(­3), ­411–​­424. O’Neill, B. (­2010). Down and then out in Bucharest: Urban poverty, governance, and the politics of place in the postsocialist city. Environment and Planning D: Society and Space, 28(­2), ­254–​­269. Peters, E. J., and Robillard, V. (­2009). ‘­Everything you want is there’: The place of the ­reserve in First Nations’ homeless mobility. Urban Geography, 30(­6), ­652–​­680. Robertson, L. (­2007). Taming space: Drug use, HIV, and homemaking in Downtown ­Eastside Vancouver. Gender, Place and Culture, 14(­5), ­527–​­549. Robinson, C. (­2011). Beside One’s Self: Homelessness Felt and Lived. Syracuse: Syracuse ­University Press. Rose, J. and Johnson, C. (­2017). Homelessness, nature, and health: Toward a feminist political ecology of masculinities. Gender, Place & Culture, 24(­7 ), ­991–​­1010. Rowe, S. and Wolch, J. (­1990). Social networks in time and space: homeless women in skid row, Los Angeles. Annals of the Association of American Geographers, 80(­2), ­184–​­204. Roy, A. and Siddique, G. (­2018). Pavement dwellers of Kolkata: A geographical appraisal. Researchers World, 9(­1), ­36–​­49. Ruddick, S. (­1996). Young and Homeless in Hollywood: Managing Social Identities. New York: Routledge. Rusenko, R. M. (­2020). Homelessness regulation and neoliberalism’s imperial past: The Janus face of anti-homeless urbanism and Tokyo’s modern socio-spatial development. Antipode, 52(­6), ­1815–​­1836. Schmidt, K. and Robaina, I. M. M. (­2017). Beyond removal: Critically engaging in research on geographies of homelessness in the city of Rio de Janeiro. Journal of Latin American Geography, 16(­1), 9­ 3–​­116. Shamshad, M. and Chaplot, B. (­2017). Houseless people in Kanpur City: An exploratory study. Forum Geografic, 16(­1), ­80–​­87. Smith, N. (­1992). Contours of a spatialized politics: Homeless vehicles and the production of geographical scale. Social Text, 33, ­55–​­81. Song, J. (­2011). Situating homelessness in South Korea during and after the Asian Debt Crisis. Urban Geography, 32(­7 ), ­972–​­988. Sparks, T. (­2010). Broke not broken: Rights, privacy, and homelessness in Seattle. Urban Geography, 31(­6), ­842–​­862. Speer, J. (­2016). The right to infrastructure: A struggle for sanitation in Fresno, California homeless encampments. Urban Geography, 37(­7 ), ­1049–​­1069. Speer, J. (­2018). The rise of the tent ward: Homeless camps in the era of mass incarceration. Political Geography, 62, ­160–​­169. Speer, J. (­2021). Subalternity as displacement: Memoirs of homelessness and the struggle to be heard. Environment and Planning D: Society and Space, 39(­4), ­627–​­644. 2007). Revanchist urbanism heads south: The regulation of indigenous Swanson, K. (­ ­beggars and street vendors in Ecuador. Antipode, 39(­4), 7­ 08–​­728. Takahashi, L. (­1998). Homelessness, AIDS, and Stigmatization: The NIMBY Syndrome in the United States at the End of the Twentieth Century. Oxford: Oxford University Press.

117

Jessie Speer Thörn, C. (­2011). Soft politics of exclusion: Entrepreneurial strategies of ambience and control of public space in Gothenburg, Sweden. Urban Geography, 32(­7 ), ­989–​­1008. Udvarhelyi, É. T. (­2014). ‘­If we don’t push homeless people out, we will end up being pushed out by them’: The criminalization of homelessness as state strategy in Hungary. Antipode, 46(­3), ­816–​­834. Ursin, M. (­2011). ‘­W herever I lay my head is home’–​­young people’s experience of home in the Brazilian street environment. Children’s Geographies, 9(­2), ­221–​­234. Veness, A. R. (­1992). Home and homelessness in the United States: Changing ideals and realities. Environment and Planning D: Society and Space, 10(­4), ­4 45–​­468. Veness, A. R. (­1994). Designer shelters as models and makers of home: New responses to homelessness in urban America. Urban Geography, 15(­2), ­150–​­167. ­Wehman-​­Brown, G. (­2016). Home is where you park it: P ­ lace-​­making practices of car dwelling in the United States. Space and Culture, 19(­3), ­251–​­259. Wolch, J., Rahimian, A., and Koegel, P. (­1993). Daily and periodic mobility patterns of the urban homeless. Professional Geographer, 45(­2), ­159–​­169. Young, L. (­2003). The ‘­place’ of street children in Kampala, Uganda: Marginalisation, ­resistance, and acceptance in the urban environment. Environment and Planning D: Society and Space, 21(­5), ­607–​­627. Zufferey, C. and Chung, D. (­2015). ‘­Red dust homelessness’: Housing, home and homelessness in remote Australia. Journal of Rural Studies, 41, ­13–​­22.

118

11 HOMELESSNESS THROUGH A FEMINIST LENS Juliet Watson

Introduction Homelessness is not a ­gender-​­neutral phenomenon. Representation of ‘­homeless people’ as a homogeneous population favours a common experience that, by default, is that of (­certain) men. This excludes experiences and social processes of oppression that differ due to gender and further serves to marginalise women in all their diversity. Despite increased awareness and visibility of (­certain) women’s experiences of homelessness, gender remains an area of research that requires greater investigation. The application of a feminist lens allows for the unique and disparate experiences of homeless women to be recognised. Existing feminist and ­feminist-​­inclined research has drawn attention to the specific challenges faced by women experiencing homelessness, and to how homelessness is mediated through gender. Key texts by scholars such as Watson and Austerberry (­1986), Tomas and Dittmar (­1995), and Wardhaugh (­1999) have been instrumental in raising the profile of women’s homelessness and demonstrating how blindness to gender reinforces invisibility. This, in turn, is reflected in how women are represented (­or not) in policy and service delivery (­Watson, 2000). More recently, initiatives such as FEANTSA’s work on women’s homelessness (­Bretherton and Mayock, 2021) and the Women’s Homelessness in Europe Network (­Mayock and Bretherton, 2016) have established connections to drive discussion and action on women’s homelessness. This has been accompanied by the emergence of an increasingly strong body of scholarly literature that is expanding and diversifying the evidence base of women’s homelessness beyond simply noting its existence (­Neale, 1997; Edgar and Doherty, 2001; Cramer, 2005; Baptista, 2010; Jasinski et al., 2010; Mayock, Sheridan and Parker, 2015; Mayock and Bretherton, 2016; Bretherton, 2017, 2020; May, Cloke and Johnsen, 2007; Johnson, Ribar and Zhu, 2018; Mayock and Sheridan, 2020). There is, nevertheless, still much that is DOI: 10.4324/9781351113113-13

119

Juliet Watson

unknown; and, as new knowledge of women’s experiences emerges, homelessness research needs fresh theorisation and analysis that are in line with contemporary feminist ideas and activity (­Bretherton, 2017). Just as homelessness is not a static field of interrogation, feminism, too, is a dynamic and contested site. Feminism/­s not only assist in highlighting the complexity of women’s homelessness, they also contribute to the politicisation of this space. It is, therefore, necessary for feminists to reassess their critical positions continually in order to adapt to changing social trends and ideologies (­W helehan, 1995). ‘­Woman’, too, is not a fixed and universal identity. As Butler argues, ‘­feminism has always been committed to the proposition that the social meanings of what it is to be a man or a woman are not yet settled’—​­categorisations are connected to time and place and are continually evolving (­Ferber, 2020, n.p.). The term ‘­woman’ is used throughout this chapter to describe anyone who identifies as such. Multiple and diverse identities further speak to the necessity for homeless research, policy and practice to be attuned and responsive to gender complexity. This chapter examines how three tenets of contemporary f­eminism—​ ­intersectionality, bodies, and p­ ostfeminism—​­can contribute to better understandings of women’s experiences of homelessness. Although addressed separately, these feminist frameworks do not exist as discrete objects of enquiry; there is overlap and entanglement. Feminist readings of homelessness cannot be categorised neatly; however, this slippage offers the opportunity to examine homelessness in new and exciting ways.

Intersectionality Black feminist scholarship and activism, in conjunction with Critical Race Theory and Antiracism, have been instrumental in highlighting that oppression operates through multiple and connected systems that create complex inequalities, including, but not exclusive to, those grounded in gender (­Crenshaw, 1989; Carastathis, 2014). In her landmark text, ‘­Demarginalizing the intersection of race and sex’, Kimberlé Crenshaw (­1989), building on earlier work of Black feminists such as Sojourner Truth and Anna Julia Cooper, identified that sexism and racism could not be disentangled as detached objects of analysis, and that disadvantage does not occur along a s­ingle-​­axis framework. Rather, oppression and privilege transpire through the interaction of multiple structures, including gender and race, but also through other junctures, such as those involving class, sexuality, place, age, ability, and faith, to produce complex and multiple inequalities. Crucially, intersectionality highlights ‘­the vexed dynamics of difference and the solidarities of sameness’ (­Cho, Crenshaw and McCall, 2013, ­p. 787). Crenshaw’s (­1991) contention is that an awareness of intersectionality involves recognition and analysis of structural, political, and cultural power dynamics. The extension of this to homelessness demonstrates that structural inequalities are experienced differently by homeless individuals, and political approaches that focus on specific categories of ‘­homeless people’ can inadvertently lead to further marginalisation. Examples include feminist responses that only recognise gender 120

Homelessness through a feminist lens

as the sole cause of oppression, and cultural representations of homelessness that continually depict individualistic and homogenising explanations of homelessness (­Zufferey, 2017). Blindness to difference not only disguises historical and structural oppression (­Crenshaw, 1989), it also hides how inequality is an active process through which social dynamics shift and change in different places and times (­Cooper, 2008). A feminist intersectional lens allows an exploration of how people experiencing homelessness negotiate multiple power structures, and provides researchers, policy makers, and practitioners with the conceptual framework to examine coherence and contradiction in women’s lives (­Watson, 2018). There are differences of opinion as to whether intersectionality constitutes a theory, a framework, or a politics (­Davis, 2008; Carbin and Edenheim, 2013; Cho, Crenshaw and McCall, 2013). Intersectionality has been informed by structuralist and poststructuralist ontologies, which can cause confusion over definitional boundaries especially with regard to how intersectionality relates to poststructuralist feminism and postcolonial feminism (­McKibbin et al., 2015). Rather than being a limitation of intersectionality, these nebulous margins offer opportunities for better understanding homelessness. As Zufferey (­2017, ­p. 2) argues, both structuralist and poststructuralist perspectives can inform homelessness knowledge according to ‘­the purpose of the political project’. There is a flexibility with intersectionality that suits the dynamic and evolving terrain of the homeless field. And at its core, intersectionality consciously tackles and attempts to ameliorate a key fragility of feminism and ­homelessness—​­the omission of experiences and perspectives of women on the margins (­especially those who are not white or cisgendered) and those who are subject to multiple oppressions. Homelessness research, while attentive to intersectional factors, has been inclined to focus on standalone identity categorisations rather than exploring the points at which they converge. Nevertheless, while intersectionality is not always made explicit in homelessness research, we are seeing more diverse investigations of characteristics that provide greater insight into how oppression manifests. ­Multi-​ ­d imensional analyses of women’s homelessness are being generated through explorations of how gender intersects with other identities and is shaped by structures such as race (­Washington and Moxley, 2008; Zufferey and Chung, 2015; Zufferey, 2017), age and ageing (­Washington and Moxley, 2008; Oliver, 2013; Watson, 2018), LGBTQ+ (­Frederick, 2014; Choi et al., 2015; Begun and Kattari, 2016), place (­W hitzman, 2006; Tipple and Speak, 2009), and migration (­Mayock, Sheridan and Parker, 2012; Mostowska and Sheridan, 2016). Intersectionality also offers the conceptual tools to understand the emerging ‘­new’ demographics (­Zufferey, 2017) of women’s ­homelessness—​­groupings, in addition to those listed above, that are slowly gaining greater visibility such as pregnant women, parenting women, women who have been incarcerated and/­or institutionalised, asylum seeking and refugee women, women without permanent residency, women living with disability, trans women, and rural women. Zufferey (­2017), in particular, is at the forefront in advancing the theorisation of homelessness through intersectionality and, in doing so, contends that when 121

Juliet Watson

designing intersectional research, it is necessary to continually question how social processes can oppress and privilege and, thus, conceal inequalities that create and sustain homelessness. Zufferey (­2017, ­p. 57) challenges us to ‘­a sk how intersectional analyses can examine intersecting power relations that are mutually constitutive, which includes focusing on identities, dynamics and social processes that constitute social inequalities, without reducing everything to being simply “­multiple” and “­complex”’. Hence, when examining how homelessness is a dynamic process through which gender interacts with other oppressions, it is important not to render these entanglements of identity narratives as meaningless through the homogenisation of complexity.

Bodies Feminist theorising has been pivotal in demonstrating relationships between the body and society. This has occurred through developments in how the body is conceptualised in material, social, and cultural ways. Central to this has been the challenging of essentialised, problematised and othered representations of women’s bodies. This has included disputing gender essentialism, challenging the gender binary, scrutinising how gender is represented, and deconstructing how race, class, and gender converge in the body (­Budgeon, 2015). Feminist contributions, alongside other ­a nti-​­essentialist and ­anti-​­foundationalist movements such as postmodernism, poststructuralism, postcolonial studies, and disability studies, have been critical in shifting Western notions of the body from Cartesian binaries of mind/­ body that position women as objects in opposition to men as subjects. The logic of aligning men with the mind, and therefore rationality and order, and women with the body, and therefore emotion and nature, has been disrupted by feminists seeking to destabilise dualist understandings of the body that sustain patriarchal interests and oppression of women and other groups (­Butler, 1993; Bordo, 2003; Braidotti, 2011). The ‘­lived’ body has emerged as a way of counteracting fixed classification of bodies. This approach recognises that bodily experiences are varied according to contexts, such as homelessness, rather than through arbitrary dualisms. Young (­2002, ­p. 422) argues that gender is ‘­a form of social positioning of lived bodies in relation to one another within historically and socially specific institutions and processes that have material effects on the environment in which people act and reproduce relations of power’. Young does not advocate for replacing gender with the lived body but instead suggests applying gender as a means for analysing social structures in order to better understand specific power dynamics and access to resources. To this, we can add other bodily signifiers such as race, ability, and age. The body, therefore, is to be understood ­relationally—​­it is an active force that interacts with other bodies and social institutions. Power dynamics, exchange, and coercion all cohere in the body (­Shilling, 2012). Clearly, this reverberates with how women are positioned in, and navigate, homelessness. Not only are inequalities based on gender (­a nd other intersectional structures) lived through the body, so too is homelessness. The body mediates 122

Homelessness through a feminist lens

experiences, opportunities, and risks faced by people experiencing homelessness. This has particular resonance for how gender is negotiated in the homeless field. The physicality of (­certain) masculine bodies allows them greater access and entitlement to certain ‘­homeless’ spaces, while women’s bodies are associated with reduced social status, vulnerability, and sites of potential victimisation (­Watson, 2018). Bodily entitlement to space has further implications for transgender and ­gender-​­diverse individuals, who have described adhering to cisgender standards of ­gender—​­or ­passing—​­in order to live and feel safe in shelter accommodation, for instance (­Begun and Kattari, 2016). Bourdieu’s (­1990) social capital framework, which emphasises relationality, is useful for explaining how meaning is attached to homeless bodies through the accumulation of different forms of capital and for exploring how social dispositions are embodied. The capital held by physical bodies, through markers such as size, race, ability, age, and strength, contributes to, and produces, social inequalities (­Shilling, 2012). Although Bourdieu’s work on gender is limited, his theoretical contribution has been extended by feminist scholars to explore the gendered body as a site of material, symbolic, and physical enquiry (­Butler, 1999; Skeggs, 2004a, 2004b). Skeggs (­1997, 2004a) has been instrumental in building Bourdieu’s concept of capital to take account of feminine ­capital—​­an embodied resource and source of regulation. Unlike certain articulations of masculinity, femininity is not symbolically dominant (­Skeggs, 2004b). Women’s bodies do not hold the same physical or symbolic authority and privilege as men’s bodies. With few resources, the deployment of embodied femininity can be a potential source of capital accrual through, for example, survival ­sex—​­the exchange of sex and/­or intimate relationships for material and ­non-​­material support (­Watson, 2018). The instability and dangers of the homeless sphere, combined with complex gendered dynamics, can result in women activating their limited feminine capital by making bodily alliances with men to manage the conditions of homelessness (­Watson, 2016, 2018). Moreover, the effects of homelessness are felt experiences (­Robinson, 2011), making it imperative that the sensory and affective dimensions are put at the forefront of feminist analysis. This provides a foundation for understanding how homelessness is both situated and produced through the body. This transcends understandings of the body as a discrete entity and the gendered body as binaristic, and instead draws attention to the variety of possible bodily experiences, and how bodies are ‘­lived’ and transformed in the context of homelessness. Stripped of a home, material possessions, and social connections, the body becomes the only conduit between the self and society. Homeless bodies are particularly unruly; they contradict the ‘­­t aken-­​­­for-​­g ranted discourse embodied from childhood’ that it is the individual’s responsibility to control and manage their body (­Coffey and Watson, 2015. ­p. 192). Lack of access to facilities can mean that opportunities for private bodily maintenance and personal hygiene are limited. Women may further have to manage bodily functions associated with menstruation, safer sex practices, pregnancy, childbirth, menopause, hormone treatment, and body modification in challenging ­circumstances—​­aspects unaccounted for if gender remains unacknowledged in responses to homelessness. The homeless body 123

Juliet Watson

becomes abject and, as Kawash (­1998, ­p. 322) contends, it is ‘­trapped by a circular logic whereby its initial exclusion further marks it as that which must be excluded’. The bodies of women experiencing homelessness are also inscribed with connotations of sexual immorality and lack of respectability through pejorative associations with commercial sex work and survival sex (­Watson, 2018). This positioning of women’s bodies as abject further reduces their capacity to accumulate the capital that could be mobilised to exit homelessness.

Postfeminism Postfeminism is a contested theoretical domain that has been applied to perspectives as disparate as ‘­­anti-​­feminist backlash, ­pro-​­feminist third wave, Girl Power dismissive of feminist politics, trendy ­me-​­first power feminism and academic postmodern feminism’ (­Genz and Brabon, 2018, p­ .  10). For the purpose of extending homelessness enquiry, postfeminism is mobilised here as an object of critical analysis to explain the complexity of gender enactment and politics in neoliberal society. The core market principles of neoliberal ideology, such as competition and choice, are central to understanding the emergence of postfeminism and its effect on women experiencing homelessness. post-​­ industrial capitalist societies, neoliberal modes of governance have In ­ transcended the purely economic to promote individual responsibility and ­self-​ r­ egulation for livelihood and w ­ ell-​­being. This dictates that it is the individual’s ethical obligation to live as though they are f­ ree-​­choosing beings unbound by structural constraints (­Rose, 1996). Postfeminism has emerged in this climate as a reaction to feminism through the entanglement of feminist and a­ nti-​­feminist discourses (­Gill, 2011) to create a kind of f­aux-​­feminism (­McRobbie, 2009). As Budgeon (­2011, ­p. 281) argues, postfeminism ‘­relies upon a fundamental c­ ontradiction— feminism ​­ is both incorporated but simultaneously reviled’. Women are positioned as the beneficiaries of the rights, representation, and opportunities attained by previous generations of feminists without being beholden to feminism. A key criticism of postfeminism is that it depoliticises the role of gender in social ­problems—​­ignoring material, physical, and emotional i­mpacts—​­and instead places responsibility on individuals for their success (­i.e. being homed) or failure (­i.e. being homeless). Collective understandings of power are shifted to discourses of choice, making it more difficult to name inequalities as markers of societal oppression. The assumption that equality has been achieved means that when women encounter problems associated with gender and other structural factors, they are expected to manage these individually rather than locate hardship within a context of structural inequality and address it through collective action. Although postfeminism has dominated much feminist theorising of gendered practices and processes over the past few of decades, homelessness is rarely included in the discussion. Nonetheless, women experiencing homelessness are still exposed to postfeminist discourses that govern gendered identities. The narrative of ­self-​­regulating individuals reaping the benefits of greater access to lifestyle choices is potent; yet, for those who are homeless, the consequence is to be left 124

Homelessness through a feminist lens

without structural explanations for disadvantage and oppression. This does not mean, however, that women experiencing homelessness are without agency. There is still possibility for resistance within the available, albeit constraining, discourses. Acknowledging such complex power dynamics allows a greater scope for capturing women’s experiences and for challenging normative assumptions (­Mayock and Sheridan, 2020). Postfeminism also distracts from considerations of how feminism can transform society beyond notions of equality with men. The assumption that equality has been reached serves to disguise other forms of intersectional oppression such as those based on class, race, sexuality, ability, age, faith, and place. A sole focus on gender equality supposes that this is the sum of the feminist project and ignores that societal transformation should not simply be measured as equality with patriarchal standards. As Ahmed (­2017, ­p. 2, original italics) states, ‘­To build feminist dwellings, we need to dismantle what has already been assembled; we need to ask what we are against, what it is we are for, knowing full well that this we is not a foundation but what we are working toward’. This is pertinent for women experiencing homelessness; if the only measure of success is equality with other oppressed groups such as homeless men, postfeminist notions of equality have little to offer homeless women. Postfeminism, on the surface, appears to be at odds with the recent upsurge in ­large-​­scale feminist activities. There has been an escalation and intensification of visible feminist activism and commentary, as witnessed in the changing media sphere, particularly as influenced by social media (­Casey and Watson, 2017). Feminist attention has heightened around sexual ­v iolence—​­predominantly ‘­rape culture’—​­and the use of social media and the internet to ‘­call out’ and challenge sexism and misogyny (­Keller, Mendes and Ringrose, 2018). This is signified by mass awareness campaigns such as #MeToo, #timesup, and #yesallwomen. However, this feminist turn also exposes the enduring complexity of resisting and challenging patriarchy. As Gill (­2016, ­p.  613) observes, ‘­for every uplifting account of feminist activism, there is another of misogyny; for every feminist “­w in”, an outpouring of hate’. So, while public identification with feminism is increasing, it is met with a surge of misogynistic activity from patriarchal culture (­­Banet-​­Weiser, 2018). Postfeminist enquiry, therefore, remains relevant, as it provides the critical tools to explain the ­co-​­existence of contrary and multiple viewpoints inside, outside, and along the margins of feminism. Feminist activity and advancement is not a linear process; cultural and political transformation does not merely involve the replacement of old ideas with new ones (­Gill, 2016). For instance, although there may be greater willingness for women to name themselves as feminists, for some, such as women navigating certain ­m asculine-​­dominated ‘­homeless’ spaces, the risks associated with feminist identification are more pronounced. Labelling oneself a feminist remains a conscious political a­ ct—​­it is an act of resistance that requires the recognition and support associated with social capital that is largely missing for women in the h ­ yper-​­masculine environment of (­particularly unsheltered/­living rough) homeless life (­Watson, 2018). 125

Juliet Watson

Mass feminist campaigning is certainly a source of hope for societal change, particularly when it challenges feminisms that privilege white, cisgendered, ­class-​ a­ dvantaged, heterosexual, and ­able-​­bodied women. To date, however, the feminist views of women experiencing homelessness, in all their diversity, have been missing. Trepidation over engaging with feminism may also arise from a sense of lacking feminist ­competence—​­namely, not being proficient in feminist theories and/­or engaged in activism (­Simic, 2010). Despite this, homelessness scholars have much to learn about the role of feminism from women experiencing homelessness. While not necessarily being conversant in the language of contemporary feminisms, or as a matter of course being confident in understanding the tensions and contradictions of this shifting field, women experiencing homelessness are perfectly positioned to speak to key ongoing feminist concerns such as oppression, violence, and inequality, and to contest the limitations of postfeminist discourse.

Conclusion The inclusion of women in homelessness research does not automatically account for the ways that gender shapes experiences and practices of homelessness. Nor does it necessarily filter through to diverse representation in policy and service provision. Feminist theorisation is, therefore, indispensable in framing the political, cultural, and social dimensions of women’s homelessness. Through the development of new discourses to explain gender inequality and institutional oppression, as well as subjectivity and agency, a feminist lens not only increases the visibility of women’s homelessness, it offers explanatory power to make sense of the coherence and contradiction in women’s lives. There is no single feminist approach to investigating homelessness. This chapter has focused on three key developments in feminism: intersectionality, bodies, and postfeminism. These represent the ­cross-​­pollination of feminism with other critical theories and social movements that seek to explain how disadvantage and privilege manifest and sustain structural oppression. Finally, although the perspectives of women experiencing homelessness are not currently a focal point of feminist activity, they are ­well-​­positioned to inform us about quintessential feminist concerns such as how women are disciplined and controlled through patriarchy and other mechanisms of oppression, and how they resist and contest these constraints. The nexus where homelessness and feminism meet, therefore, can only advance wisdom in each domain.

References Ahmed, S. (­2017). Living a feminist life. Durham: Duke University Press. ­Banet-​­Weiser, S. (­2018). Empowered: Popular feminism and popular misogyny. Durham and London: Duke University Press. Baptista, I. (­2010). Women and homelessness. In V. ­Busch-​­Geertsema, E. O’Sullivan, N. Pleace and D. Quilgars (­Eds). Reflections on homelessness research in Europe, 1 ­ 990–​­2010: A festschrift to honour Bill Edgar and Joe Doherty. Brussels: FEANTSA, p­p. ­163–​­186.

126

Homelessness through a feminist lens Begun, S. and Kattari, S. K. (­2016). Conforming for survival: Associations between transgender visual conformity/­passing and homelessness experiences. Journal of Gay and Lesbian Social Services, 28(­1), ­54–​­66. Bordo, S. (­2003). Unbearable weight: Feminism, western culture, and the body. Berkeley: University of California Press. Bourdieu, P. (­1990). The logic of practice. Cambridge: Polity Press. Braidotti, R. (­2011). Nomadic subjects: Embodiment and sexual difference in contemporary feminist theory. 2nd edn. New York: Columbia University Press. Bretherton, J. (­2017). Reconsidering gender in homelessness. European Journal of Homelessness, 11(­1), ­1–​­21. Bretherton, J. (­2020). Women’s experiences of homelessness: A longitudinal study. Social Policy and Society, 19(­2), ­255–​­270. Bretherton, J. and Mayock, P. (­2021). Women’s homelessness: European evidence review. Brussels: FEANTSA. Budgeon, S. (­2011). The contradictions of successful femininity: ­Third-​­wave feminism, postfeminism and ‘­new’ femininities’. In R. Gill and C. Scharff (­Eds). New femininities: Postfeminism, neoliberalism and subjectivity. Basingstoke: Palgrave Macmillan, p­p. ­279–​­292. Budgeon, S. (­2015). Bodies: Corporeality and embodiment in childhood and youth studies. In J. Wyn and H. Cahill (­Eds). Handbook of children and youth studies. Springer: Singapore, p­p. ­243–​­256. Butler, J. (­1993). Bodies that matter: On the discursive limits of ‘­sex’. 2nd edn. New York: Routledge. Butler, J. (­1999). Performativity’s social magic. In R. Shusterman (­Ed.). Bourdieu: A critical reader. Oxford: Blackwell, p­p. ­113–​­128. Carastathis, A. (­2014). The concept of intersectionality in feminist theory. Philosophy Compass, 9(­5), ­304–​­314. Carbin, M. and Edenheim, S. (­2013). The intersectional turn in feminist theory: A dream of a common language? European Journal of Women’s Studies, 20(­3), ­233–​­248. Casey, S. and Watson, J. (­2017). The ­u npalatable-​­palatable: Celebrity feminism in the Australian mainstream media. Outskirts: Feminisms along the edge, 37. [Online]. Available at: http://­w ww.outskirts.arts.uwa.edu.au/­volumes/­­volume-​­37/­­casey-​­watson [Accessed 19 February 2019]. Cho, S., Crenshaw, K. W. and McCall, L. (­2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs: Journal of Women in Culture and Society, 38(­4), ­785–​­810. Choi, S. K., Wilson, B. D., Shelton, J. and Gates, G. J. (­2015). Serving our youth 2015: The needs and experiences of lesbian, gay, bisexual, transgender, and questioning youth experiencing homelessness. Los Angeles: The Williams Institute with True Colors Fund. Coffey, J. and Watson, J. (­2015). Bodies: Corporeality and embodiment in childhood and youth studies. In J. Wyn and H. Cahill (­Eds). Handbook of children and youth studies. Singapore: Springer, p­p. ­185–​­200. Cooper, D. (­2008). Intersectional travel through everyday utopias: The difference sexual and economic dynamics make. In E. Grabham, D. Cooper. J. Krishnadas, and D. Herman (­Eds). Intersectionality and beyond: Law, power and the politics of location. Abingdon: Routledge, p­p. ­299–​­325. Cramer, H. (­2005). Informal and gendered practices in a homeless persons unit. Housing Studies, 20(­5), ­737–​­751. Crenshaw, K. (­1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1(­8), ­139–​­167. Crenshaw, K. (­1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, ­1241–​­1299. Davis, K. (­2008). Intersectionality as buzzword: A sociology of science perspective on what makes a feminist theory successful. Feminist Theory, 9(­1), ­67–​­85.

127

Juliet Watson Edgar, B. and Doherty, J. M. (­2001). Women and homelessness in Europe: Pathways, services and experiences. Bristol: Policy Press. Ferber, A. (­2020). Judith Butler on the culture wars, JK Rowling and living in ‘­­anti-​ ­i ntellectual times’. New Statesman. [Online]. Available at: https://­w ww.newstatesman. com/­i nternational/­2 020/­0 9/­­judith-­​­­butler- ­​­­c ulture-­​­­wars-­​­­jk-­​­­rowling- ­​­­a nd-­​­­l iving- ­​­­a nti-­​ ­­i ntellectual-​­t imes [Accessed 30 May 2021]. Frederick, T. (­2014). Diversity at the margins: The interconnections between homelessness, sex work, mental health, and substance use in the lives of sexual minority homeless young people. In Handbook of LGBT communities, crime, and justice. New York: Springer, p­p. ­473–​­501. Genz, S. and Brabon, B. A. (­2018). Postfeminism: Cultural texts and theories. 2nd edn. Edinburgh: Edinburgh University Press. Gill, R. (­2011). Sexism reloaded, or, it’s time to get angry again! Feminist Media Studies, 11(­1), ­61–​­71. Gill, R. (­2016). ­Post-​­postfeminism? New feminist visibilities in postfeminist times. Feminist Media Studies, 16(­4), ­610–​­630. Jasinski, J. L., Wesely, J. K., Wright, J. D. and Mustaine, E. E. (­2010). Hard lives, mean streets: Violence in the lives of homeless women. Lebanon: Northeastern University Press. Johnson, G., Ribar, D. C. and Zhu, A. (­2018). Women’s homelessness: International evidence on causes, consequences, coping, and policies. In S. L. Averett, L. M. Argys and S. D. Hoffman (­Eds). The Oxford handbook of women and the economy. Oxford: Oxford University Press, p­p. ­799–​­823. Kattari, S. K. and Begun, S. (­2017). On the margins of marginalized: Transgender homelessness and survival sex. Affilia, 32(­1), ­92–​­103. Kawash, S. (­1998). The homeless body. Public Culture, 10(­2), ­319–​­339. Keller, J., Mendes, K. and Ringrose, J. (­2018). Speaking ‘­u nspeakable things’: Documenting digital feminist responses to rape culture. Journal of Gender Studies, 27(­1), ­22–​­36. McKibbin, G., Duncan, R., Hamilton, B., Humphreys, C. and Kellett, C. (­2015). The intersectional turn in feminist theory: A response to Carbin and Edenheim (­2013). European Journal of Women’s Studies, 22(­1), ­99–​­103. McRobbie, A. (­2009). The aftermath of feminism: Gender, culture and social change. London: Sage. May, J., Cloke, P. and Johnsen, S. (­2007). Alternative cartographies of homelessness: Rendering visible British women’s experiences of ‘­v isible’ homelessness. Gender, Place and Culture, 14(­2), ­121–​­140. Mayock, P. and Bretherton, J. (­Eds). (­2016). Women’s homelessness in Europe. London: Palgrave Macmillan. Mayock, P. and Sheridan, S. (­2020). Women negotiating power and control as they ‘­journey’ through homelessness: A feminist poststructuralist perspective. European Journal of Homelessness, 14(­2), ­17–​­47. Mayock, P., Sheridan, S. and Parker, S. (­2012). Migrant women and homelessness: The role of ­gender-​­based violence. European Journal of Homelessness, 6(­1), ­59–​­82. Mayock, P., Sheridan, S. and Parker, S. (­2015). ‘­It’s just like we’re going around in circles and going back to the same thing …’: The dynamics of women’s unresolved homelessness. Housing Studies, 30(­6), ­877–​­900. Mostowska, M. and Sheridan, S. (­2016). Migrant women and homelessness. P. Mayock and J. Bretherton (Eds.) In Women’s Homelessness in Europe. London: Palgrave Macmillan, p­p. ­235–​­263. Neale, J. (­1997). Homelessness and theory reconsidered. Housing Studies, 12(­1), ­47–​­61. Oliver, V. (­2013) Healing home: Health and homelessness in the life stories of young women. Toronto: University of Toronto Press. Robinson, C. (­2011). Beside one’s self: Homelessness felt and lived. Syracuse: Syracuse University Press. Rose, N. (­1996). Inventing our selves: Psychology, power and personhood. Cambridge: Cambridge University Press.

128

Homelessness through a feminist lens Shilling, C, (­2012). The body and social theory. 3rd edn. London: Sage. Simic, Z. (­2010). ‘­Door bitches of club feminism’? Academia and feminist competency, Feminist Review, 95, ­75–​­91. Skeggs, B. (­1997). Formations of class and gender: Becoming respectable. London: Sage. Skeggs, B. (­2004a). Class, self, culture. London: Routledge. Skeggs, B. (­2004b). Introduction: Pierre Bourdieu’s analysis of class, gender and sexuality. In L. Adkins and B. Skeggs (­Eds). Feminism after Bourdieu. Malden, MA: Blackwell, p­p. ­19–​­33. Tomas, A. and Dittmar, H. (­1995). The experience of homeless women: An exploration of housing histories and the meaning of home. Housing Studies, 10(­4), 4­ 93–​­515. Tipple, G. and Speak, S. (­2009). The hidden millions: Homelessness in developing countries. London and New York: Routledge. Wardhaugh, J. (­1999) The unaccommodated woman: Home, homelessness and identity. The Sociological Review, 47(­1), ­91–​­109. Washington, O. G. and Moxley, D. P. (­2008). Telling my story: From narrative to exhibit in illuminating the lived experience of homelessness among older African American women. Journal of Health Psychology, 13(­2), ­154–​­165. Watson, J. (­2016). Gender-based violence and young homeless women: Femininity, embodiment and vicarious physical capital. The Sociological Review, 64(­2), ­256–​­273. Watson, J. (­2018). Youth homelessness and survival sex: Intimate relationships and gendered subjectivities. London and New York: Routledge Watson, S. and Austerberry, H. (­1986). Housing and homelessness. London: Routledge. Watson, S. (­2000). Homelessness revisited: New reflections on old paradigms. Urban Policy and Research, 18(­2), ­159–​­170. Whelehan, I. (­1995) Modern feminist thought: From the second wave to ­post-​­feminism. New York: New York University Press. Whitzman, C. (­2006). At the intersection of invisibilities: Canadian women, homelessness and health outside the ‘­big city’. Gender, Place and Culture, 13(­4), 3­ 83–​­399. Young, I. M. (­2002). Lived body vs gender: Reflections on social structure and subjectivity. Ratio, 15(­4), ­410–​­428. Zufferey, C. (­ 2017). Homelessness and social work: An intersectional approach. Abingdon: Routledge. Zufferey, C. and Chung, D. (­2015). ‘­Red dust homelessness’: Housing, home and homelessness in remote Australia. Journal of Rural Studies, 41, ­13–​­22.

129

12 ­EVIDENCE-​­BASED APPROACHES TO GUIDE HEALTH PROVIDERS FOR PEOPLE EXPERIENCING VULNERABLE HOUSING AND COMPLEX NEEDS Kevin Pottie, Olivia Magwood, Ammar Saad, Sihyun (­Shaun) Baek and Alex Lee Many clinicians or other health care providers may not know where to focus their initial efforts when encountering patients who face vulnerable housing. Early identification of patients with unstable housing, just like early identification of myocardial infarction, can play a critical role in preventing illness and poor l­ong-​ t­erm social and health outcomes. We suggest the ­evidence-​­informed ‘­HOUSE approach’ that begins with understanding a patient’s lived experience but also integrates effective and ­evidence-​­based actions and interventions. Research now shows that the next generation of clinicians should learn an early focus on interventions that address housing, income, and comprehensive primary care to set the stage for addressing other underlying conditions and health issues. Providers should also learn to recognize mental health and substance use disorders early and support patients with these disorders using t­eam-​­based interventions. Once a patient is en route to stable housing and income and mental health support, clinicians can more effectively address any ongoing diseases of poverty, for example, TB, HIV, diabetes, and scabies. This chapter will take the reader through a series of ­evidence-​ b­ ased interventions and introduces the H.O.U.S.E. approach as a new approach for medical care.

Introduction ­Front-​­line clinicians and providers, emergency physicians, primary care professionals, and psychiatric outreach teams often provide health care to people with 130

DOI: 10.4324/9781351113113-14

Evidence-based approaches

lived experience of homelessness or housing vulnerability. Inexperienced clinicians may not know where to focus their attention; which patient concerns and expressed needs to address, and which mental health conditions or infectious diseases to screen and manage. People with lived experience of homelessness now come from a wide range of ethnicities, languages, and socioeconomic backgrounds (­Pottie et al. 2020). Research suggests that fear of clinical uncertainty, m ­ edical-​ ­legal concerns, the complexity of care, and sometimes language differences are all potent clinician deterrents to providing optimal and ongoing care (­Mota et al. 2015, Beach et al. 2006). Developing a ‘­positive regard’ and compassion towards people with lived experience of homelessness (­Magwood, Salvalaggio, Pottie et al. 2019), nurturing an openness to alternative lifestyles and worldviews, focusing on a patient’s current complaints, and working in interdisciplinary teams is a key for success (­Hashmi et al. 2020). The H.O.U.S.E. approach, just like the very effective A (­a irway) B (­breathing) and C (­circulation) approach of emergency medicine, has the potential to transform emergent and primary care for unstable housing with the help of new e­ vidence-​­based guidelines. Maybe most importantly, it can turn a daunting chore into a rewarding clinical experience and career for emerging providers (­Pottie et al. 2020, Moledina et al., 2021). An inexperienced carpenter sees nails and strikes them with their hammer. A master carpenter carefully examines the wood, selects the best tools, and executes a series of planned and efficient steps. Inexperienced clinicians may only see signs and symptoms of medical diseases and immediately act to assess and manage them (­Mathies et al. 2020). This can lead to inappropriate use of time and resources and poor patient outcomes that could discourage rather than energize providers. The H.O.U.S.E. approach is a pragmatic medical acronym that teaches emerging clinicians to focus on Housing First, Outcome of mental health, Understand income, Start case management for mental health, and Evaluate substance use. The Canadian ­evidence-​­based research team conducted a comprehensive Delphi Consensus process to determine the medical and social priorities for people facing homelessness or housing vulnerability (­Shoemaker et al. 2020). This Canadian Delphi process included 76 people with lived experience of homelessness and 84 clinicians with experience caring for people with unstable housing. The initial list of conditions included TB, HIV, diabetes, and scabies, but also included interventions to address social determinants of health: housing, income, and mental health. After three rounds of surveys and feedback, people with lived experience and experienced clinicians came to a consensus. The final priority list showed housing vulnerability, income instability, and care coordination for complex mental illness as top priority conditions. The Delphi process also identified special populations in need of ­in-​­depth study, including indigenous people, women, youth, and migrants (­Shoemaker et al. 2020) which reframed prevention and care priorities and informed the H.O.U.S.E. approach (­Mathies et al. 2021). The Cochrane Collaboration was founded on the principle that resources will always be limited and the most effective approaches employed (­Schunemann et al. 2014, ­A lonso-​­Coello 2016). Indeed, new ­evidence-​­based guidelines for people with lived experience of homelessness recommend that clinicians must first address 131

Kevin Pottie et al.

housing instability (‘­Housing First’ research has led the way) and income instability and develop links to comprehensive primary care (­Pottie et al. 2020). The H.O.U.S.E. approach includes not just identifying vulnerable housing and complex needs, but we also now have identified a new style of practice that will prevent and address these needs. A refocusing on interventions that target these conditions can lay a foundation for prevention and transition from sleeping rough and homelessness to the treatment of mental health, chronic and infectious diseases; for example, see emerging clinical tips and medical acronyms (­A ndermann et al. 2020, Mathies et al. 2020).

Guideline Development for Emerging Providers ­ vidence-​­based guidelines represent the integration of clinical expertise, patient’s E values, and best available evidence in the process of decision making related to patient health care (­Sackett et al. 1996, Schunemann et al. 2014, Pottie et al. 2021). The emergence of such guidelines can empower a new generation of emerging providers and focus ongoing research efforts. Indeed, guidelines can improve uptake of, and health outcomes related to, health services, even more so when they are tailored for specific populations (­Pottie et al. 2017). The GRADE guideline development approach uses evidence in a structured and transparent way to inform decisions in the context of clinical recommendations, health system coverage decisions, and health system or public health recommendations and decisions (­­Alonso-​­Coello 2016). Leading guideline organizations, from the World Health Organization to the US Centers for Prevention and Disease Control to the UK National Institute of Clinical Evidence (­N ICE), all use the GRADE 18 step guideline development approach (­Schunemann et al. 2014). The H.O.U.S.E. approach has emerged from the world’s first set of GRADE guideline for prevention and care of vulnerable housed and complex need persons. As shown in ­Figure 12.1, GRADE guideline development groups collect and summarize evidence, assess the certainty of the available evidence, and draft clinical guidance statements. Selecting the most effective intervention is at the core of this process. It is important to note that homeless populations are often underrepresented in randomized controlled trials and other medical intervention research (­Magwood, Salvalaggio, Pottie et  al. 2019). Recruiting, registering, and tracking homeless populations are more challenging than for patients with stable housing, income, and health care services. For this same reason, developing e­ vidence-​­based recommendations and delivering ongoing care for people without housing and income require empathy and advanced health care skills (­Welch et al. 2017, Pottie et al. 2017). When available, studies that included populations experiencing unstable housing or homelessness are prioritized (­Magwood et  al. 2020). Yet, when researchers study homeless populations, indirect evidence, or evidence that does not come from their homeless patients, may still be very useful to estimate the certainty or quality of evidence for people with lived experience of homelessness.

132

­Figure 12.1  D  iagram of the guideline development process (­From Schunemann et al. 2014; with permission (­pending from CMAJ))

Evidence-based approaches

133

Kevin Pottie et al.

­Evidence-​­based methods can estimate the effects (­A ndrews et al. 2013) and relevant equity considerations (­Pottie et al. 2017) of related evidence. The GRADE guideline development approach states that indirect population or intervention evidence may be used and the certainty or quality rating can reflect any imprecisions (­GRADE Paper 15, 2015). Where evidence from housed populations was used, input from the expert panel regarding the applicability and validity for homeless populations was sought, and the certainty or quality of the evidence was reflected in the evidence rating. Further, to inform the implementation considerations of these recommendations, and to ensure applicability and transferability to other homelessness contexts and settings, the guideline development group completed two activities. The first was a systematic review of qualitative literature to understand the acceptability of the proposed interventions and identification of barriers and facilitators to implementation (­Magwood, Leki, Kpade, Saad, Alkhateeb, Gebremeskel, et al. 2019). Second, the group surveyed a panel of experts and interviewed people with lived experience of vulnerable housing to understand the implementation considerations of our recommendations using the GRADE FACE instrument (­Magwood, Hanemaayer, Saad, Salvalaggio, Bloch, Moledina, ...  & Kpade 2020). The GRADE FACE instrument is used to assess the equity implications of recommendations, including perceptions on (­1) the level of priority for the problem, (­2) barriers or enablers related to the e­ vidence-​­based statements’ feasibility, acceptability, cost, and health equity, as well as (­3) intention to implement the statements in practice (­Pottie et al. 2021). Our interviews with vulnerably housed persons were remarkably humbling experiences for our research team. The years of rough living and discrimination left many persons with unstable housing with a strong retrospective bias. They believed that ongoing stigma prevents real change for them or any other vulnerably housed person. However, they expressed hope that c­ apacity-​­building and advocacy initiatives could lead to true system change (­Magwood, Hanemaayer, Saad, Salvalaggio, Bloch, Moledina, ... & Kpade 2020). The results of our study emphasized the need to share evidence on effective interventions with emerging clinicians, as they have a role to play in ongoing advocacy and effective prevention and treatment.

Priority Interventions in the Context of Homelessness and Housing Vulnerability Permanent Supportive Housing A comprehensive systematic review (­Aubry et  al. 2020) identified 14 trials on permanent supportive housing (­­housing-​­led/­Housing First services). This review reported that supportive housing interventions for people experiencing homelessness with multiple and complex needs that did not require substance abstinence increased housing stability (­for up to five years) among persons living with homelessness, compared with existing services (­Aubry et al. 2020). This review, however, did not find that housing people with chronic homelessness led to significant 134

Evidence-based approaches

Box 12.1 Summary of E ­ vidence-​­Based Guidelines for Vulnerably Housed Populations with Complex Needs Permanent supportive housing (­Housing First services) • •

Identify homelessness or housing vulnerability and willingness to consider housing interventions. Ensure access of homeless or vulnerably housed individuals to local housing coordinator or case manager (­i.e., call 211 or via a social worker) for an immediate link to Housing First and/­or coordinated access system.

Case management for mental illness •

•

Identify histories of severe mental illness, such as psychotic or mood and anxiety disorders, associated with substantial disability, substance use disorders, or multiple or complex health needs. Ensure access to local community mental health programmes, psychiatric services for assessment and linkage to intensive case management, assertive community treatment or critical time intervention where available.

Income assistance • •

Identify income insecurity. Assist individuals with income insecurity to identify income support resources and access income.

Opioid agonist therapy • •

Identify opioid use disorder. Ensure access to opioid agonist therapy in primary care or by referral to an addiction specialist, potentially in collaboration with public health or community health centre for linkage to pharmacologic interventions.

­Harm-​­reduction interventions • •

Identify problematic substance use, including alcohol or other drugs. Identify the most appropriate approach or refer to local addiction and harm reduction/­prevention services (­e.g., supervised consumption facilities and managed alcohol programmes) via appropriate local resources, such as public health or community health centres. (­Pottie et al. 2020)

135

Kevin Pottie et al.

improvements of mental health symptoms compared with standard care, emphasizing the importance of preventing homelessness (­Moledina et al. 2021).

Case Management for Mental Illness Another systematic review (­Ponka et al. 2020) examined the effectiveness of different ­community-​­based case management approaches to support mental illness. The key differences in approaches related to the intensity of the services provided. Ten trials reported on standard case management, eight trials on assertive community treatment (­ACT),16 trials reported on intensive case management (­ICM), and five trials reported on critical time interventions (­CTIs) (­Ponka et al. 2020). ICM substantially reduced the number of days spent homeless, as well as substance and alcohol use. CTIs and ACT were found to have a protective effect on rehospitalizations and a promising effect on housing stability. Assertive, intensive, and critical time interventions showed only modest benefits for mental health, potentially attributable to the acute, multiple, and complex needs experienced by case management clients. Nevertheless, outreach interventions play an important role in the transition from homelessness into stable housing, income, and primary care (­Moledina et al. 2021).

Income Assistance A systematic review (­Aubry et al. 2020) identified ten trials on i­ncome-​­assistance interventions. ­Income-​­assistance interventions have not been as widely studied as housing interventions, in part due to the complexity of isolating the intervention in populations with complex social and economic needs. These interventions included rental assistance (­housing subsidies), financial empowerment, social enterprise interventions, individual placement and support, and compensated work therapy. Housing subsidies with case management were the most promising income intervention to support housing stability (­Aubry et al. 2020). A recent review also showed the benefit that i­ ncome-​­assistance interventions have on housing stability (­Moledina et al. 2021).

Opioid Agonist Therapy A systematic overview of reviews (­Magwood, Salvalaggio, Beder, Kendall, Kpade, Daghmach 2020) on pharmacologic interventions for opioid use disorders for people experiencing homelessness who also have addiction issues demonstrated the importance of detecting and treating substance use. This review expanded its study inclusion criteria to general populations after demonstrating that most studies among ‘­general populations’ had a large representation of homeless populations in their samples. Reviews on pharmacologic interventions showed the effectiveness of use of methadone, buprenorphine, diacetylmorphine (­heroin), ­levo-­​­­α-​ a­ cetylmethadol, ­slow-​­release oral morphine, and hydromorphone for the treatment of opioid use disorder. Interventions showed the ability of these interventions to 136

Evidence-based approaches

link patients to other primary health services (­Magwood, Salvalaggio, Beder, Kendall, Kpade, Daghmach 2020).

Harm Reduction Interventions Harm reduction is a potent public health intervention in the context of homelessness and substance use disorder. A systematic overview of reviews (­Magwood, Salvalaggio, Beder, Kendall, Kpade, Daghmach 2020) showed that supervised consumption facilities had positive impacts on fatal overdose prevention, public injecting, and other h ­ igh-​­risk consumption, which constitute an important mechanism for drug ­use-​­associated morbidity and mortality For example, in a f­ our-​­year period following the opening of a supervised consumption facility in Vancouver, Canada, there were 336 reported opioid overdose reversals in 90 individuals (­Potier et al. 2014). Harm reduction programmes also improved access to food, shelter, and other primary health and social care services (­Magwood, Salvalaggio, Beder, Kendall, Kpade, Daghmach 2020). Since homelessness and unstable housing are factors that continue to be associated with public injection, infection, and reduced access to care, we emphasize the importance of offering ­low-​­threshold services in close and integrating housing supportive services for individuals who are homeless and have concomitant substance use disorders, such as in the Canadian At Home/­Chez Soi programme.

H.O.U.S.E. Medical Mnemonic A pragmatic medical mnemonic has emerged to help emerging f­ront-​­line care providers incorporate both prevention and management of unstable housing, income instability, mental illness, and substance use disorders within primary care services. The H.O.U.S.E. approach is a ‘­chain of survival’ algorithm that can help clinicians reframe their usual medical approach, remind them of the importance of trauma informed care to garner patient trust, and avoid the learned helplessness of complex medical and social care. The e­ vidence-​­informed recommendations in the H.O.U.S.E. medical mnemonic include interventions that address housing precarity, income insecurity, substance use, and case management of mental illness (­­Table 12.1). How may the H.O.U.S.E. mnemonic be utilized in a clinical setting? For example: an ER patient presents with a broken ankle and history of alcohol use disorder, anxiety, and identified unstable housing. Using the H.O.U.S.E. clinical approach, an ER physician would provide an orthopaedic consultation to the patient with a referral to Housing First programme, social work assistance in finding future job opportunities and a referral to primary care for ongoing case management of anxiety. The physician also reviews ­low-​­risk drinking guidelines with the patient and provides a list of resources for alcohol reduction. Implementation of the H.O.U.S.E. approach will require ongoing local innovation and it will be important to prevent misrepresentation of mnemonic items to avoid unintentional harms. We believe that emerging f­ront-​­line health providers 137

Kevin Pottie et al. ­Table 12.1  H.O.U.S.E. medical mnemonic H.O.U.S.E. Mnemonic

Recommendations

[H] Housing Precarity

Identify precarious housing or homelessness and willingness to consider housing interventions. Notify the primary health team, and contact housing coordinator or call 311 for help immediately to link to Housing First and community coordinated care. Identify history of debilitating mental illness, such as psychosis or mood and anxiety disorders associated with significant disability, substance use or complex health needs. Outcomes are associated with mental health care. Identify income insecurity such as difficulty making ends meet at the end of the month. Link to teams for income support, resources, and solutions. Ensure access to local community mental health programmes, psychiatric services for assessment, and linkage to intensive case management (­ICM), assertive community treatment (­ACT), or critical time intervention (­CTI) where available. Identify, during history or physical examination, problematic substance use, including alcohol or other drugs. Link to team approach for addiction, harm reduction and pharmacological intervention.

[O] Outcomes of mental illness [U] Understanding income [S] Start case management for mental health [E] Evaluate substance use

Source: Mathies et al. (­2020).

such as emergency room and family physicians could implement this approach with patients with complex needs to prevent homelessness, reduce recurrent ER visits, and improve ­long-​­term health. Furthermore, the foundations of the H.O.U.S.E. medical mnemonic will prove to be effective especially in the context of the housing epidemic caused by the ­COVID-​­19 pandemic. This approach is now being incorporated into community service learning (­CSL) programmes for junior health professional students. Students enrolled in H.O.U.S.E. CSL programmes participate in interactive service learning activities directly involving members of the community who have been impacted by housing precarity or have lived experience of homelessness. The designs of the service learning activities have been informed by the principles of the H.O.U.S.E. approach, involving community engagement projects that include income support assistance, employment support, mental health literacy, and substance use education. Through implementation of the H.O.U.S.E. approach, the CSL programmes aim to nurture a next generation of homeless health advocates who can utilize practical strategies for early recognition of precarious housing and provide a ­team-​ b­ ased crisis intervention based on the H.O.U.S.E. recommendations. As part of this effort, the H.O.U.S.E. manual and H.O.U.S.E. CSL manual have been developed for medical learners to serve as a homeless health education resource and CSL programme guide, respectively. 138

Evidence-based approaches

Priority Homeless Populations Indigenous Homelessness Indigenous homelessness is a term used to describe First Nations, Métis and Inuit individuals, families or communities in Canada who lack stable, permanent, and appropriate housing, or the immediate prospects, means, or ability to acquire such housing. However, this term must be interpreted through an indigenous lens to understand the factors contributing to this condition. These factors include individuals, families, and communities isolated from their relationships to land, water, place, family, kin, each other, animals, cultures, languages, and identities as well as the legacy of colonialism and genocide (­Thistle 2017). It is estimated that Canadian urban indigenous people are eight times more likely to experience homelessness than the general population (­Belanger et al. 2013).

Women Research shows that Housing First is effective in reducing the risk of intimate partner violence and improving psychological symptoms for women experiencing homelessness with multiple and complex needs (­A ndermann et al. 2021). Priority access to permanent housing subsidies can reduce child separations and foster care placements, allowing women to maintain family ties. As well, Housing First programmes for families and CTIs during times of crisis are associated with lower levels of psychological distress, increased ­self-​­esteem, and improved quality of life for women and their families. A g­ ender-​­based analysis highlighted the importance of safety, service accessibility, and empowerment among homeless women (­A ndermann et al. 2021).

Youth Housing First interventions improve youth housing stability (­Wang et al. 2019). As well, individual cognitive behavioural therapy has been shown to result in significant improvements in depression scores. ­Family-​­based therapies are also promising, resulting in reductions in youth substance use through restoring the family dynamic. Findings on motivational interviewing, s­kill-​­building, and case management interventions have been inconsistent, with some trials showing a positive impact and others not identifying significant benefits (­Wang et al. 2019).

Refugees and Migrant Populations Refugee and migrant populations often face discrimination, limited local language proficiency, and severed social networks which negatively affect homeless migrants’ sense of belonging and access to social services, such as housing (­K aur et al. 2021). It is notable how employment opportunities provide a sense of independence and improved social integration and provide positive opportunities for newcomer populations. 139

Kevin Pottie et al.

Illustrative Medical Illnesses Best Treated in the Context of Housing and Stable Income Tuberculosis (­TB) Poor nutrition, difficult living conditions, and crowded congregate shelters all contribute to the spread of TB within homeless populations (­Beijer, Wolf & Fazel 2012). Research shows that TB, however, is both a preventable and treatable infectious disease that may be detected within comprehensive primary health care. Screening for active pulmonary TB includes a chest ­x-​­ray and often sputum samples.

Human Immunodeficiency Virus (­HIV) Comprehensive primary care may facilitate access to testing and treatment. ­HIV-​ r­elated stigma may still play a large role in delaying diagnosis and treatment. ­Community-​­based rapid HIV testing and links to counselling and treatment programmes may also support persons with stable housing and income (­Pottie et al. 2014).

Diabetes Preventing diabetes complications is difficult without ongoing continuous care. Stable housing and income and comprehensive primary health care are critical to providing effective ­long-​­term programmes to prevent and care for diabetes.

Scabies Chronic skin diseases are a concern for people living rough on the street or within homeless shelters. This highly contagious parasitic skin disease, which is caused by the burrowing itch mite Sarcoptes scabiei var. hominis, is most commonly transmitted through personal contact in close living quarters. In the context of stable housing and income, primary care clinicians can detect this skin disease based on severe nocturnal itch and examination of the interdigital, abdomen, and leg areas and followed by permethrin treatment. Chronic scabies is a more challenging diagnosis, as it often includes ­multi-​­agent infection with staphylococcus and even yeast contamination.

Strengths and Limitations of the H.O.U.S.E. Approach H.O.U.S.E. provides clinicians and other health care providers with an e­ vidence-​ i­nformed approach to addressing and preventing housing vulnerability in a f­ast-​ p­ aced clinical setting. This approach initiates a chain of clinical actions that ensures patients with housing vulnerability leave the clinical setting with a holistic care plan that addresses both their health and social needs. Furthermore, the H.O.U.S.E. medical mnemonic is easy to memorize and integrate into undergraduate and graduate medical education curricula, both theoretically and practically, through hospital rotations and community service learning initiatives. This approach, however, 140

Evidence-based approaches

is not without limitations. Effectively implementing H.O.U.S.E. requires the availability and rapid utilization of services and interventions. A ­m ixed-​­method study exploring the implementation considerations of clinical recommendations for homeless health highlighted the limited availability and long wait times of housing and case management interventions in many communities (­Magwood, Hanemaayer, Saad, Salvalaggio, Bloch, Moledina, ... & Kpade 2020). Referring patients with housing vulnerability and complex needs to these interventions is not enough, and a vigilant and continuous ­follow-​­up plans to ensure that proper uptake of such services is, therefore, merited. As well, linking patients with housing vulnerability to the H.O.U.S.E. interventions may require a ­health-​­social services liaison (­e.g., ­on-​­site social worker or case manager) who can fulfil the provider’s requisition for referral in a timely fashion. Such position may not exist in all clinical settings, especially in remote and rural communities where human resources are scarce. Policy and decision makers need to weigh in the costs of implementing this approach in their clinical context, compared to the inevitable medical costs of caring for homeless patients in the long term if their social needs are not addressed on the first encounter. Nonetheless, when possible, clinicians and health care providers equipped with the knowledge and skills that the H.O.U.S.E. approach brings are set to effectively care for patients experiencing homelessness or housing vulnerability and ensure their smooth transition to housing and health stability.

Conclusions As ­evidence-​­based research advances worldwide the quality and precision of our approaches to people with unstable housing and homelessness, we can begin to also study access, feasibility, accessibility, cost, and ultimately health equity implications of interventions. Indeed, most detectable medical diseases will respond to treatment once we stabilize housing, income, and establish ongoing comprehensive primary health care. At the same time, ­evidence-​­based research suggests that we must learn to turn our knowledge into accessible interventions and that, more than ever, we must now focus our attention on ­evidence-​­based prevention of homelessness in clinical care. Author Contribution Statement: KP, OM, and AS drafted the chapter, SB and AL provided expert comments, revisions, tables, and resources, and all authors approved the final version. Disclosure Statement: KP, OM, and AS received a p­ eer-​­reviewed grant from the Inner City Health Associates (­ICHA) to create clinical guidelines for homeless and vulnerably housed populations. SB received a summer research bursary from the Summer Studentship Program, Faculty of Medicine, University of Ottawa. AL received a summer research bursary from the Global Health, University of Ottawa.

References ­A lonso-​­Coello, P., Oxman, A. D., Moberg, J. et al. (­2016). GRADE Evidence to Decision (­EtD) frameworks: A systematic and transparent approach to making well informed

141

Kevin Pottie et al. healthcare choices. 2: Clinical practice guidelines. BMJ. Published online 2016. https://­ doi.org/­10.1136/­bmj.i208 Andermann, A., Bloch, G., Goel, R., Brcic, V., Salvalaggio, G., Twan, S. ... & Pottie, K. (­2020). Caring for patients with lived experience of homelessness. Canadian Family Physician, 66(­8), ­563–​­570. Andermann, A., Mott, S., Mathew, C. M., Kendall, C., Mendonca, O., Harriott, D., McLellan, A., Riddle, A., Saad, A., Iqbal, W., Magwood, O. & Pottie, K. (­2021). ­Evidence-​ ­informed interventions and best practices for supporting women experiencing or at risk of homelessness: A scoping review with gender and equity analysis. Health Promotion and Chronic Disease Prevention in Canada, 41(­1) ( ­January), ­1–​­13. English, French. https://­doi. org/­10.24095/­hpcdp.41.1.01 Andrews, J. C., Schunemann, H. J., Oxman, A.D., Pottie, K., Joerg, J., Meerpohl, J. J., Coelloh, P. A. et  al. (­2013). GRADE Guidelines 15: Going from evidence to ­recommendation-​­determinants of a recommendation’s direction and strength. Journal of Clinical Epidemiology, 66(­7 ), ­726–​­735. Aubry, T., Bloch, G., Brcic, V., Saad, A., Magwood, O., Abdalla, T. et al. (­2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in ­h igh-​­income countries: A systematic review. The Lancet Public Health, 5(­6), ­e342- ​­e360. https://­doi.org/­10.1016/­­S2468-​­2667(­20)­­30055- ​­4 Beach, M. C., Gary, T. L., Price, E. G. et  al. (­ 2006) Improving health care qualethnic minorities: A systematic review of the best evidence regardity for racial/­ ing provider and organization interventions. BMC Public Health, 6, ­1–​­11. https://­doi. org/­10.1186/­­1471-­​­­2458-­​­­6 -​­104 Beijer, U., Wolf, A. & Fazel, S. (­2012). Prevalence of tuberculosis, hepatitis C virus, and ­ eta-​­analysis. The Lancet Infectious HIV in homeless people: A systematic review and m Diseases, 12, ­859–​­870. Belanger, Y. D., Awosoga, O. & Head, G. W. (­2013). Homelessness, urban Aboriginal people, and the need for a national enumeration. Aboriginal Policy Studies, 2, ­4 –​­33. Hashmi, S. S., Saad, A., Leps, C., ­Gillies-​­Podgorecki, J., Feeney, B., Hardy, C. et al. (­2020). A s­tudent-​­led curriculum framework for homeless and vulnerably housed populations. BMC Medical Education, 20(­1), ­1–​­7. https://­doi.org/­10.1186/­­s12909-­​­­020-­​­­02143-​­z Magwood, O., Hanemaayer, A., Saad, A., Salvalaggio, G., Bloch, G., Moledina, A., ... & Kpade, V. (­2020). Determinants of Implementation of a clinical practice guideline for homeless health. International Journal of Environmental Research and Public Health, 17(­21), 7938. https://­doi.org/­10.3390/­ijerph17217938 Magwood, O., Leki, V. Y., Kpade, V., Saad, A., Alkhateeb, Q., Gebremeskel. A. et  al. (­2019). Common trust and personal safety issues: A systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness. PLoS One, 14(­12), e0226306. https://­doi.org/­10.1371/­journal.pone.0226306 Magwood, O., Salvalaggio, G., Pottie, K. et al. (­2019). Harm reduction and pharmacotherapeutic interventions for the homeless and vulnerably housed: An empty systematic review. Cochrane Equity Methods. https://­methods.cochrane.org/­equity/­projects/­­homeless­​­­health-​­g uidelines Magwood, O., Salvalaggio, G., Beder, M., Kendall, C., Kpade, V., Daghmach, W. et al. (­2020). The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder. PLoS One, 15(­1), e0227298. https://­doi.org/­10.1371/­journal.pone.0227298 Mathies, N., Saad, A., Magwood, O., Lee, A., Tugwell, P., Pottie, K. on behalf of the Homeless Health Research Network. (­2021). The Fifth Vital Sign: ‘­H.O.U.S.E,’ a practical medical mnemonic that puts ‘­­housing-​­first’ and includes social determinants of health for current and ­post-­​­­COVID-​­19 Emergency and Primary Health Care. Cochrane Equity Methods. January 26. Available at: https://­methods.cochrane.org/­sites/­methods.

142

Evidence-based approaches cochrane.org.equity/­f iles/­u ploads/­h .o.u.s.e_approach_cochrane_methods_equity_ 2021.pdf Moledina A., Magwood O., Agbata E., Hung J.H., Saad A., Thavorn K., Salvalaggio G., Bloch G., Ponka D., Aubry T., Kendall C., Pottie K.. (2021, June) A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17(2), e1154. https:// doi.org/10.1002/cl2.1154 Mota, L., Mayhew, M., Grant, K. J., Batista, R., Pottie, K. (­2015). Rejecting and accepting international migrant patients into primary care practices: A mixed method study. International Journal of Migration, Health and Social Care, 11(­2), ­108–​­129. https://­doi. org/­10.1108/­­I JMHSC-­​­­04-­​­­2014-​­0 013 Ponka, D., Agbata, E., Kendall, C., Stergiopoulos, V., Mendonca, O., Magwood, O., et al. (­2020). The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review. PLoS One, 15(­4), e0230896. https://­doi.org/­10.1371/­journal.pone.0230896 Potier, C., Laprevote, V., ­Dubois-​­Arber, F., Cottencin, O., Rolland, B. (­2014). Supervised injection services: What has been demonstrated? A systematic literature review. Drug Alcohol Depend, 145 (­December), ­48–​­68. https://­doi.org/­10.1016/­j.drugalcdep.2014.10.012, PMID: 25456324. Pottie, K., Kendall, C. E., Aubry, T., Magwood, O., Andermann, A., Salvalaggio, G., et al. (­2020). Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience. CMAJ: Canadian Medical Association Journal, 192(­10), E240. https://­doi.org/­10.1503/­cmaj.190777 Pottie, K., Magwood, O., Rahman, P., Concannon, T., ­A lonso-​­Coello, P., Jaramillo Garcia, A., Santesso, N., Thombs, B., Welch, V., Wells, G. A., Saad, A., Archibald, D., Grad, R., Moore, A., Ximena Rojas, M., Lorio, A., Pinto, N., Doull, M., Morton, R., Akl, E. A., Schünemann, H. J., Tugwell, P. (­2021, March). Validating the “­feasibility, acceptability, cost, and equity” instrument using stakeholder perceptions of feasibility, acceptability, cost, and equity in guideline implementation. Journal of Clinical Epidemiology, 131, ­133–​­140. https://­doi.org/­10.1016/­j.jclinepi.2020.11.018 Pottie, K., Medu, O., Welch, V., Dahal, G., Tyndall, M., Rader, T., & Wells, G. (­2014). Effect of rapid HIV testing on HIV incidence and services in populations at high risk for HIV exposure: An equity focused systematic review. BMJ Open, 4(­12), ­1–​­13. Pottie, K., Welch, V., Morton, R., Akl, A. E, ­Eslava-​­Schmalbach, J., Katikireddi, V., Singh, J., Moja, L., Lang, E., Magrini, N., Thabane, L., Stanev, R., Matovinovic, E., Snellman, A., Briel, M., Shea, B., Tugwell, P., Schunemann, H., Guyatt, G., & A ­ lonso-​­Coello, P. (­2017, October). GRADE Equity Guidelines: 4. Guidance on how to assess and address health equity within the evidence to decision process. Journal of Clinical Epidemiology, 90, ­84–​­91. https://­doi.org/­10.1016/­j.jclinepi.2017.08.001 Sackett, D. L., Rosenberg, J., Gray, M., Haynes, B., Richardon, S. (­ 1996). Evidence based practice: What it is and what it isn’t. BMJ, 312(­7023), ­71–​­72. https://­doi.org/­ 10.1136/­bmj.312.7023.71 Schunemann, H. J., Wiercioch, W., Etxeandia, I., et al. (­2014). Guidelines 2.0: Systematic development of a comprehensive checklist for a successful guideline enterprise. Canadian Medical Association Journal, 186(­3), E128. Shoemaker, E. S., Kendall, C. E., Mathew, C., Crispo, S., Welch, V., Andermann, A., et al. (­2020). Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus study. PLoS One, 15(­4), e0231758. https://­doi.org/­10.1371/­journal.pone.0231758 Thistle, J. (­2017). Indigenous Definition of Homelessness in Canada. Toronto: Canadian Observatory on Homelessness Press. Wang, J. Z., Mott, S., Magwood, O. et  al. (­ 2019). The impact of interventions for youth experiencing homelessness on housing, mental health, substance use, and

143

Kevin Pottie et al. family cohesion: A systematic review. BMC Public Health, 19, 1528. https://­ doi. org/­10.1186/­­s12889-­​­­019-­​­­7856-​­0 Welch, V. A., Akl, E. A., Guyatt, G., Pottie, K., ­Eslava-​­Schmalbach, J., Ansari, M. T., de Beer H., Briel, M., Dans, T., Dans, I., Hultcrantz, M., Jull, J., Katikireddi, S. V., Meerpohl, J., Morton, R., Mosdol, A., Petkovic, J., Schünemann, H., Sharaf, R., Singh, J., Stanev, R., Tonia, T., Tristan, M., Vitols, S., Watine, J., & Tugwell, P. (­2017, October). ​­ GRADE Equity Guidelines 1: Health equity in guideline d­ evelopment – Introduction and rationale. Journal of Clinical Epidemiology, 90, ­59–​­67. https://­doi.org/­10.1016/­j. jclinepi.2017.01.014

144

SECTION 3

The dimensions of homelessness

13 GENDER Joanne Bretherton

Introduction This chapter explores the rapidly shifting evidence base on the gender dynamics of homelessness, focusing in particular on the improved understanding of women’s experience of homelessness. This chapter begins by looking at why women’s experience of homelessness has never been fully acknowledged, before moving on to consider the nature and extent of women’s homelessness. The longstanding failure to fully recognise need and develop ­women-​­specific services is then discussed. Following this, this chapter looks at the emergence of new strategies, services and systems that are more effective in preventing and reducing women’s homelessness.

Assumptive and distorted data In the late 1970s, homelessness legislation had been developed in the UK that was posited not simply on whether or not someone had a roof over their head, but whether that housing was fit for occupation, a key element of the law being that it had to be physically safe for someone living in it, i.e. they were not under the threat of domestic abuse by other household members (­Raynsford, 2016). Watson, writing in the early 1980s, argued that homelessness was a cultural political construct, i.e. imagery and ideology were at least as important as any data in how ‘­homelessness’ was defined, and not being based on data, the definitions of homelessness missed the complexities, she noted: … exploring women’s domestic role and economic dependence within the family is to propose that it could be argued that according to a relative definition of homelessness, where factors such as the conditions, standards, form and location of the physical structure, the relation to tenure, and the nature DOI: 10.4324/9781351113113-16

147

Joanne Bretherton

of actual and possible relations within the dwelling, are taken into account, women may be located at a different point on the h ­ ome-­​­­to-​­homelessness continuum than their male partners. (­Watson, 1984, ­p. 64) Watson’s ideas and those of other feminist theorists have proven important in questioning assumptions about the nature of women’s homelessness (­see also Neale, 1997). One example, illustrating Watson’s point that women and men in the same household can be at different points on a continuum between securely, appropriately and safely housed and being homeless, is when a women is subject to domestic abuse, lacking the physical safety, choices and control, privacy and all the other positives associated with having a home. An abusive partner is not in that same position, i.e. their housing and their home remain safe and secure for them (­Mayock et al., 2016). This point that women’s experience of homelessness can be different from that of men is at the root of the fundamental criticisms that have emerged of assumptions about the nature, extent and consequences of homelessness over the course of the last decade. ­Hansen-​­Löfstrand is among those researchers who have highlighted another important element in the gender dynamics of homelessness, differential judgements and differentiated responses towards women’s homelessness compared to ­ ansen-​­Löfstrand highlights the role that of men. As Watson did decades earlier, H of the domestic, in a cultural, ideological and political sense. She argues that women’s homelessness is interpreted in relation to cultural, i.e. patriarchal, constructs of women’s social roles. Women lone parents becoming homeless with dependent children are protected, partially because even the most limited welfare systems in OECD countries tend to draw the line at allowing child destitution but also, she argues, because the woman is fulfilling her culturally expected domestic role (­­Hansen-​­Löfstrand, 2015; ­Hansen-​­Löfstrand and Quilgars, 2016). As Baptista (­2010) also notes, when a woman experiencing homelessness is without children or has lost or become separated from her children, the supports and protections that she has are, at best, reduced and at worst, fall away altogether (­see also Bretherton and Mayock, 2021). Lone women’s homelessness, in this sense, is arguably culturally ­interpreted – ‘­ ​­culture’ including mainstreamed sexism and patriarchy and gender ­inequalities – ​­as a deeper expression of deviance than lone male homelessness because a woman is outside her ‘­expected’ roles as a woman, as a mother, wife and/­or carer (­Bretherton, 2017). Both the differing dynamics of women’s homelessness, for example, a woman being homeless because she is unsafe in the same housing in which an abusive man is, is effectively not homeless, and the stigmatisation associated with lone women’s homelessness have often received far less attention than other aspects of homelessness. The longstanding tendency to focus research on a minority of homeless people, i.e. lone recurrently and l­ong-​­term homeless men in shelters and living rough, while paying far less attention to other, often larger homeless populations, which include more women, has been noted elsewhere (­O’Sullivan, 2020). In the face of new evidence, attitudes are shifting and understanding of women’s homelessness

148

Gender

is increasing (­Bretherton, 2020) although there are still some gaps in the evidence base (­Bretherton and Mayock, 2021). The scale of women’s homelessness was long misunderstood. Longstanding spatial, administrative and methodological errors limited the understanding of women’s homelessness for decades (­Bretherton and Mayock, 2021). Women were not visible to the same extent as men in places that researchers defined as containing people experiencing homelessness, i.e. shelters, encampments/­informal settlements and among people sleeping rough. This was taken as meaning that there were fewer women present, because that was the observation of a ‘­homeless’ population. In reality, lone adult women were concealed when living rough, avoided m ­ ale-​ ­dominated services and, crucially, in Ireland (­Mayock et al., 2015a) and the UK (­Bretherton, 2020) were, collectively, not reacting to homelessness in the same way as men, i.e. they were more likely to keep a roof over their heads by going to family, friends or via acquaintances. Older evidence from the USA and the UK reported that women with dependent children were often exhausting informal sources of support, precarious accommodation provided by relatives, friends and acquaintances before they eventually approached formal homelessness services (­Shinn et al., 1998; Pleace et al., 2008). Women were not experiencing homelessness at much lower rates than men; it was instead the case that researchers had been looking in the wrong places, i.e. a spatial error was occurring. Another widespread assumption was that women’s homelessness was uncommon because if a woman had one or more dependent children with her, a state would step in and in protecting the children from homelessness, also protect their mother. At the European level (­Baptista, 2010; Baptista et  al., 2017), there was some evidence to show that this was the case, although in some countries, such as Ireland (­O’Sullivan, 2020) and the UK (­Bretherton, 2017), this homelessness was not necessarily rapidly resolved, with long waits in emergency and temporary accommodation. This homelessness was being recorded as ‘­family’ homelessness, but ­ ouseholds – across ​­ was in reality heavily gendered, with the majority of h Europe and also in countries like the U lone women parents. Causation of fam­ SA – being ​­ ily homelessness was also strongly associated with male domestic abuse (­Baptista et al., 2017). Beyond this, there was also a strong association between lone women’s homelessness and domestic abuse. Both families and lone women who were experiencing homelessness because of domestic abuse and who were assisted by domestic abuse services were often recorded in administrative data as experiencing and needing assistance because of domestic abuse, but not as homeless (­Baptista et al., 2017; Bretherton and Mayock, 2021). Two sets of administrative errors were occurring, homelessness that was largely experienced by lone women with dependent children was being recorded as ‘­family’ rather than ‘­women’s homelessness and, where a woman or a woman with children had been made homeless because of domestic abuse, their homelessness often was not being recorded. Deep methodological errors had been detected when Culhane and colleagues shifted the analysis of who was using homeless shelters in the USA from ­cross-​ ­sectional surveys (­which collect data over short periods) to a longitudinal analysis

149

Joanne Bretherton

(­Culhane and Kuhn, 1998; O’Sullivan, 2020). Longitudinal analysis found a small population with high and complex needs, centred on addiction and severe mental illness, and including high rates of poor physical health and frequent contact with criminal justice systems, tended to be in the shelters on a repeated and ­long-​­term basis, while a much larger population, who tended to be characterised by socioeconomic marginalisation, made ­short-​­term use of the shelters. Collecting data over short periods had massively oversampled the long and repeat stay residents with high and complex needs, who were lone men. It also became apparent that alongside often taking different trajectories through homelessness than men, women were actively avoiding homelessness services that were dominated by men with complex needs and, when they did live rough, generally sought to conceal themselves (­Bretherton, 2017). Women’s homelessness had received little attention during the 1990s and 2000s, but as research began to focus on this issue, with, for example, the creation of the Women’s Homelessness in Europe Network (­W HEN)­1 and increasing attention from FEANTSA, the European Federation of Homelessness Organisations and some national charities, such as St Mungo’s and Homeless Link in England, longstanding assumptions began to be challenged. It was clear that women’s homelessness existed in different forms and had different causes than was the case for much male homelessness. It was not the case, nor was anyone arguing, that causal factors and trajectories for women’s homelessness were always different than was the case for men; a man can, for example, experience homelessness as a result of domestic abuse and they may also seek assistance from friends, relatives or acquaintances, rather than going to homelessness services. However, women were, on the basis of increasing evidence, much more likely to experience this kind of trajectory into homelessness (­Bretherton, 2017; Bretherton and Mayock, 2021).

A failure to recognise need The development of services for women experiencing homelessness has been inconsistent. Until the early 20th century, workhouses, casual wards and their equivalents had provided generic social protection for economically marginalised people, characterised by ­long-​­term or permanent worklessness, catering for women, children and men. The core functions of these services had been replaced by comprehensive welfare systems in many European and OECD countries, providing safety nets to prevent poverty and unemployment leading to destitution (­Renwick, 2017). The services that replaced the workhouses and casual wards and equivalent provision were intended for a different population. Homelessness services emerged in a distinct form, sometimes (­l iterally) building on the foundations of workhouses and casual wards, and were designed on the basis that they were intended for an overwhelmingly lone male population who were itinerant, a­ lcohol-​­dependent and often had mental and physical health problems (­Dant and Deacon, 1989). The spatial, administrative and methodological errors discussed above meant that this image of homelessness, as lone men with high and complex needs, persisted into the 1990s and has, arguably, never really fully disappeared, despite the extent of evidence to the contrary (­O’Sullivan, 2020). Women were clearly present in the 150

Gender

populations that were living rough and using homeless shelters, but research tended to report that they were broadly similar to the men, in that they had high and complex needs and, while there was some evidence of increases over time, they appeared to be very much in the minority (­A nderson et al., 1993), which made the idea of building separate and distinct services for women seem illogical. The idea of basic emergency shelters as a response to homelessness had lost currency in countries with more developed welfare and social protection systems, with such provision being seen as expensive and ineffectual ‘­warehousing’ (­Dant and Deacon, 1989). These services, being replaced with ‘­­housing-​­ready’ services, temporarily supported housing that provided the treatment, support and training needed ­for – ​­what was assumed to ­be – ​­a largely lone adult male population with complex needs to enable them to live independently in their own homes. These services were having mixed results and concern about their effectiveness increased when new evidence on the nature of homelessness arrived in the late 1990s. There was the realisation that, in several countries, most of this service provision was being, often unsuccessfully, used by a small group with complex needs, while a much larger population experienced homelessness mainly associated with poverty (­O’Sullivan, 2020). Two sets of responses were developed. The first was Housing First, designed to stop the l­ong-​­term and recurrent homelessness associated with high and complex needs, using a ­choice-​­orientated, mobile support model centred on ordinary housing. The second response was a new emphasis on homelessness prevention, stopping eviction and providing rapid rehousing, aimed at stopping homelessness caused by economic and social factors, with support (­which could include something like Housing First) when high and complex needs that might cause homelessness were present (­Pleace, 2012). What was remarkable about these strategic changes, particularly the mainstreaming of Housing First across North America and much of Europe, including the UK, was that marked changes in service provision were made with very little consideration at all of gender difference. Continued errors, false assumptions and simple ignorance about the nature and extent of women’s homelessness had meant that, beyond some concerns being raised that it was a growing issue (­Doherty, 2001), little attention was paid to the needs of women as approaches to homelessness services began to change. The assumptions underpinning this were twofold. Women were thought highly unlikely to experience homelessness as a lone adult and if they did, their needs seemed to be similar to men. This was because no account had been taken of ‘­h idden’ homelessness among women staying with relatives, friends and acquaintances. Women were also assumed to be largely ‘­protected’ from homelessness because social services protected a lone mother as well as her dependent ­children  – ​­although in countries like Ireland and the UK, sustained ‘­family’ homelessness was being disproportionately experienced by women (­Baptista et al., 2017). The process of understanding women’s needs was led by women academics, who began to scrutinise assumptions about women’s experiences of homelessness. In Ireland, significant work was done on what the experience of ‘­h idden’ homelessness 151

Joanne Bretherton

was like for women, lacking privacy, control over access to their space, physical safety and any security of tenure, clearly homeless according to existing legal and policy definitions in many European countries (­Mayock et al., 2015a and 2015b). In the UK too, the concealed, but highly damaging experience of many women’s homelessness within housing was also being explored (­Reeve et al., 2006; Reeve, 2018). Assessing the scale was and remains difficult, but evidence of extreme housing precarity, extending into homelessness that exists in housing, not on the street, shelters or homelessness services, that is being experienced by women, is increasing (­Bretherton, 2017; Bretherton and Mayock, 2021; Pleace and Hermans, 2020). Evidence that women were more likely to experience ‘­h idden’ or ‘­concealed’ homelessness and that this population included women with complex needs (­Mayock et al., 2015b) was not initially seen by all commentators as meaning that there might be a need for specific services, on the dubious basis that men could also experience this form of homelessness (­for a discussion, see Bretherton and Mayock, 2021). However, the role of women’s choices in influencing their trajectories through homelessness (­Bretherton, 2017) and associations between women’s homelessness, domestic abuse and sexual violence and exploitation, which were orders of magnitude stronger than was the case for male homelessness (­Mayock et al., 2016), began to change these debates. Women were often distinct, in their needs, their choices and their trajectories through homelessness and that meant service design, operation and commissioning, alongside the development of effective, integrated strategies for the prevention and reduction of homelessness had to take full account of their needs. Evidence of a developing shift in policy and practice came from the home of effective strategic integration in preventing and reducing homelessness. Finland had radically altered strategy, largely ending the provision of emergency/­homeless shelter services and replacing it with an array of prevention, supported housing and ­housing-​­led services that was integrated with health and social care services. Homelessness in general and ­long-​­term homelessness in particular had fallen to next to nothing, with Finland making more progress on reducing homelessness than any other European State, including those within and outside the EU (­A llen et  al., 2020). Growing evidence and experience had led the Finns to identify a limit in their existing practice and policy, despite all the success they had achieved, which a new phase in the strategy now sought to address: Housing First work in Finland has been carefully documented and research has continually been done to support it. Recently it was discovered from the statistics that women’s homelessness has not decreased even though homelessness and ­long-​­term homelessness in general have. Consequently, closer attention has been paid to solving and finding solutions to women’s homelessness. (­Y Foundation, 2017, ­p. 94)

Building effective services and strategies Evidence on what is most effective for women, in terms of both homelessness service design and strategy, is still relatively sparse. Here, the issue is not that services, 152

Gender

including innovative homelessness services, that are used by women are not researched, nor that guidance is not written, but a phenomenon that might be called ‘­and 30%’ remains very widespread. This is a shorthand for evaluative research that reports the effectiveness of services, but which does not go into the gender dynamics of that service provision in any real detail. Hence, many ­peer-​­reviewed articles, policy research reports and books can be described as including ‘­a nd 30% of people using the services were women’ and similar statements, but not extending their analysis much beyond reporting how many service users were women (­the 30% figure is obviously nominal; the percentage will vary between each report on each service). Detailed analysis of women’s trajectories through services and their experiences within services remains unusual, including within the very large amount of research that has been conducted on Housing First in recent years (­­Woodhall-​ M ­ elnik and Dunn, 2016; Pleace, 2018; Aubry et al., 2018). Perhaps the most important findings in terms of service and strategic design going forward are those emphasising the importance of choice in how women experience homelessness (­Bretherton, 2017 and 2020) and the growing evidence that the ­long-​­documented associations between women’s homelessness, domestic abuse, sexual violence and exploitation may be more pronounced than was previously understood. Research had reported that among lone adult women, experience of abuse and violence was ­near-​­ubiquitous for years ( ­Jones, 1999; Reeve et al., 2006) but more and more evidence from Europe (­Bretherton and Mayock, 2021), the UK (­Reeve, 2018), Canada (­Fotheringham et al., 2014), the USA (­Shinn, 2010) and beyond ( ­Johnson et  al., 2017) was emphasising the importance of domestic abuse, sexual violence and exploitation as both a cause of women’s homelessness and traumatic events during their homelessness. Further, many of those women experiencing homelessness are additionally suffering from trauma related to having had children taken away from them at some point prior to, or during, homelessness (­Bretherton and Mayock, 2021). Again, some critical voices have emphasised that abuse and trauma in similar forms are a feature of male homelessness, but while this is true, it is important to note that the associations with women’s homelessness are far stronger (­Mayock et al., 2016). Two indications of an effective strategy and service design flowed from these findings. The first was that, as women were exercising controls over how they experienced homelessness and that relying on their own resources, rather than using services, was the default position that many women adopted, services that followed a s­ trength-​­based, ­choice-​­led approach were likely to be most appropriate. Equally, the existing c­hoice-​­ based and ­ strength-​­ based models, the most widespread of which was Housing First, tended not to be built around the needs many women were likely to have, i.e. they would often be managing the psychological, emotional and traumatic effects of abuse and violence. Alongside this, some women were likely to be managing an ongoing risk from male perpetrators. An evaluation of a pilot Housing First service, built for women by a team of women and operating in Greater Manchester in the UK, reported that the original design of Housing First had needed to be modified in just these ways (­Quilgars et al., forthcoming), enabling women to recover from the trauma they had experienced 153

Joanne Bretherton

and providing and arranging the support needed to help them manage what were often high and complex needs. The Housing First service also had to actively provide support with security, enabling women to live securely and to move if they had to, where a perpetrator was still actively in pursuit of them. Issues around door control, ‘­cuckooing’ (­a vulnerable individual living on their own having their housing used and abused by outsiders) and risk management have to be considerations for all forms of Housing First, but much of existing service design is posited on managing isolation, stigmatisation and disconnection, which are associated with lone male homelessness. In the case of the Housing First service for women, the issues were somewhat different, often centring on keeping women safe and secure from former, traumatic, relationships while enabling them to live independently in ways that recognised and supported their strengths. The Housing First service was successful, but in order to work effectively with women with complex needs, the original model had to be adapted in not insignificant ways. Research had also highlighted another issue, a disconnect of varying severity between domestic abuse services and the homelessness services and strategies. One issue here was that domestic abuse and homelessness services had often been designed with different priorities under different circumstances. This separation had been reinforced by many European and OECD governments treating domestic abuse and hence services for the (­largely female) populations at risk from domestic abuse as something that was separate, in terms of policy, monitoring and funding, from homelessness (­Baptista et al., 2017). One result of this had been the administrative failures to recognise some women’s homelessness when it was happening because the women experiencing it were categorised and recorded as people experiencing ‘­domestic abuse’, not homelessness (­Pleace, 2016). This separation was logistically unhelpful, as there was at least some evidence showing that an effective homelessness service for women had to also incorporate specific support and safety measures to manage domestic and other abuse. Equally, domestic abuse services often addressed housing needs for women who needed to return to and remain safe in their existing homes, alongside provision for women who needed to move to do so rapidly and safely. Hybrid services, addressing both the risk of domestic abuse and associated risks of homelessness, have been developed, most notably the ‘­sanctuary scheme’ approach, which when working effectively provided a mix of offender management, physical security and support that enabled someone at risk of homelessness due to domestic abuse to remain in their existing home safely ( ­Jones et al., 2010). An interesting development here has been the UK’s Domestic Abuse Housing Alliance (­DAHA) ‘­Accreditation’ model, which creates a form of homelessness prevention that is of greatest potential benefit to women (­Bretherton and Pleace, 2020). Prevention has, along with Housing First, been the most important shift in homelessness policy and practice in the last decade. The UK has led developments in this field, shifting towards a preventative, rather than reactive approach ­ id-​­2000s in England and then in public/­commissioned service provision in the m adopting an actively preventative stance by changing the homelessness laws in Wales and, subsequently, in England (­Mackie et al., 2017). As with Housing First, 154

Gender

many preventative systems were not designed with the needs of women at risk of homelessness in mind, focusing on preventing eviction, through mediation within households and with landlords and rapid rehousing, to stop an experience of homelessness occurring when there is no way to stop existing housing from being lost. These systems can, of course, benefit women at risk of homelessness just as Housing First can benefit women experiencing homelessness associated with high and complex needs but they are not built with the needs of women integrated into their design. By contrast, DAHA Accreditation is a preventative system that is designed mainly around a major trigger for women’s homelessness. It is a system for early detection and intervention for domestic violence that is specifically designed to stop homelessness. Alongside the enhancements to early detection, the system also enhances the array of domestic abuse and housing management services offered by housing providers (­Bretherton and Pleace, 2020). At present, the development of specific systems for enhancing the prevention of women’s homelessness and the reduction of women’s homelessness is in a process of mainstreaming. Gender is not fully integrated into how homelessness services are designed or how homelessness strategies are developed, but as the Finnish example shows, awareness is bringing about a shift in attitudes, understanding and in policy. Getting to this point, indeed even getting to a point where women’s homelessness was starting to be properly recognised, let alone responded to, has been a long and difficult journey, as systems, conventions and cultures were running for decades on a set of false assumptions and, to be entirely truthful, a simple indifference to women’s needs and experiences. The challenge is ongoing, but in 2021, the situation was different to that in 2011 and certainly in 2001, there is more recognition, understanding and a growing realisation that systems and approaches to homelessness have to fully consider and fully respond to the gender dynamics of homelessness. FEANTSA, the European Federation of Homelessness Organisations, notes the following in its 2021 guidance Guide for developing effective ­gender-​­responsive support and solutions for women experiencing homelessness (­­p. 6). A comprehensive gendered homelessness strategy aims at ensuring support services meet women’s needs, are intersectional, and shaped by the expertise of women with lived experience. Furthermore, such a strategy aims at securing continuous funding of women specific services and ensures policy responses are gender informed.

Note 1 http://­womenshomelessness.org.

References Allen, M., Benjaminsen, L., O’Sullivan, E. and Pleace, N. (­2020) Ending Homelessness in Denmark, Finland and Ireland. Bristol: Policy Press, ­p. 198.

155

Joanne Bretherton Anderson, I., Kemp, P.A. and Quilgars, D. (­1993) Single Homeless People. London: HMSO. Aubry, T., Bernad, R. and Greenwood, R. (­2018) A ­multi-​­country study of the fidelity of Housing First programmes: Introduction. European Journal of Homelessness, 12(­3), p­p. ­15–​­31. Baptista, I. (­ 2010) Women and homelessness in Europe. In O’Sullivan, E., ­ Busch-​ ­Geertsema, V., Quilgars, D. and Pleace, N. (­eds), Homelessness Research in Europe. Brussels: FEANTSA, p­p. ­163–​­86, 179. Baptista, I., Benjaminsen, L., ­Busch-​­Geertsema, V. and Pleace, N. (­2017) Family Homelessness in Europe. Brussels: FEANTSA. Bretherton, J. (­2017) Reconsidering gender in homelessness. European Journal of Homelessness, 11(­1), p­p. ­1–​­21. Bretherton, J. (­2020) Women’s experiences of homelessness: A longitudinal study. Social Policy and Society, 19(­2), p­p. ­255–​­270. Bretherton, J. and Pleace, N. (­2020) DAHA Accreditation: An Evaluation (­Interim Report). London: DAHA. Bretherton, J. and Mayock, P. (­2021) Women’s Homelessness: European Evidence Review. Brussels: FEANTSA. Culhane, D.P. and Kuhn, R. (­1998) Patterns and determinants of public shelter utilization among homeless adults in New York City and Philadelphia. Journal of Policy Analysis and Management, 17(­1), p­p. ­23–​­43. Dant, T. and Deacon, A. (­1989) Hostels to Homes?: The Rehousing of Homeless Single People. Avebury: Aldershot. Doherty, J. (­2001) Gendering homelessness. In Edgar, B. and Doherty, J. (­eds), Women and Homelessness in ­Europe  – ​­Pathways, Services and Experiences, Bristol: The Policy Press, pp.­9 –​­20. Fotheringham, S., Walsh, C.A. and Burrowes, A. (­2014) ‘­A place to rest’: The role of transitional housing in ending homelessness for women in Calgary, Canada. Gender, Place and Culture, 21(­7 ), p­p. ­834–​­853. ­Hansen-​­Löfstrand, C. (­2015) The policing of a homeless shelter: Private security patrolling the border of eligibility. European Journal of Homelessness, 9(­2), p­p. ­17–​­38. Hansen Löfstrand, C. and Quilgars, D. (­2016) Cultural images and definitions of homeless women: implications for policy and practice at the European level. In Mayock, P. and Bretherton, J. (­eds), Women’s Homelessness in Europe, London: Palgrave Macmillan, p­p. ­41–​­73. Jones, A., Bretherton, J., Bowles, R. and Croucher, K. (­2010) The Effectiveness of Schemes to Enable Households at Risk of Domestic Violence to Remain in Their Own Homes. London: Communities and Local Government. Johnson, G., Ribar, D.C. and Zhu, A. (­2017) Women’s Homelessness: International Evidence on Causes, Consequences, Coping and Policies Melbourne Institute Working Paper No. 7/­ 17, Available at SSRN: https://­ssrn.com/­abstract=2927811 or https://­doi.org/­10.2139/ ­ssrn.2927811 Jones, A. (­1999) Out of Sight, Out of Mind?: The Experiences of Homeless Women. London: Crisis. Mackie, P.K., Thomas, I. and Bibbings, J. (­2017) Homelessness prevention: Reflecting on a year of pioneering Welsh legislation in practice. European Journal of Homelessness, 11(­1), p­p. ­81–​­107. Mayock, P., Sheridan, S. and Parker, S. (­2015a) ‘­It’s just like we’re going around in circles and going back to the same thing …’: The dynamics of women’s unresolved homelessness. Housing Studies, 30(­6), p­p. ­877–​­900. ­ ong-​­term Homelessness Mayock, P., Sheridan, S. and Parker, S. (­2015b) The Dynamics of L among Women in Ireland. Dublin: Dublin Regional Homeless Executive. Mayock, P., Bretherton, J. and Baptista, I. (­2016) Women’s homelessness and domestic violence: (­In)­v isible interactions. In Mayock, P. and Bretherton, J. (­eds), Women’s Homelessness in Europe, London: Palgrave Macmillan, p­p. ­127–​­154. Neale, J. (­1997) Homelessness and theory reconsidered. Housing Studies, 12(­1), p­p. ­47–​­61.

156

Gender O’Sullivan, E. (­2020) Reimagining Homelessness for Policy and Practice. Bristol: Policy Press. Pleace, N., Fitzpatrick, S., Johnsen, S., Quilgars, D. and Sanderson, D. (­2008) Statutory ­ 6–​­17 Year Olds. London: Department Homelessness in England: The Experience of Families and 1 for Communities and Local Government. Pleace, N. (­2012) HABITACT Review of Homelessness Service and Homeless Strategy Evaluation Methodologies for Use in the EU. Brussels: FEANTSA. ­ nder-​­representation of women in European Pleace, N. (­2016) Exclusion by definition: The u homelessness statistics. In Mayock, P. and Bretherton, J. (­eds), Women’s Homelessness in Europe, London: Palgrave Macmillan, p­p. ­105–​­126. Pleace, N. and Hermans, K. (­2020) Counting all homelessness in Europe: The case for ending separate enumeration of ‘­h idden homelessness’. European Journal of Homelessness, 14(­3), p­p. ­35–​­62. Quilgars, D., Bretherton, J. and Pleace, N. (­forthcoming) Threshold Housing First: Building a Service for Women with Complex Needs. York: University of York. Raynsford, N. (­2016) Substance Not Spin. Bristol: Policy Press. Reeve, K., Casey, R. and Goudie, R. (­2006) Homeless Women: Still being Failed Yet Striving to Survive. London: Crisis. Reeve, K. (­2018) Women and homelessness: Putting gender back on the agenda. People, Place and Policy Online, 11(­3), ­p. 167. Renwick, C. (­2017) Bread for All: The Origins of the Welfare State. London: Penguin Random House. Shinn, M., Weitzman, B.C., Stojanovic, D., Knickman, J.R., Jimenez, L., Duchon, L., James, S. and Krantz, D.H. (­1998) Predictors of homelessness among families in New York City: From shelter request to housing stability. American Journal of Public Health, 88(­11), p­p. ­1651–​­1657. Shinn, M. (­2010). Homelessness, poverty and social exclusion in the United States and Europe. European Journal of Homelessness, 4(­1), p­p. ­19–​­4 4. Watson, S. (­1984) Definitions of homelessness: A feminist perspective. Critical Social Policy, 4(­11), p­p. ­60–​­73. ­Woodhall-​­Melnik, J.R. and Dunn, J.R. (­2016) A systematic review of outcomes associated with participation in Housing First programs. Housing Studies, 31(­3), p­p. ­287–​­304. Y Foundation (­2017) A Home of Your Own: Housing First and ending homelessness in Finland. Helsinki: Y Foundation.

157

14 LGBTQ+ PEOPLE AND HOMELESSNESS Jama Shelton

Introduction A disproportionate number of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities (­LGBTQ+) experience homelessness. The structural dynamics of heterosexism, cisgenderism, classism, and racism contribute to their overrepresentation. While there is no single pathway into homelessness for LGBTQ+ individuals, the most frequently cited reason for homelessness among LGBTQ+ young people is ­identity-​­based family rejection, which can be understood as a ­by-​­product of the systematic marginalization and societal disregard for diverse sexual and gender identities. This chapter will describe the unique experiences of LGBTQ+ people experiencing homelessness, including their pathways in and out of homelessness, their experiences while homeless, and ways to best support LGBTQ+ people experiencing homelessness.

Macro Context Before examining the issue of LGBTQ+ homelessness, it is imperative to contextualize homelessness among LGBTQ+ people within the larger social context and structural forces that produce and maintain the marginalization of LGBTQ+ people in society at large, and particularly within the housing market and homeless serving systems. Heterosexism refers to the systematic marginalization of lesbian, gay, and bisexual people and the structural favouring of heterosexual people and relationships (­A nsara & Hegarty, 2012). Cisgenderism can be understood as the belief system that underlies transbias (­P yne, 2011). This prejudicial ideology disregards the inherent knowledge people possess of their gender and their bodies (­A nsara & Berger, 2016) and presumes that all people are cisgender. Pervasive heterosexism and cisgenderism impact the daily lives of LGBTQ+ people in myriad ways. 158

DOI: 10.4324/9781351113113-17

LGBTQ+ people and homelessness

Social systems often render LGBTQ+ people invisible through marginalizing policies and practices that assume a heterosexual and/­or cisgender identity (­Shelley, 2009). Homeless service systems may perpetuate heteronormativity and cisnormativity through exclusionary paperwork, a lack of inclusive a­ nti-​­discrimination policies, the absence of adequate training for staff, and an overall lack of knowledge regarding LGBTQ+ identities. Abramovich (­2017) details the ways in which the systematic enactment of homophobia and transphobia is normalized in shelter settings, resulting in barriers to safe and affirming service acquisition. Likewise, a qualitative examination of LGBTQ+ adults experiencing homelessness (­N=17) in a Canadian city revealed the negative impact of social, structural, and physical environments, including discrimination and dangerous social environments within the shelter system (­Bardwell, 2019). LGBTQ+ people of colour experiencing homelessness not only face challenges rooted in heterosexism and cisgenderism; they also face systemic racism and its effects, such as racial profiling, police and community harassment, and racial microaggressions (­Gattis & Larson, 2017). Racism is inextricably linked to housing access and homelessness. For instance, the United States is built upon centuries of racist housing policy that has directly impacted people of colour, particularly Black people, for generations (­Shelton et al., 2018). Service systems and settings rarely possess the ability to recognize and respond to the needs of people whose lives are negatively impacted by oppression rooted in racism, classism, cisgenderism, and transbias (­Olivet & Dones, 2016).

Prevalence Little is known about the prevalence of homelessness among LGBTQ+ adults. Sexual orientation is rarely reported among adults experiencing homelessness. Estimated prevalence rates vary across research studies and administrative data. Several methodological challenges contribute to the dearth of knowledge regarding homelessness among LGBTQ+ adults. For instance, questions about sexual orientation are rarely asked and gender questions do not always include comprehensive options that would allow transgender and ­gender-​­expansive (­TGE) people to ­self-​­identify accurately. If comprehensive sexuality and gender options do exist on intake forms or in surveys, individuals may not feel comfortable disclosing this information for fear of harassment or service denial. When utilizing administrative level data to estimate the prevalence of homelessness among LGBTQ+ people, it is important to remember that many LGBTQ+ people may not be engaged in homeless serving organizations due to prior experiences of discrimination. Therefore, LGTBQ+ people may not be captured by social service administrative data. Recent ­point-­​­­in-​­time (­PIT) counts in the United States include the gender options “­transgender” and “­gender ­non-​­conforming.” According to PIT count data from 2018, transgender and ­gender-­​­­non-​­conforming people made up approximately 1% of the 372,417 individuals experiencing homelessness in the United States. Even at an approximate 1%, transgender and ­gender-­​­­non-​­conforming people are overrepresented in the population of people experiencing homelessness 159

Jama Shelton

compared to their representation in the general U.S. population (­Herman, Flores & O’Neil, 2022). It is also likely that this is an u ­ nder-​­estimate, as PIT counts rely largely on street and s­helter-​­based identification; they likely exclude people who are more hidden, such as those who are ­couch-​­surfing or sleeping rough (­Morton et al., 2018) or for whom it is not safe to disclose their gender identity. The number of TGE people experiencing homelessness increased by 22% from 2017 to 2018, the increase consisting primarily of unsheltered individuals (­U.S. Department of Housing and Urban Development, 2018). Though little is known about the prevalence of homelessness among LGBTQ+ adults, a robust literature addresses homelessness among LGBTQ+ youth and young adults (­Y YA). LGBTQ+ YYA are overrepresented in the population of YYA experiencing homelessness in the United States and Canada. While LGBTQ+ YYA comprise approximately 10% of the general population, they account for up to 40% of the population of YYA experiencing homelessness (­Shelton et al., 2018; Choi et al., 2015). According to the most comprehensive study of youth homelessness in the United States, LGBTQ+ YYA reported experiencing homelessness at over twice the rate of their heterosexual and cisgender counterparts (­Morton et  al., 2018). While LGBTQ+ YYA make up approximately 10% of the general YYA population, they are disproportionately represented in the population of YYA experiencing homelessness, comprising an estimated 2­ 0–​­40% of YYA experiencing homelessness. When disaggregating sexual orientation and gender identity in ­single-​­site and m ­ ulti-​­city studies, TGE YYA are even more overrepresented in the population of homeless YYA (­Shelton et al., 2018).

Pathways into Homelessness There is no single, universal reason LGBTQ+ people experience homelessness. Multiple, interacting factors are often at play, including structural factors (­e.g. cisgenderism, heterosexism, and racism), systemic inequity (­e.g. unequal treatment under the law), interpersonal factors (­e.g. family conflict), and individual factors (­e.g. mental health issues and addiction) (­Ecker, Aubrey & Sylvestre, 2019). System involvement, mental health challenges, and poverty have also been noted as possible precipitators to homelessness (­Ecker, Aubry & Sylvestre, 2019; Shelton et al., 2018; Choi et al., 2015). In a European context, ­identity-​­related family conflict, social rejection, and lack of institutional support have been noted as leading causes of homelessness for LGBTQ+ youth (­Shelton et al., 2021). Thus, multiple factors must be considered when thinking about pathways into homelessness and efforts to prevent homelessness among LGBTQ+ people. A frequently cited reason for homelessness among LGBTQ+ YYA is a family conflict related to sexual and/­or gender identity (­Shelton & Bond, 2017; Choi et al., 2015). However, according to a recent study, LGBTQ+ YYA did not typically end up homeless following their “­coming out” – ​­rather, their homelessness was often the result of strained relationships and family instability over time (­Robinson, 2018). Regardless of the specific family dynamics at play, it is important to not overlook the social and economic conditions and structural factors that produce 160

LGBTQ+ people and homelessness

and maintain the conditions that lead individuals into homelessness (­Shelton  & Bond, 2017). To focus solely on family conflict and intrapersonal risk ignores the systematic oppression and role of stigma in the lives of marginalized YYA. Additional reasons for homelessness among LGBTQ YA noted in the literature include verbal abuse, parental substance use, ageing out of child welfare systems, and a lack of affordable housing (­Choi et al., 2015).

The Impact of ­COVID-​­19 Pandemic The ­ COVID-​­ 19 pandemic disproportionately impacted people experiencing homelessness, and in the United States, particularly LGBTQ+ people experiencing homelessness. This disproportionality was due in large part to the U.S. Department of Health and Human Services (­H HS) November 2019 announcement that it would stop enforcing a­nti-​­discrimination protections against federal grantees that deny services to, or discriminate against, individuals. As a result of this action, LGBTQ+ people experiencing or at risk of experiencing homelessness were left extraordinarily vulnerable during the pandemic, as the decision to halt enforcement of ­non-​­discrimination protections implicitly permitted discrimination against LGBTQ+ people seeking critical support and services. The following list, taken from a press release1 regarding advocacy groups’ lawsuit against the Trump administration’s HHS, details some of the ways in which the action taken by HHS negatively impacted LGBTQ+ people of all ages. •

•

•

• •

At a time when colleges and universities have shut down housing to help halt the spread of ­COVID-​­19, students experiencing homelessness are susceptible to discrimination as they seek shelter through HHS’ Runaway and Homeless Youth Program. Federally funded foster care agencies can refuse to place children with families because of a prospective host family’s sexual orientation or gender identity, limiting the pool of potential homes for kids who need them. Child welfare agencies and homelessness service providers can engage in abusive and discriminatory practices, including verbal and physical abuse, conversion therapy, and forcing LGBTQ youth to accept services that deny their sexual orientation or gender identity. A federally funded adult d­ ay-​­care provider could adopt a policy of “­No Trans People May Enter.” At a time when senior centres are shutting down in major metropolitan centres to help combat the spread of C ­ OVID-​­19, LGBTQ older adults are vulnerable to providers that subject them to harassment or refuse to offer services, such as home delivered meals, on the basis of their sexual orientation or gender identity.

Further, in locations where stay at home orders were issued, people experiencing homelessness have no home in which to stay, putting them at a greater risk of contracting COVID. Accessing adequate healthcare for LGBTQ+ people experiencing 161

Jama Shelton

homelessness is full of challenges, given the already existing barriers to access to healthcare for people experiencing homelessness, as well as challenges in accessing LGBTQ+ affirming healthcare.

Unique Challenges LGBTQ+ people experience physical and mental health disparities and barriers to healthcare, regardless of housing status. For instance, available research suggests that ­ ealth-​­related conditions, such as LGBTQ+ people are at a high risk for a range of h depression, anxiety, substance use, suicidality, HIV, and other sexually transmitted infections. Once homeless, LGBTQ+ people experience further challenges and are at an increased risk for a range of negative outcomes than their heterosexual and cisgender counterparts. When considering these unique challenges, it is important to contextualize them within the current s­ocio-​­political environment, as well as within the historic oppression faced by LGBTQ+ people. Minority stress theory provides a framework for understanding the cumulative impact of discrimination, marginalization, and stigma on the health and w ­ ell-​­being of LGBTQ+ people. LGBTQ+ people experiencing homelessness face unique challenges, such as violence and victimization based on sexual orientation, gender identity, and/­or expression, longer durations of homelessness, ­identity-​­based family rejection, barriers to service acquisition rooted in heterosexism and cisgenderism, and discrimination within housing and employment. Each of these unique challenges results in an increased risk for negative physical, mental, and behavioural health outcomes. LGBTQ+ people experiencing homelessness report high rates of sexual orientation and gender ­identity-​­based discrimination within shelter settings (­Romero, Goldberg & Vasquez, 2020). These experiences may lead to LGBTQ+ people finding alternative accommodations through exchanging sex for a place to stay, or may lead to LGBTQ+ people sleeping rough. Sex exchange places LGBTQ+ people at an increased risk for victimization, sexual health concerns, and involvement with the criminal legal system. Sleeping rough exposes LGBTQ+ people to potentially damaging environmental factors (­i.e., frostbite and excessive heat), victimization, and police interaction. Thus, the inability of the housing assistance system to adequately and safely serve LGBTQ+ people experiencing homelessness places them at risk and is a public health concern. LGBTQ YYA experience longer durations of homelessness than their heterosexual and cisgender counterparts; this is particularly true for TGE YYA (­Choi et al., 2015). The duration of homelessness is a critical factor, as longer durations of homelessness have been identified as a threat to resilience among YYA experiencing homelessness. Longer durations of homelessness are also associated with higher levels of sexual risk behaviours, including engaging in sex while using substances, less consistent contraceptive use, and less motivation to engage in ­HIV-​­protecting behaviours (­Collins & Slesnick, 2011). Longer durations of homelessness resulted in greater difficulty exiting homelessness among a sample (­N=1,677) of Australian people who first experienced homelessness when they were aged 18 or younger

162

LGBTQ+ people and homelessness

( ­Johnson & Chamberlain, 2008). In addition to experiencing longer durations of homelessness, one U.S.-​­based study found that LGBTQ+ people experienced more frequent episodes of homelessness than their heterosexual and cisgender counterparts (­Ecker, Aubry & Sylvestre, 2019). Family rejection as a result of sexual orientation, gender identity, and/­or gender expression is a risk factor unique to LGBTQ+ people. ­Identity-​­based family rejection refers to negative reactions, primarily from parents or guardians, upon learning about their child’s sexual orientation or gender identity. These negative reactions range from physical abuse and/­or expulsion from the home to more subtle forms of rejection such as keeping the sexual orientation or gender identity of the child a secret and/­or limiting access to LGBTQ+ affirming information, events, and people (­Ryan et al., 2009). I­dentity-​­based family rejection can cause exacerbated levels of depression and suicidality, increased substance use, lower levels of life satisfaction, increased sexual risk behaviours, legal problems, and is a frequently cited cause of homelessness among LGBTQ+ YYA (­Abramovich, 2017; Choi et al., 2015; Ryan et al., 2009; Shelton, 2018). Evidence indicates that, once homeless, LGBTQ+ people are at a heightened risk for experiencing a range of negative physical, mental, and behavioural health outcomes. For example, compared to their heterosexual and cisgender counterparts, LGBTQ+ YYA experiencing homelessness report higher rates of substance abuse, engagement in the sex industry, mental health symptoms, and experiences of victimization (­Corliss et al., 2011; Walls, Hancock & Wisneski, 2007).

Supporting LGBTQ+ People Experiencing Homelessness To best support LGBTQ+ people experiencing homelessness, change must occur on all levels. In addition to individual interventions, which tend to be the focus of homeless serving systems, structural interventions must also occur. For example, educating homeless services staff to provide affirming care for LGBTQ+ people experiencing homelessness may increase shelter access for this population, but addressing the structural causes of marginalization and systematic erasure experienced by LGBTQ+ people may help serve to alleviate the need for shelter access in the first place. Or, consider how individuals are prioritized for housing placement. Given the documented disparities of LGBTQ+ people experiencing homelessness, including more frequent episodes of homelessness and longer durations of homelessness, consider adding LGBTQ+ identity as a factor in determining vulnerability scores and prioritization for housing. One way to help ensure your local homeless system is meeting the needs of LGBTQ+ people experiencing homelessness is to involve LGBTQ+ people directly in the development of policy and programme structures. The unique needs of LGBTQ+ people experiencing homelessness are well documented; it would be irresponsible to not consider these unique needs when developing programmes for people experiencing homelessness. LGBTQ+ people who have experienced homelessness can be included in various ways. Examples include:

163

Jama Shelton ­Table 14.1  Creating a safe and affirming programme Organizational policy

• Include sexual orientation, gender identity, and gender expression in ­non-​­d iscrimination policies. • Create a grievance policy with clear procedures to follow if someone has been harassed or mistreated within the programme. • Review organizational policies and documents for heteronormative and binary gendered language (­i.e., mother/­father, husband/­w ife) and replace such language with more inclusive terminology. For instance, mother/­father could be replaced with parents; he or she could be replaced with he, she, or they. Physical space • Post welcoming messages in the physical space, such as “­People of all races, gender identities, gender expressions, sexual orientations, religions, and abilities are welcome here.” • Ensure your organization has at least one designated all gender restroom. • When creating a new programme, design it such that all restrooms are individual, ADA accessible restrooms, which better ensures privacy, accessibility and safety for all. • Post the LGBTQ+ inclusive ­non-​­discrimination policy in clear sight of all who enter. Staff training • Ensure all employees who interact with service users receive ongoing training on best practices for working with LGBTQ+ people. • Partner with a local LGBTQ+ organization and/­or LGBTQ+ people who have experienced homelessness to design and deliver trainings. Documentation Provide a space on paperwork for people to ­self-​­identify their sexual Intake/­Screening orientation, gender, and pronouns. • Ensure service users’ names and pronouns are clearly documented for staff to avoid misgendering. • Review the LGBTQ+ inclusive ­non-​­discrimination policy with all service users and require their signature of agreement. • If possible, eliminate ­check-​­in areas that are separated by gender. • Include questions about sexual orientation, gender identity and pronouns on intake paperwork. (­But only after intake staff have been trained and are comfortable with discussing these topics). • Service users should be able to indicate their name, rather than providing an ID card that is used to gather this information. An individual’s name and gender may not be the same as what is indicated on their government issued ID. • Only the name an individual specifies as the name they use should be called out in public areas such as a waiting room or lobby. A person’s government name (­or “­dead name”) should never be used. • Intake workers should introduce themselves to all service users with their name and pronoun, modelling how this is done and setting a standard for inclusion of transgender and ­gender-​ ­expansive people.

164

LGBTQ+ people and homelessness Placement

Physical Space

Community Engagement

• Transgender individuals should be allowed to access ­sex-​­segregated programmes that correlate with their ­self-​­stated gender. • In ­sex-​­segregated programmes, transgender and ­gender-​­expansive individuals should be placed where they feel the safest. Transgender and ­gender-​­expansive people are at risk of victimization, not the other way ­a round – ​­that transgender and ­gender-​­expansive people are the perpetrators of violence in ­sex-​­segregated spaces is a myth. • When creating a new programme, consider individual sleeping rooms, which better ensures safety and privacy for all, while also offering a more humane form of shelter than the traditional warehouse model. • Post welcoming messages in the physical space, such as “­People of all races, gender identities, gender expressions, sexual orientations, religions, and abilities are welcome here.” • Ensure your organization has at least one designated all gender restroom. • When creating a new programme, design it such that all restrooms are individual, ADA accessible restrooms, which better ensures privacy, accessibility and safety for all. • Post the LGBTQ+ inclusive ­non-​­discrimination policy in clear sight of all who enter. • Establish relationships with local LGBTQ+ organizations. • Participate in ­community-​­based activities related to LGBTQ+ people and communities (­i.e., LGBTQ+ Pride events, Transgender Day of Remembrance). • Engage in structural change efforts to address the inequities faced by LGBTQ+ people, particularly transgender and ­gender-​ e­ xpansive people, in your community. • Discuss how partnering organizations ensure the safety and inclusion of LGBTQ+ service users and include these terms in any MOUs outlining organizational partnerships. • Ensure that any third parties associated with the organization are aware of your organizational policies regarding the safety and inclusion of LGBTQ+ people, and do not do business with outside vendors who do not share the same values. • Be a visible and vocal ally to LGBTQ+ people. • Become known as an LGBTQ+ affirming organization within your community.

Source: Chapter author.

• • • •

Hire LGBTQ+ people who have experienced homelessness to work in homeless serving organizations and/­or as consultants. Form a community advisory board that includes LGBTQ+ people. Conduct a needs assessment of LGBTQ+ people in your community. Employ LGTBQ+ people to conduct ongoing training and assessment within homeless serving organizations to help ensure a safe, inclusive, and affirming environment. 165

Jama Shelton

Organizations in the UK have recently released a report detailing the ways in which the LGBTQ+ sector and the homelessness sector can work together to address LGBTQ+ homelessness. This resource can be accessed here: https://­w ww. feantsa.org/­public/­user/­Resources/­reports/­StudySessionReport_FINAL.pdf

Creating a Safe and Affirming Programme Homeless serving organizations can take specific actions to become safer for and affirming of LGBTQ+ people in the areas of organizational policy, physical space, staff training, documentation, intake/­screening, placement, and community engagement. The following recommendations are based on existing best practice recommendations from both European and U.S.-​­based organizations for working with LGBTQ+ people experiencing homelessness and in other service settings (­A lbert Kennedy Trust, n.d.; Bardwell, 2019; Mottet & Ohle, 2006; www.truecolorsunited.org; Wilber, Ryan, & Marksamer, 2006) (­­Table 14.1).

Conclusion Sexuality and gender impact individuals’ pathways into homelessness, their experiences while homeless, and their exits into stable housing. LGBTQ+ people experience a range of negative health outcomes, largely due to stressors associated with belonging to a marginalized and stigmatized group. It is imperative that homeless serving systems consider the unique needs of LGBTQ+ people experiencing homelessness. Interventions aimed at addressing homelessness among this population must occur at all levels, including the dismantling of systemic barriers rooted in heterosexism and cisgenderism that constrain LGBTQ+ people’s ability to transition out of homelessness into permanent, stable living arrangements.

Note 1 https://­w ww.lambdalegal.org/­blog/­­20200319_lawsuit-­​­­trump-­​­­hhs-­​­­anti-­​­­d iscrimination­​­­lgbtq-­​­­covid-­​­­19-​­pandemic.

References Abramovich, A. (­2017). Understanding how policy and culture create oppressive conditions for LGBTQ2S youth in the shelter system. Journal of Homosexuality, 64(­11), ­1484–​­1501. Albert Kennedy Trust. (­n.d.). How homeless services can be more inclusive and support young trans people. Retrieved from: https://­­homelesslink-​­1b54.kxcdn.com/­media/­ documents/­Supporting_young_trans_people_in_homelessness_services_HkEagip.pdf Ansara, Y. G. & Berger, I. (­2016). Cisgenderism. The Wiley Blackwell Encyclopedia of Gender and Sexuality Studies. Hoboken, NJ: W ­ iley-​­Blackwell, ­1–​­3. Ansara, Y. G. & Hegarty, P. (­2012). Cisgenderism in psychology: Pathologizing and misgendering children from 1999 to 2008. Psychology & Sexuality, 3, ­137–​­160. Bardwell, G. (­2019) The impact of risk environments on LGBTQ2S adults experiencing homelessness in a midsized Canadian city. Journal of Gay & Lesbian Social Services, 31(­1), ­53–​­64.

166

LGBTQ+ people and homelessness Choi, S. K., Wilson, B. D. M., Shelton, J. & Gates, G. (­2015). Serving Our Youth 2015: The Needs and Experiences of Lesbian, Gay, Bisexual, Transgender, and Questioning Youth Experiencing Homelessness. Los Angeles: The Williams Institute with the True Colors Fund. Collins, J. & Slesnick, N. (­2011). Factors associated with motivation to change HIV risk and substance use behaviors among homeless youth. Journal of Social Work Practice in the Addictions, 11(­2), ­163–​­180. Corliss, H., Goodenow, C., Nichols, L. & Austin, S. (­2011). High burden of homelessness among sexual minority adolescents: Findings from a representative Massachusetts high school sample. American Journal of Public Health, 101(­9), ­1683–​­1689. Ecker, J., Aubry, T. & Sylvestre, J. (­2019). A review of the literature on LGBTQ adults who experience homelessness. Journal of Homosexuality, 66(­3), ­297–​­323. Gattis, M. & Larson A. (­2017). Perceived microaggressions and mental health in a sample of Black youths experiencing homelessness. Social Work Research, 41(­1), ­7–​­17. Herman, J. L., Flores, A. R. & O’Neill, K. (­2022). How many adults and youth identify as transgender in the United States? The Williams Institute. Retrieved from: https://­ williamsinstitute.law.ucla.edu/­publications/­­t rans-­​­­adults-­​­­u nited-​­states/ Johnson, G., & Chamberlain, C. (­2008) From youth to adult homelessness. Australian Journal of Social Issues, 43(­4), ­563–​­582. Morton, M. H., Dworsky, A., Matjasko, J., Curry, S., Schleuter, D., Chavez, R. & Farrell, A. (­2018). Prevalence and correlates of youth homelessness in the United States. Journal of Adolescent Health, 62, ­14–​­21. Morton, M. H., Samuels, G. M., Dworsky, A. & Patel, S. (­2018). Missed Opportunities: LGBTQ Youth Homelessness in America. Chicago, IL: Chapin Hall at the University of Chicago. Retrieved from: https://­voicesofyouthcount.org/­­w p-​­content/­uploads/­2018/­04/­­VoYC-­​ ­­LGBTQ-­​­­Brief-​­FINAL.pdf Mottet, L. & Ohle, J. (­2006). Transitioning our shelters: Making homeless shelters safe for transgender people. Journal of Poverty, 10(­2), ­77–​­101. Olivet, J. & Dones, M. (­2016). Intersectionality and race: How racism and discrimination contribute to homelessness among LGBTQ youth. In At the Intersections: A Collaborative Report on LGBTQ Youth Homelessness, edited by Price, C., Wheeler, C., Shelton, J. & Maury, M. New York: True Colors Fund and the National LGBTQ Task Force, ­56–​­59. Pyne, J. (­2011). Unsuitable bodies: Trans people and cisnormativity in shelter services. Canadian Social Work Journal, 28(­1), ­129–​­138. Robinson, B.A. (­2018), Conditional families and lesbian, gay, bisexual, transgender, and queer youth homelessness: Gender, sexuality, family instability, and rejection. Journal of Marriage & Family, 80, ­383–​­396. Romero, A. P., Goldberg, S. K. & Vasquez, L. A. (­2020). LGBT people and housing affordability, discrimination, and homelessness. The Williams Institute. Retrieved from: https://­escholarship.org/­content/­qt3cb5b8zj/­qt3cb5b8zj.pdf Ryan, C., Huebner, D., Diaz, R., & Sanchez, J. (­2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(­1), ­346–​­352. Shelley, C. (­2009). Transgender people and social justice. The Journal of Individual Psychology, 65(­4), ­386–​­396. Shelton, J., Ritosa, A., Van Roozendaal, B., Hugendubel, K. & Dodd, S. J. (­2021). Perceptions: Addressing LGBTI Youth Homelessness in Europe and Central ­A sia – ​­Findings from a Survey of LGBTI Organisations. New York: I­ LGA-​­Europe, True Colors United, and the Silberman Center for Sexuality and Gender at Hunter College. Shelton, J., DeChants, J., Bender, K., Hsu, H., Narendorf, S., Ferguson, K., Petering, R., ­Barman-​­Adhikari, A. & Santa Maria, D. (­2018). Homelessness and housing experiences among LGBTQ youth and young adults: An intersectional examination across seven U.S. cities. Cityscape, 20(­3), ­9 –​­33.

167

Jama Shelton Shelton, J.  & Bond, L. (­2017). “­It just never worked out”: How transgender and gender expansive youth understand their pathways into homelessness. Families in Society, 98(­4), ­235–​­242. U.S. Department of Housing and Urban Development. (­2018). Homelessness in the United States: The 2018 Annual Homeless Assessment Report to Congress. Retrieved from: https://­huduser.gov/­portal/­sites/­default/­fi les/­pdf/­­2018-­​­­A HAR-­​­­Part-​­1.pdf Walls, E, Hancock, P. & Wisneski, H. (­2007). Differentiating the social service needs of homeless sexual minority youths from those of ­non-​­homeless sexual minority youths. Journal of Children and Poverty, 13(­2), ­177–​­205. Wilber, S., Ryan, C., & Marksamer, J. (­2006). Best Practice Guidelines: Serving LGBT Youth in ­O ut-­​­­of-​­Home Care. Washington, DC: Child Welfare League of America. Retrieved from: http://­w ww.nclrights.org/­­w p-​­content/­uploads/­2013/­07/­bestpracticeslgbtyouth. pdf

168

15 YOUTH Paula Mayock and Sarah Parker

Introduction Youth homelessness is a growing problem across Europe and a crisis strongly associated with young people’s exclusion from housing markets (­FEANTSA, 2017a, 2018). It is estimated that youth aged ­18–​­29 years represent 20%–​­30% of the total homeless population in many countries (­­Busch-​­Geertsema et al., 2014). There is also evidence that youth homelessness has increased: by 50% in the Netherlands between 2015 and 2016 (­FEANTSA, 2017a); by 85% in Denmark between 2009 and 2015 (­Benjaminsen  & Hesselberg Lauritzen, 2015); and by 90% in Ireland between 2011 and 2016 (­Central Statistics Office, 2012, 2017). In the UK, recent estimates for ­2019–​­2020 indicate that 121,000 young people aged ­16–​­24 were homeless or at risk of homelessness (­Centrepoint, 2021) while, in the US, 34,210 unaccompanied young people under the age of 25 were reported to be experiencing homelessness on a single night in January 2020 (­H UD, 2021). Rising numbers of youth accessing homelessness services have also been recorded in Canada (­Gaetz et al., 2016a) and Australia (­A HURI, 2020). ­Cross-​­country comparisons on the extent of youth homelessness are hampered by a lack of uniformity in how ‘­youth’ and ‘­homelessness’ are defined (­FEANTSA, 2020). The age range associated with the category ‘­youth’ has implications for what situations and individuals may be counted as homeless. The United Nations defines youth as individuals aged ­15–​­24 years and the European Union follows this definition (­European Commission, 2001). The importance of distinguishing between child and youth homelessness is widely recognised (­Quilgars, 2010), with the former usually understood as affecting people under the age of 18 years, which is the age of majority in most European countries. In Ireland, data on adults living in s­ tate-​­funded emergency accommodation are recorded by the Pathway Accommodation and Support System (­PASS). However, DOI: 10.4324/9781351113113-18

169

Paula Mayock and Sarah Parker

PASS only records data on homelessness among youth who are 18 years and over. In contrast, in the UK, analyses of trends in youth homelessness tend to focus on the situations and housing needs of those aged between 16 and 24 years (­Quilgars et al., 2011). FEANTSA (­2020: 2) proposes ­13–​­26 years as the age range of youth homelessness, emphasising that “­services should not be designed with a cliff edge cut off point”. Like ‘­youth’, the category ‘­homeless’ is understood and defined differently and there is no universally accepted definition (­­Busch-​­Geertsema, 2010). There is, however, consensus that wider definitions that capture those who are at risk of homelessness or residing in insecure or inadequate living situations, better reflect the full spectrum of experiences that constitute homelessness. While the widely accepted European Typology of Homelessness and Housing Exclusion is one such framework, it nevertheless raises “­definitional issues when considering the housing position of young people” (­Quilgars et al., 2011: 15). For example, homeless hostels and transitional accommodation are listed under the category ‘­houseless’ but tend to offer very different types of supports and services to young people. More broadly, enumeration systems in most countries do not capture individuals living in situations of hidden ­homelessness—​­couch surfing or staying temporarily with family members or ­friends—​­which means that available statistics likely underestimate the scale of youth homelessness.

Young People’s Paths to Homelessness Young people’s paths to homelessness are shaped by a range of experiences and risks that frequently interact in complex ways. Research has identified a wide array of factors that contribute to youth homelessness, including histories of state care (­Dworsky et al., 2013; King et al., 2017; Mayock et al., 2014); LGBTQI+ identification (­Ecker et al., 2019; FEANTSA, 2017b); racial disparities (­Moser Jones, 2016); mental health problems (­­Harleigh-​­Bell, 2014) and substance use (­Cheng et al., 2013; Tyler & Johnson, 2006). In the literature, family environment consistently emerges as a dominant theme in the reasons why youth experience homelessness (­Mallett et al., 2010; Mayock & O’Sullivan, 2007; Mayock et al., 2011). Homeless youth frequently report difficult or fractured relationships with a parent(­s) (­Mayock et al., 2011, 2014; Randall & Brown, 2001) and research has also documented ­step-​­parent (­Mallett et al., 2005) and sibling (­Mayock et al., 2014) conflict as contributing to young people’s early departure from the family home. Substance use in the family home features quite prominently in the literature, with research suggesting that parental substance use can result in family difficulties, disrupted schooling and feelings of anxiety, anger and resentment on the part of young people (­Mallet et al., 2005; Mayock et al., 2021). Importantly, the family situations of youth who experience homelessness are diverse and there is considerable variation in the type, severity and nature of f­ amily-​ b­ ased conflict. At the more severe end, abusive family s­ituations—​­characterised by some level of physical, emotional and/­or sexual abuse or n ­ eglect—​­are strongly associated with young people’s early experiences of housing instability and 170

Youth

homelessness (­Mallett et  al., 2010; Mayock et  al., 2014). More broadly, there is emerging evidence on the role of t­ rauma—​­related to early experiences of bereavement, abuse and neglect, as well ­as neighbourhood-​­based stressors (­K im et  al., 2018; Mayock et al., 2021)—​­and how such experiences may lead homeless youth to rely on negative coping strategies rather than seeking formal supports (­Bender et al., 2018). Crucially, ‘­individual’ risk factors must be viewed in the context of the structural drivers ­of—​­and the centrality of poverty ­to—​­the generation of homelessness, including youth homelessness. Young people who experience homelessness invariably come from poor neighbourhoods and grow up in households where there may be persistent financial stress related to parental unemployment or low income (­Mayock et al., 2014; Pleace et al., 2008; Quilgars et al., 2008). Additionally, factors such as poverty and unemployment are likely to “­put a strain on social relationships (­w ith family and friends) that often act to ‘­buffer’ people from experiences of homelessness” (­Watts et al., 2015: 63). Structural and systemic factors therefore create the conditions under which personal or relational crises produce vulnerability to homelessness. For young people who cannot remain in the family home, a lack of affordable and accessible ­housing—​­including ­age-​­related discrimination within private rented ­m arkets—​­as well as poor access to social protection significantly increases their risk of homelessness (­FEANTSA, 2020). These risks are heightened for young people who do not have personal and familial safety nets (­Gaetz et al., 2016b) or are exiting child welfare systems. It is well documented that for many, “­the transition from child welfare support is not to ­self-​­sufficiency, but rather to homelessness” (­Gaetz, 2014a: 12), signalling failures linked to poor coordination across and between systems. The legal distinction that separates ‘­child’ from ‘­adult’ in most jurisdictions forces an abrupt transition from child welfare to adult service systems, thereby parachuting young people into service environments that are not designed or resourced to respond to their needs (­Gaetz, 2014a; Mayock et al., 2008; Mayock et al., 2013, 2014). While there are clearly a range of factors or ‘­triggers’ that push young people out of home or care, for most, the route to homelessness is not linear and is rarely experienced as a single event. More typically, prior to making a final ‘­break’ from home, youth will have embarked on a pattern of moving back and forth between home and various informal living places, including the homes of friends or relatives where they are invisible to services and systems of intervention (­Gaetz et al., 2016b; Mayock  & Parker, 2021; Mayock et  al., 2021). By the time young people enter into the official network of homelessness services, the vast majority will therefore have endured numerous upheavals and very many will have multiple and complex needs.

The Process of Youth Homelessness Homelessness is increasingly conceptualised as a process and not simply as a situation or event. Viewed as ­episodic—​­and not necessarily resulting in a downward spiral 171

Paula Mayock and Sarah Parker

towards ­long-​­term or ‘­chronic’ homeless ­states—​­homelessness can be understood as “­a n episode or episodes in a person’s housing pathway” (­Clapham, 2003: 123). Research has therefore begun to focus to a far greater extent than previously on ‘­t racking’ young people’s paths through and out of homelessness. Using a longitudinal approach, quantitative and qualitative studies have bolstered understanding of youths’ changing interactions with homelessness and housing over time and of the circumstances and resources that enable or hinder housing stability.

Young People Exiting Homelessness Emerging longitudinal evidence suggests that young people can transition from homelessness to housing relatively quickly (­M ilburn et al., 2007, 2009). In Australia, Mallett et al.’s (­2010) longitudinal study of 40 newly homeless young people found that more than half had returned to the family home or secured entry to stable private or public housing by the time of ­follow-​­up. Compared to others who continued to use the service system or move in and out of home, those who were securely housed had experienced homelessness for a shorter period of time. High rates of returns to stable housing have also been reported in a more recent ­US-​­based study of 243 homeless adolescents, aged 12.­7–​­17.9 years, followed over a ­seven-​­year period (­Braciszewski et al., 2016). Returning home was the most frequent outcome among those who experienced consecutive days of housing, “­w ith approximately two thirds of participants back in their parents’ homes at the beginning of their string of housed days” (­Braciszewski el al., 2016: 362). In Ireland, a ­six-​­year qualitative longitudinal study of 40 homeless youth in Dublin recorded relatively strong exit rates from homelessness (­Mayock et  al., 2008, 2011; Mayock & Corr, 2013). Similar to the work of Mallett et al. (­2010), the findings strongly suggest that the duration of young people’s homelessness significantly impacts the likelihood of a transition to stable housing, highlighting the critical importance of speedy exits from homelessness. Those who remained homeless by Phase 3 of the study were primarily young men who first experienced homelessness during their early or ­m id-​­teenage years and subsequently embarked on an ‘­institutional circuit’, moving between homeless hostels, unstable living situations and periods of incarceration. To date, longitudinal research that has ‘­t racked’ homeless youth over time suggests that a resolution to homelessness is possible, particularly among younger age cohorts. Youth who quickly exit emergency systems of intervention appear to have a better chance of sustaining housing while those who continue to navigate the service system are at risk of ­longer-​­term homelessness trajectories.

Determinants of Housing Stability A strong message arising from longitudinal studies of homeless youth is that negotiating a route out of homelessness can be a long and challenging path (­K idd et al., 2016; Mayock & Corr, 2013). A consistent finding arising from research that has examined the factors or experiences that support an exit from homelessness is 172

Youth

that social support, particularly family support, plays a significant enabling role (­Braciszewski et  al., 2016; Mallet et  al., 2010; Mayock et  al., 2011; Mayock  & Corr, 2013; Milburn et al., 2009). While young people who experience homelessness may have complex relationships with family (­Parker & Mayock, 2019), there is evidence that they derive significant benefits from reconnecting and resolving past difficulties with family members. These benefits include a greater likelihood of sourcing and maintaining housing, often because they feel connected to valued people, which, in turn, supports their ability to negotiate new challenges (­Mayock et al., 2011). Connections to broader social systems and access to resources, including education, employment and medical care, have been found to predict change in homelessness among youth (­Roy et al., 2016), while a number of studies have identified the positive impact of disassociating from street peers as a facilitator to exiting homelessness and remaining housed (­K arabanow, 2008; Mayock et  al., 2011). Other research has emphasised that service engagement and professional supports play an important role in enabling youth to negotiate a route to stable housing (­Fitzpatrick, 2000; Mayock et al., 2011; Mayock & Parker, 2017, 2020). Gender appears to be a factor that impacts the likelihood of youth exiting homelessness, with a number of studies indicating that being female facilitates an exit or more speedy transition to housing (­Fitzpatrick, 2000; Mayock  & Corr, 2013; Mayock et  al., 2008; Roy et  al., 2016). This may be because women are more likely to be protected, at least to some extent, from the most severe forms of homelessness due to the presence of children (­Hansen Löfstrand & Quilgars, 2016). It may also be that young women are more willing to seek assistance from formal agencies (­Fitzpatrick, 2000) and/­or to draw on the support of family members (­Mayock & Corr, 2013). Finally, younger age, being homeless for shorter periods of time and having the option of returning to the family home appear to facilitate a resolution to young people’s homelessness (­Mallett et al., 2010). Hence, routes out of homelessness for older ­youth—​­particularly males who are homeless for longer periods of ­t ime—​­are likely to be more restricted. Irrespective of gender, there is evidence that young people, particularly those over the age of 18 years, do not generally view returning to the family home as a viable option, even if they wish to remain in contact with family members (­Mayock et  al., 2011; Milburn et  al., 2009; Parker  & Mayock, 2019). The available evidence strongly suggests that the factors that support youths’ attempts to access housing span a range of domains and encompass behavioural, social and individual characteristics and experiences. However, access to affordable and appropriate housing is consistently highlighted as the most significant determinant of youth exiting homelessness (­Cheng et al., 2013; Mayock & Parker, 2020). With shortfalls in affordable housing affecting young people in many countries, homeless youth are particularly vulnerable to housing exclusion. Other structural factors impacting rising rates of youth homelessness include reforms in social benefit systems and activation policies, which present particular risks for socially ­ usch-​­Geertsema, 2009). These same marginalised young people (­Benjaminsen & B 173

Paula Mayock and Sarah Parker

reforms may negatively impact homeless young people’s ability to access affordable housing, particularly in contexts where rising rental costs essentially lock them out of the private rented sector (­Mayock & Parker, 2020; Rugg & Quilgars, 2015). Research focusing specifically on young people’s transitions to housing is only beginning to emerge. However, it seems clear that exiting homelessness is best understood as an incremental process, often connected to youth adjusting to becoming housed. Thus, while housing is clearly critical, it may not be sufficient in and of itself to ensure a ­long-​­term transition from homelessness for some young people. The ability of youth to sustain housing appears to be contingent on the presence of broader mechanisms that support community integration and quality of life as well as success with the achievement of broader personal goals, including (­re)­engagement in education and labour market participation.

Responses to Youth Homelessness Interventions targeting homeless youth vary significantly across jurisdictions. In recent years, homelessness policy and service developments have been driven by critiques of service systems characterised by an o ­ ver-​­reliance on emergency models of provision that do not serve young people well, particularly if their stay in these settings is prolonged (­Gaetz, 2011, 2014a; Mayock & Parker, 2017). Rather than ‘­m anaging’ the problem by providing youth with food, a place to stay and other basic needs, the focus has shifted to preventing homelessness in the first instance and supporting rapid transitions out of homelessness through the provision of appropriate accommodation alongside ­housing-​­ and ­person-​­centred supports (­Gaetz, 2014a, 2017). There are a range of housing programmes targeting homeless youth, including transitional housing, supported housing and supported lodgings, which can be broadly characterised as ­housing-​­led in that they aim to provide access to temporary or interim housing. While staircase approaches to housing people expleriencing homelessness have been subjected to severe criticism (­Hansen Löftstrand, 2010; Sahlin, 2005), ‘­stepped’ or transitional models may be appropriate for some young people, particularly “­for young 1­ 6–​­18 year olds (­a nd sometimes older) young people who often need a supportive environment for a significant period of time before moving to independent living” (­Quilgars et al., 2008: 113). ­Youth-​­oriented transitional housing programmes have been evaluated positively, including for youth exiting the foster care system and LGBTQ2S youth (­Abramovich & Kimura, 2019). ­Housing-​­led interventions, including Housing First, have achieved international recognition as an effective alternative to emergency shelter systems (­A llen et al., 2020; ­Busch-​­Geertsema, 2013; Padgett et al., 2016; Shinn & Khadduri, 2020) and, although staircase models of provision prevail throughout Europe, Housing First is now central to strategic responses to homelessness in many countries. Pioneered in Canada, Housing First for Youth (­HF4Y) has gained traction, and programmes have been established in a number of European countries. HF4Y differs from transitional or supported housing models in that the latter often come with conditions, are ­time-​­limited and do not separate housing and 174

Youth

supports. As outlined in the HF4Y Program Model Guide (­Gaetz, 2017), HF4Y provides immediate access to housing without preconditions; it is a ­rights-​­based approach that promotes youth choice and ­self-​­determination; it has a positive youth development orientation; and is underpinned by the goal of social and community integration. Advocates of HF4Y make it clear that the model is distinct from the traditional Housing First approach and must be adapted to the developmental, social and legal circumstances and needs of young people. Strong emphasis is also placed on the causes and consequences of youth homelessness, which differ from the adult experience. There is broad agreement that models of housing for young people who experience homelessness must take account of their developmental stage (­Gaetz, 2014a), address their practical and emotional support needs (­Munson et al., 2017), provide (­sometimes intensive) housing support and understand that youths’ service preferences may change and evolve over time (­Scott & Harrison, 2013). Consequently, young people are likely to need a range of housing options within the Housing First ‘­u mbrella’, including models that go beyond the scattered site, independent living model that is fundamental to many Housing First approaches (­Gaetz, 2014b). Housing First services for youth were established in Ireland in 2013 and are being implemented in the cities of Limerick, Cork and Waterford. In the UK, the first HF4Y project was launched in Scotland by Rock Trust in 2017, while in France, the Logis Jeunes project, initiated in 2010, provides housing to 1­ 8–­​­­25-­​ ­­year-​­olds alongside a personalised support plan (­FEANTSA, 2018). Compared to Housing First for adults, the research base on HF4Y is far less developed but there is emerging evidence that Housing First works effectively for young people (­Blood et al., 2020; Lawlor & Bowen, 2017). In 2019, the original HF4Y Program Model Guide (­Gaetz, 2017) was revised and adapted to take account of contextual differences between Canada and Europe, leading to the publication of This is Housing First for Youth Europe (­Gaetz, 2019), which aims to support and guide the implementation of HF4Y in the European context. As with adult homeless populations, there is growing recognition in Europe, North America and Australia that moving young people out of emergency accommodation to independent housing must be a policy imperative. While HF4Y is at an early stage of development, the design and implementation of these programmes signal a shift towards a more strategic and integrated system of responses that prioritises prevention and early intervention, underpinned by a broader aim of ending youth homelessness.

Conclusion Globally, the knowledge base on youth homelessness has expanded significantly alongside shifts in thinking that have prompted greater research attention to the evolving nature of the homeless experience among youth and the processes that support, or alternatively obstruct, a resolution to their homelessness. A core message arising from longitudinal research in particular is that young people must be 175

Paula Mayock and Sarah Parker

supported to exit homeless service systems at the earliest possible juncture. Secure housing, alongside the provision of additional supports as needed, is an essential first step in achieving a sustained resolution to youth homelessness. The development and expansion of housing models and options for homeless y­ outh—​­including ­HF4Y—​­require urgent attention if the aim of preventing young people from embarking on cycles of ­long-​­term patterns of homelessness is to be realised.

References Abramovich, A. & Kimura, L. (­2019) Outcomes for youth living in Canada’s first LGBTQ2S transitional housing program. Journal of Homosexuality, 68(­1), ­1–​­18. AHURI (­2020) Redesign of a Homelessness Service System for Young People. Melbourne: AHURI. Available at: https://­papers.ssrn.com/­sol3/­papers.cfm?abstract_id=3635887 Allen, M., Benjaminsen, L., O’Sullivan, E. & Pleace, N. (­2020) Ending Homelessness? The Contrasting Experiences of Denmark, Finland and Ireland. Bristol: The Policy Press. Bender, K., Begun, S., Durbahn, R., Ferguson, K. & Schau, N. (­2018) My own best friend: Homeless youths’ hesitance to seek help and strategies for coping independently after distressing and traumatic experiences. Social Work in Public Health, 33(­3), ­149–​­162. Benjaminsen, L. & B ­ usch-​­Geertsema, V. (­2009) Labour market reforms and homelessness in Denmark and Germany: Dilemmas and consequences. European Journal of Homelessness, 3, ­127–​­153. Benjaminsen, L. & Hesselberg Lauritzen, H. H. (­2015) Hjemløshed i Danmark 2015: National kortlaegning [Homelessness in Denmark: National Mapping]. København: ­SFI  – ​­Det Nationale Forskningscenter for Velfaerd. ­SFI-​­Rapport; Nr. 15:35. Blood, I., Aldern, S. & Quilgars, D. (­2020) Rock Trust Housing First for Youth Pilot: Evaluation Report. Available at: https://­w ww.rocktrust.org/­­w p-​­content/­uploads/­2020/­07/­­HF4Y-­​ ­­Evaluation-­​­­Report-­​­­July-­​­­2020-​­Final.pdf Braciszewski, J. M., Toro, P. A.  & Stout, R. L. (­2016) Understanding the attainment of stable housing: A ­seven-​­year longitudinal analysis of homeless adolescents. Journal of Community Psychology, 44(­2), 3­ 58–​­366. ­Busch-​­Geertsema, V. (­2010) Defining and measuring homelessness. In E. O’Sullivan, V. ­Busch-​­Geertsema, D. Quilgars & N. Pleace (­Eds.) Homelessness Research in Europe. Brussels: FEANTSA. p­p. ­19–​­39. ­Busch-​­Geertsema, V. (­2013) Housing First in Europe: Final Report. Bremen/­Brussels: GISS. Available at: https://­housingfirsteurope.eu/­research/­­housing-­​­­fi rst-­​­­europe-­​­­fi nal-​­report/ ­Busch-​­Geertsema, V., Benjaminsen, L., Filipovic Hrast, M. & Pleace, N. (­2014) Extent and Profile of Homelessness in European Member States: A Statistical Update. Brussels: FEANTSA. Central Statistics Office (­2012) Homeless Persons in Ireland: A Special Census Report. Available at: https://­w ww.cso.ie/­en/­media/­csoie/­census/­documents/­homelesspersonsinireland/­ Homeless_persons_in_Ireland_A_special_Census_report.pdf Central Statistics Office (­2017) Census of Population 2 ­ 016-​­Profile 5: Homeless Persons in Ireland. Available at: https://­w ww.cso.ie/­en/­csolatestnews/­presspages/­2017/­­census2016profile5​­homelesspersonsinireland/ Centrepoint (­2021) Youth Homelessness Databank Factsheet. Available at: https://­centrepoint. org.uk/­d atabank/ Cheng, T., Wood, E., Feng, C., Mathias, S., Montaner, J., Kerry, T. & DeBeck, K. (­2013) Transitions into and out of homelessness among ­street-​­involved youth in a Canadian setting. Health & Place, 23, ­122–​­127. Clapham, D. (­2003) Pathways approaches to homeless research. Journal of Community and Applied Social Psychology, 13(­2), ­119–​­127. Dworsky, A., Napolitano, L. & Courtney, M. (­2013) Homelessness during the transition from foster care to adulthood. American Journal of Public Health, 103(­2), ­318–​­323.

176

Youth Ecker, J., Aubry, T. & Sylvestre, J. (­2019) A review of the literature on LGBTQ adults who experience homelessness. Journal of Homosexuality, 66(­3), ­297–​­323. European Commission (­2001) European Commission White Paper: A New Impetus for European Youth. Brussels: Commission of the European Communities. FEANTSA (­2017a) Second Overview of Housing Exclusion in Europe 2017. Brussels: FEANTSA. FEANTSA (­2017b) Homelessness in Europe: LGBTQI Homelessness. Brussels: FEANTSA. FEANTSA (­2018) Locked Out: Housing Solutions for Vulnerable Young People Transitioning to Independence. Brussels: FEANTSA. FEANTSA (­2020) European Framework for Defining Youth Homelessness. Brussels: FEANTSA. Fitzpatrick, S. (­2000) Young Homeless People. Basingstoke: Macmillan. Gaetz, S. (­2011) Plans to End Youth Homelessness in Canada - A Review of the Literature. Toronto, ON: Eva’s Initiatives. Gaetz, S. (­2014a) Coming of Age: Reimagining the Response to Youth Homelessness in Canada. Toronto: The Canadian Observatory on Homelessness Press. Gaetz, S. (­2014b) Can Housing First work for youth? European Journal of Homelessness, 8(­4), ­159–​­175. Gaetz, S. (­2017) THIS is Housing First for Youth: A Program Model Guide. Toronto: Canadian Observatory on Homelessness Press. Gaetz, S. (­2019) THIS is Housing First for Youth: Europe. A Program Model Guide. Toronto: Canadian Observatory on Homelessness Press. Gaetz, S., Dej, E., Richter, T. & Redman, M. (­2016a) The State of Homelessness in Canada 2016. Available at: https://­w ww.homelesshub.ca/­sites/­default/­fi les/­attachments/­SOHC16_final_20Oct2016.pdf Gaetz, S., O’Grady, B., Kidd, S. & Schwan, K. (­2016b) Without a Home: The National Youth Homelessness Survey. Toronto: Canadian Observatory on Homelessness Press. Hansen Löfstrand, C. (­2010) Reforming the work to combat ­long-​­term homelessness in Sweden. Acta Sociologica, 53, ­19–​­34. Hansen Löfstrand, C. & Quilgars, D. (­2016) Cultural images and definitions of homeless women: Implications for policy and practice at the European level. In P. Mayock  & J. Bretherton, J. (­Eds.) Women’s Homelessness in Europe. London: Palgrave Macmillan, p­p. ­41–​­73. ­Harleigh-​­Bell, N. (­2014) Youth Homelessness in Scotland 2014: An Overview of Youth Homelessness and Homelessness Services in Scotland. Homeless Action Scotland. Available at: http://­w ww.parliament.scot/­S4_EqualOpportunitiesCommittee/­Inquiries/­Homeless_ Action_Scotland_supplementary.pdf HUD (­2021) The 2020 Annual Homeless Assessment Report (­A HAR) to Congress. Washington, DC: The U.S. Department of Housing and Urban Development. Available at: https://­ www.huduser.gov/­portal/­sites/­default/­fi les/­pdf/­­2020-­​­­A HAR-­​­­Part-​­1.pdf Karabanow, J. (­2008) Getting off the street: Exploring the process of young people’s street exits. American Behavioral Scientist, 51(­6), ­772–​­788. Kidd, S., Frederick, T., Karabanow, J., Hughes, J., Naylor, T. & Barbic, S. (­2016) A mixed methods study of recently homeless youth efforts to sustain housing and stability. Child and Adolescent Social Work Journal, 33, ­207–​­218. Kim, Y., Bender, K., Ferguson, K. M., Begun, S. & DiNitto, D. M. (­2018) Trauma and posttraumatic stress disorder among homeless young adults: The importance of victimization experiences in childhood and once homeless. Journal of Emotional and Behavioral Disorders, 26(­3), ­131–​­142. King, B., Abrego, D., Narendorf, S., Ha, Y. & Santa Maria, D. (­2017) Representations of homelessness, home environments, and authority in the context of runaway behaviors reported by foster care youth residing in an emergency shelter. Journal of Social Distress and the Homeless, 26(­2), ­138–​­147. Lawlor, E.  & Bowen, N. (­2017) Limerick Youth Housing Evaluation Report. Dublin: Focus Ireland. Available at: https://­homelesshub.ca/­sites/­default/­fi les/­Limerick%20Youth%20 Housing%20Evaluation%20(­2017)%20Full%20Report.pdf

177

Paula Mayock and Sarah Parker Mallett, S., Rosenthal, D. & Keys, D. (­2005) Young people, drug use and family conflict: Pathways into homelessness. Journal of Adolescence, 28, ­185–​­199. Mallett, S., Rosenthal, D., Keys, D. & Averill, R. (­2010) Moving Out, Moving On: Young People’s Pathways In and Through Homelessness. London: Routledge. Mayock, P. & Corr, M. L. (­2013) Young People’s Homeless and Housing Pathways: Key Findings from a S ­ ix-​­year Qualitative Longitudinal Study. Dublin: Department of Children and Youth Affairs. Available at: https://­w ww.homelessdublin.ie/­content/­fi les/ ­­Young-­​­­Peoples-­​ ­­Homeless-­​­­a nd-­​­­Housing-​­Pathways.pdf Mayock, P., Corr, M. L. & O’Sullivan, E. (­2008) Young People’s Homeless Pathways. Dublin: The Homeless Agency. Available at: https://­w ww.drugsandalcohol.ie/­4239/­1/­­homeless_ agency_Young-­​­­People- ­​­­s-­​­­Homeless-​­Pathways.pdf Mayock, P., Corr, M. L.  & O’Sullivan, E. (­2011) Homeless young people, families and change: Family support as a facilitator to exiting homelessness. Child and Family Social Work, 16(­4), 3­ 91–​­401. Mayock, P. Corr, M. L. & O’Sullivan, E. (­2013) Moving on, not out: When young people remain homeless. Journal of Youth Studies, 16(­4), 4­ 41–​­459. Mayock, P. & O’Sullivan, E. (­2007) Lives in Crisis: Homeless Young People in Dublin City. Dublin: The Liffey Press. Mayock, P. & Parker, S. (­2017) Living in Limbo: Homeless Young People’s Paths to Housing. Dublin: Focus Ireland. Available at: https://­w ww.focusireland.ie/­­w p-​­content/­uploads/­2017/­01/­­ Mayock- ­​­­a nd- ­​­­Parker-­​­­2 017- ­​­­ L iving-­​­­i n- ­​­­ L imbo- ­​­­H omeless-­​­­Young- ­​­­Peoples-­​­­Paths- ­​­­t o-­​ ­­Housing-­​­­BOOK-​­2 .pdf Mayock, P. & Parker, S. (­2020) Homeless young people ‘­strategizing’ a route to housing stability: Service fatigue, exiting attempts and living ‘­off grid’. Housing Studies, 35(­3), ­459–​­483. Mayock, P. & Parker, S. (­2021) Young people narrating the meaning of homelessness and home. In L. Moran, K. Reilly, & B. Brady (­Eds.) Narrating Childhood with Children and Young People: Diverse Contexts, Methods and Stories of Everyday Life. London: Palgrave Macmillan. p­p. ­35–​­61. Mayock, P., Parker, S. & Murphy, A. (­2014) Young People, Homelessness and Housing Excluw ww.focusireland.ie/­­ wp-​­ content/ sion. Dublin: Focus Ireland. Available at: https://­ ­uploads/­2 021/­0 9/­­M ayock- ­​­­Parker- ­​­­a nd- ­​­­Murphy-­​­­2 014-­​­­Young- ­​­­People- ­​­­Homelessness-­​ ­­a nd-­​­­Housing-­​­­Exclusion-­​­­F ULL-​­BOOK.pdf Mayock, P., Parker, S. & Murphy, A. (­2021) Family ‘­turning point’ experiences and the process of youth becoming homeless. Child & Family Social Work, doi: doi.org/­10.1111/­ cfs.12823 ­ otheram-​­Borus, M. J., Mallett, S., Rosenthal, D., Batterham, Milburn, N. G., Rice, E., R P., May, S. J., Witkin, A. & Duan, N. (­2009) Adolescents exiting homelessness over two years: The risk amplification and abatement model. Journal of Research on Adolescence, 19(­4), ­762–​­785. Milburn, N. G., Rosenthal, D. ­Rotheram-​­Borus, M. J., Mallett, S., Batterham, P., Rice, E. & Solorio, R. (­2007) Newly homeless youth typically return home. Journal of Adolescent Health, 40(­6), ­574–​­576. Moser Jones, M. (­2016) Does race matter in addressing homelessness? A review of the literature. World Medical & Health Policy, 8(­2), ­139–​­156. Munson, M. R., Stanhope, V., Small, L. & Atterbury, K. (­2017) “­At times I kinda felt I was in an institution”: Supportive housing for transition age youth and young adults. Child and Youth Services Review, 73, ­430–​­436. Padgett, D., Henwood, B. & Tsemberis, S. (­2016) Housing First: Ending Homelessness, Transforming Systems, and Changing Lives. New York: Oxford University Press. Parker, S.  & Mayock, P. (­2019) “­They’re always complicated but that’s the meaning of family in my eyes”: Homeless youth making sense of “­family” and family relationships. Journal of Family Issues, 40(­4), ­540–​­570.

178

Youth Pleace, N., Fitzpatrick, S., Johnsen, S., Quilgars, D. & Sanderson, D. (­2008) Statutory Homelessness in England: The Experience of Families and 16 and 17 Year Olds. London: Department for Communities and Local Government. Quilgars, D. (­2010) Youth homelessness. In V. ­Busch-​­Geertsema, E. O’Sullivan, N. Pleace & D. Quilgars (­Eds.) Homelessness Research in Europe. Brussels: FEANTSA, p­p. ­187–​­210. Quilgars, D., Fitzpatrick, S.  & Pleace, N. (­2011) Ending Youth Homelessness: Possibilities, Challenges and Practical Solutions. York: Centre for Housing Policy, University of York and School of the Built Environment, ­Heriot-​­Watt University. Quilgars, D., Johnsen, S.  & Pleace, N. (­2008) Youth Homelessness in the UK: A Decade of Progress? York: Joseph Rowntree Foundation. Randall, G. & Brown, S. (­2001) Trouble at Home: Family Conflict, Young People and Homelessness. London: Crisis. Roy, E., Robert, M., Fournier, L., Laverdiere, E., Berbiche, D. & Bovin, J.-​­F. (­2016) Predictors of residential stability among homeless young adults: A cohort Study. BMC Public Health, 16(­131), ­1–​­8. Rugg, J. & Quilgars, D. (­2015) Young people and housing: A review of the present policy and practice landscape. Youth & Policy, 114, ­5 –​­16. Sahlin, I. (­ 2005) The staircase of transition: Survival through failure. Innovation, 18, ­115–​­135. Scott, F.  & Harrison, S. J. (­2013) Calgary, Alberta: The infinity project. In S. Gaetz, F. Scott & T. Gulliver (­Eds.) Housing First in Canada: Supporting Communities to End Homelessness. Toronto, Canada: Canadian Homelessness Research Network Press, p­p. ­45–​­56. Shinn, M. & Khadduri, J. (­2020) In the Midst of Plenty: Homelessness and What to Do About It. New Jersey: Wiley. ­ omeless-​ Tyler, K. A. & Johnson, K. A. (­2006) Pathways in and out of substance use among h ­emerging adults. Journal of Adolescent Research, 21(­2), ­133–​­157. Watts, B., Johnsen, S. & Sosenko, F. (­2015) Youth Homelessness in the UK: A Review for the OVO Foundation. Edinburgh, Scotland: ­Heriot-​­Watt University.

179

16 CHILDREN AND FAMILIES Deborah Quilgars and Nicholas Pleace

Introduction This chapter examines the experience of homelessness by children and families. This chapter begins by describing the scale of family homelessness, before moving on to discuss the current evidence base. The following section explores the consequences for children who experience homelessness. This chapter concludes by exploring the provision of effective services and strategies to prevent and reduce these forms of homelessness.

The scale and nature of child and family homelessness In some countries, such as the UK, which has dedicated legislation and systems centred on family homelessness in the four constituent administrations, England, Scotland, Wales and Northern Ireland, dedicated administrative statistics on child and family homelessness are available (­M inistry of Housing, Communities and Local Government, 2021; Scottish Government, 2021; Welsh Government, 2020; Boyle and Pleace, 2020). While the data are not directly comparable, as each UK administration has different homelessness laws, there is evidence of family homelessness at a significant scale (­Fitzpatrick et al., 2016). In the USA, emergency shelters and other homelessness services, along with annual counts of people experiencing homelessness, also show significant numbers (­Henry et al., 2021). In recent years, spikes in family homelessness, which appear to be driven by chronic and severe undersupply of affordable housing, have also been reported in Ireland (­Department of Housing, Local Government and Heritage, 2021). France has also experienced spikes in family homelessness, from very low levels in the late 1990s to much higher levels (­Slimani et  al., 2019). Other countries that monitor levels of hidden or concealed homelessness, such as Finland, 180

DOI: 10.4324/9781351113113-19

Children and families

also report the presence of families living with relatives, friends and acquaintances because they have nowhere else to go (­A RA, 2021). Family homelessness exists in different forms and at different scales. In the UK and the USA, the issue is a longstanding one (­Pleace et al., 2008; Grant et al., 2013), in other countries like France and Ireland, the issue has intensified in importance relatively recently (­Baptista et al., 2017). The numbers and circumstances of homeless families vary considerably. In 2020, the annual US count reported 171,575 people in families with children who experienced homelessness on a single night (­Henry et  al., 2021). These families were mainly in sheltered conditions, i.e. within homelessness services and temporary accommodation. In England, family homelessness tends to receive a response from the State that is either preventative (­stopping an eviction from occurring) or involves what is termed ‘­relief ’, i.e. rapid rehousing to avoid an actual experience of homelessness when existing housing is going to be lost. There is also longstanding legislation that protects households containing dependent children and households (­including women and children at risk of domestic abuse) in the event that homelessness occurs, centring on a broad right to settled housing. Difficulties in delivering on these rights, because of a deep and l­ong-​­term shortage of suitable affordable and social housing in some housing markets, mean that homeless families pool in temporary accommodation in England. As at December 2020, 59,670 homeless families containing 121,340 dependent children were reported (­M inistry of Housing, Communities and Local Government, 2021). On the surface, this appears to show a higher level of family homelessness in a country of 55 million than in a country of 332 million. However, the families in England (­a nd at lower levels, in the rest of the UK) are, for the most part, those who have been found to be owed a duty under the homelessness laws; they are in temporary accommodation because they are waiting for settled or social housing to be found for them by local elected authorities (­most are within the most overheated housing markets, particularly London). By contrast, the families in the USA are often in emergency accommodation that is not within a similar system (­Henry et al., 2021), i.e. in emergency shelters, with another difference being that families in temporary accommodation in England are quite often in apartment hotels, sometimes in hotels, but most frequently awaiting settled/­social housing in private rental housing (­M inistry of Housing, Communities and Local Government, 2021). Unlike the USA, the UK does not report the presence of a population of unsheltered (­living rough, in encampments/­unregulated settlements, cars, etc.) families, which in the USA is around 10% of the total (­Henry et al., 2021). By contrast, family homelessness in Ireland is at a fraction of the levels seen in the UK and the USA, but has escalated rapidly, with many families placed in hotels and increasingly in dedicated temporary accommodation services because, as in the UK, providing rehousing is difficult because of an overheated housing market with limited supply of affordable/­social housing (­Sheridan and Hooey, 2017; Allen et al., 2020). In France, spikes in temporary accommodation use by families are strongly associated with migrant homelessness, as France has provision of emergency accommodation for migrant families experiencing homelessness and particularly 181

Deborah Quilgars and Nicholas Pleace

concentrated in Paris (­Slimani et al., 2019), this is not a pattern seen in many other European countries because there is no such provision. Local connection rules tend to be used to determine the eligibility of any person or family experiencing homelessness across much of Europe, which migrant families are not able to demonstrate (­Baptista et al., 2015). In Scandinavian countries, which, with some variation, tend towards extensive welfare/­social protection systems, family homelessness is unusual (­A llen et al., 2020), much more so than in Ireland, despite its broadly similar population size. Much of Central, Eastern and Southern Europe, which tends to have lower GDP than the Northwest (­including the UK), has two sets of characteristics that seem to keep levels of family homelessness low. The first is that welfare/­social protection provision resources, while quite often more limited in overall terms, are relatively concentrated on children and the second is that responsibility for family homelessness often falls on social services departments, which is specified under national laws (­Baptista et al., 2017). Unaccompanied children are present in homeless populations but at generally low levels across Europe. One reason for this is that duties towards a child who is not a legal adult generally fall under the duties of social services departments and child protection services, i.e. the first response in European societies for a child on their own (­legal age of adulthood can range from the late teens to early 20s) is to place them into local authority care. Lone children in much of Europe do not become homeless because they are placed in foster care, adoption systems or children’s homes, i.e. the State takes direct responsibility. This is in marked contrast to societies that have the phenomenon of street children, which can occur in the poorest regions of Europe and is much more clearly associated with the Global South (­Woan et al., 2013). Conceptually, the degree of difference between ­upper-​­, ­m iddle-​­ and ­lower-​­income countries, where, for example, North Western definitions of ‘­homelessness’ would define much of the national population (­a nd tens of millions of children) as ‘­homeless’, even though those populations would not necessarily see themselves in that way, makes a comparative analysis difficult (­­Busch-​­Geertsema et al., 2016). Where this extreme of homelessness occurs, the ­evidence – ​­of ­course – ​­indicates that children experiencing it can face fundamental damage to their health and ­well-​­being (­Woan et al., 2013).

The evidence base The evidence base on homelessness in general is skewed towards work on lone men experiencing repeated and sustained homelessness that is associated with high and complex needs. Some research effectively defines this group, largely composed of lone men living on the streets, in encampments/­unregulated settlements and in shelters, as representing all ‘­homelessness’ (­O’Sullivan et  al., 2020). Women tend to be underrepresented in this research because the populations surveyed and research tend to miss both populations who experience homelessness for shorter periods of time and by effectively excluding analysis of hidden or concealed homelessness, miss the forms of homelessness that ­women  – ​­and lone women parents 182

Children and families

with dependent c­ hildren – ​­are more likely to experience (­Bretherton and Mayock, 2021). Family homelessness was long assumed to not be a significant phenomenon in many European and OECD countries because of the presence of social work and social protection (­welfare) systems that protect children from destitution and abuse (­Baptista et al., 2017). Women’s homelessness was also thought not to exist at scale, in part because populations experiencing concealed or hidden homelessness were not examined, but also because it was assumed that the presence of dependent children, given the bulk of homeless families are headed by lone women parents in European and OECD countries, meant that those women, as mothers, were ‘­protected’ from homelessness by the governmental systems that were designed to prevent child destitution and abuse (­Bretherton and Mayock, 2021). Despite evidence that family homelessness can exist at scale or as a small, but persistent, social problem, in European and other OECD countries, the study of this form of homelessness remains relatively unusual. The evidence on family homelessness is now somewhat less developed than the now burgeoning literature on the gender dynamics of homelessness (­Bretherton and Mayock, 2021). Comparative research in this field is unusual but has been attempted (­Woan et al., 2013; Baptista et al., 2017) and one issue here may be the variation in the nature of family homelessness, which ranges in scale and scope in ways that seem to be broadly related to overall welfare and social protection systems. In Finland, family homelessness is, extremely unusual, with 201 families counted in 2020, mainly staying with relatives and friends and equivalent to less than 5% of the, also very small number, lone homeless adults (­4,341) (­A RA, 2021). By contrast, Ireland with a similar population size (­around five million, compared to Finland’s 5.5 million) was reporting 925 families with over 2,000 children in them in m ­ id-​­2021 (­Department of Housing, Local Government and Heritage, 2021), but this was still a very low number relative to population size. Equally, family homelessness as a proportion of total homelessness is very low in much of Europe, around 3% of Danish homelessness, just over 5% of German homelessness and 14% of Swedish homelessness (­Baptista et al., 2017). Outside some European and OECD countries, like the UK and the USA, family homelessness has not been detected at scale in surveys of homelessness and it is this apparent pattern that has led to a limited and inconsistent evidence base, in that, in many of these countries, family homelessness appears to be a ‘­residual’ problem, a small issue because the bulk of potential need is already handled by comparatively developed social protection systems (­Meert, 2005). However, research on the enumeration of homelessness has been characterised by methodological, sampling and methodological errors of very considerable magnitude. The scale of high and complex needs among people experiencing homelessness was hugely overestimated in much work conducted until the ­m id-​­1990s because of a sampling and methodological error and whole and significant dimensions of homelessness, particularly the experience of hidden or concealed homelessness, were simply missed because they were not being looked at (­O’Sullivan et al., 2020). There are also ­large-​­scale gaps in evidence, data are not being collected 183

Deborah Quilgars and Nicholas Pleace

and surveys are not being conducted on family homelessness in much of Central, Eastern and Southern Europe (­Baptista et al., 2017). The US counts families in emergency shelters, but not those living in states of hidden or concealed homelessness, ‘­doubled up’ in the US parlance, i.e. staying with relatives and friends because they have nowhere else to go. Bringing those data alongside the 171,575 people in families with children who experienced homelessness on a single night (­Henry et  al., 2021) creates a different picture, with one estimate being that in 2018, more than 15% of all US children lived in ­doubled-​­up (­shared) households with additional adults beyond their siblings, parents and parents’ partners (­Harvey et al., 2021). One 2009 estimate put the number of US households with an ‘­unrelated subfamily’ at 622,000 (­Bush and Shinn, 2017), something of a contrast with Finland’s 2020 count of 201 of families living with relatives and friends (­A RA, 2021). There have been some sobering lessons for homelessness researchers in the last 30 years who have, collectively, often conflated an absence of data with the absence of certain forms of homelessness (­O’Sullivan et al., 2020). While the apparently low levels of family homelessness in much of Europe and in some other OECD countries may be associated with other systems effectively stopping most child and family homelessness before it occurs (­or very soon afterwards), the data are not complete. As we have learned in relation to women’s homelessness (­Bretherton and Mayock, 2021), exploring the subject of family homelessness in greater detail could reveal a much bigger, more complex social problem than is assumed to exist based on present data. Another point here is that the extreme of child homelessness, which means becoming part of the populations of ‘­street children’, is concentrated in the Global South. One issue here is that the minority of the global population who live in the North, the comparatively highly prosperous societies of the OECD and much of the EU, tend to dominate homelessness research. One aspect of this domination is the use of ideas about homelessness and how to define homelessness that stem from how the problem exists in these societies, which, as noted, would define a significant part of the total population of the Global South as ‘­homeless’ or in situations of housing exclusion (­­Busch-​­Geertsema et al., 2016). The bulk of child homelessness, including the extreme forms, exists in the Global South, where most of the population of the Earth live, and debates about human rights and the rights of the child and addressing deep inequalities between countries come into play come to the fore when discussing a social problem with these global dimensions. In this sense, the issue of child and family homelessness remains profoundly ­under-​­researched.

The effects of homelessness on children Research has centred on physical deprivation and disruption as the main consequences of an experience of homelessness as a child. Physical deprivation incorporates staying in temporary accommodation or experiencing hidden/­concealed homelessness that is unfit for habitation, which is a risk to child health, e.g. where there is mould and damp which might increase risks of respiratory illness or there 184

Children and families

is a lack of space, including a garden and/­or parks, in which to play. Overcrowding is also associated with risks to social and educational development, for example, a child cannot invite around friends nor can they find a quiet and suitable place to do their homework (­Pleace et al., 2008). Disruption is associated with unwanted moves that can disrupt schooling, social and familial support networks and create disconnections and discontinuities in any support service a child is receiving help, for example, treatment around a health need (­Quilgars and Pleace, 2003; Mitchell et al., 2004; Gultekin et al., 2020). In essence, exposure to homelessness as a child has found to be a potential accelerant to processes that will make it more likely that a child will become a socioeconomically marginalised adult. Although the idea is widely discussed, evidence to support the idea that homelessness is an intergenerational phenomenon, i.e. the children of homeless parents will themselves go on to become homeless parents, perpetuating a cycle of deep deprivation and inequality is limited. An Australian study has suggested that there is an association, with around half of people experiencing homelessness reporting experiences during childhood, although this also included lone adults without children, which is distinct from one homeless family being the ancestor of subsequent homeless families (­F latau et al., 2013). In addition, causation of homelessness appears to be multifaceted and to be determined in part by structural factors, rather than entirely reducible to individual characteristics, experiences and choices (­Pleace, 2016). It is clear that youth homelessness, across Europe, the UK, Australia and North America, as an experience of lone young adults, is strongly associated with experience of disrupted childhoods that has included contact with child protection services. A child that has been in contact with social work services, taken into care, fostered or placed in a children’s home is much more likely to enter homelessness as a youth than other children and this group is ­over-​­represented among lone adults who experience l­ong-​­term and repeated homelessness associated with high and complex support needs. However, the association between youth and later, ­long-​ ­term and recurrent homelessness is with child protection interventions, not with an experience of homelessness as a child (­Schwan et al., 2018). Alongside this, there is evidence that youth homelessness exists as a series of interconnected processes and experiences of deep and sustained social and economic isolation that tracks back into childhood, but again, with those disruptions to a normal, healthy childhood being centred on any and all significant harms and traumas, including abuse, not simply experiences of homelessness as a child (­Mayock and Parker, 2020). In essence, the evidence that is available on what homelessness does to children is that it takes a range of risks to mental and physical health, including the risks of developing health issues as an adult, alongside risks to progress in education, training and successful employment and exacerbate them (­Schwan et al., 2018; Pleace et al., 2008). The key point here is that child homelessness is often acting as an accelerant to existing systemic disadvantage (­Culhane et al., 2007; Pleace et al., 2008), as the families who tend to experience homelessness are already poor and marginalised and they have often experienced traumatic events because of the broad association between family homelessness and domestic abuse across the Global North. 185

Deborah Quilgars and Nicholas Pleace

Evidence from across Europe (­Baptista et al., 2017), North America (­Shinn and Khadduri, 2020) and Australia (­Blunden et al., 2020) shows a strong association between domestic abuse and family homelessness, manifested in the experience of family homelessness being highly gendered, i.e. the bulk of homeless families in many societies are lone women parents whose homelessness is often (­though not exclusively) triggered by domestic abuse (­Bretherton and Mayock, 2021). Parental distress, triggered by the events that led to homelessness, by concern for the welfare and future of children and by the experience of homelessness, for example, staying in basic, overcrowded, unfit or unpleasant or frightening environments, can also influence a child’s ­well-​­being. This may be because a parent is ­short-​­tempered and more difficult to live with than before, and/­or a child picking up on parental distress and becoming worried or frightened. Both parents and children can be exposed to prolonged uncertainty when it is difficult to exit from family homelessness, something that is inherently stressful in and of itself and stemming from lacking the physical and ontological security of a settled home (­Pleace et al., 2008; Baptista et al., 2017; Blunden et al., 2020). There is a final point here which is to do with both family homelessness and the emergent evidence on women’s experiences of homelessness. This centres on the differentiated trajectories that women, and also women who have dependent children with them, take into and through homelessness. Decades ago, Shinn and her colleagues noticed something about family homelessness in the USA, which as elsewhere in the Global North was disproportionately experienced by lone women parents. The women with children were using informal networks and supports to address their homelessness, staying with relatives, friends and acquaintances to keep a roof over their and their children’s heads and only approaching formal homelessness services when those informal supports were exhausted (­Shinn et al., 1998). Subsequent research in the UK (­Pleace et al., 2008) and in Australia (­Blunden et al., 2020) has found a similar pattern, explained by anxiety, and also sometimes knowledge, about what some homelessness services and s­tate-​­funded temporary accommodation can be like which creates a wish to avoid them, and by a lack of knowledge that support is available (­Pleace et al., 2008). Family homelessness may therefore only sometimes manifest, in the sense of becoming visible to the State and the homelessness, health and welfare services funded by the State, some considerable time after it has happened, potentially increasing risks to child ­well-​­being (­Blunden et al, 2020).

Building effective services and strategies Homeless families have not been found to contain disproportionate numbers of people with addiction or severe mental illness; instead, causation appears to be most strongly linked to three factors: poverty, relationship breakdown as the major trigger event and, within that relationship breakdown, a high proportion of cases involving domestic abuse (­Baptista et  al., 2017). Family homelessness is highly gendered, disproportionately experienced by lone women with dependent children who are characterised by socioeconomic exclusion prior to becoming 186

Children and families

homelessness. Both survey and longitudinal evidence from administrative data analysis has reinforced this picture; family homelessness is mainly experienced by lone women parents who are poor and whose relationships have broken down, with a high proportion of those relationship breakdowns involving domestic abuse. The families do not contain people showing high rates of severe mental illness and/­or addiction. Evidence of this pattern has been reported in the USA, Canada, Australia, across Europe and in detail in the UK (­Culhane et al., 2007; Shinn and Khadduri, 2020; Sylvestre et al., 2017; Blunden et al., 2020; Baptista et al., 2017; Pleace et al., 2008). This pattern is not universal, i.e. it does not explain all family homelessness, nor is it always constant, so, for example, there are ­two-​­parent households experiencing homelessness in Ireland because of a deep and sustained shortage in affordable and social housing supply (­Sheridan and Hooey, 2017). However, the gender and poverty dimensions of family homelessness and the associations with domestic abuse are really quite different from the patterns of causation identified around lone adult homelessness. The pattern of l­ong-​­term and recurrent homelessness among lone adults that is associated with high and complex needs, such as addiction combined with severe mental illness (­O’Sullivan et al., 2020), is not seen among homeless families (­Baptista et al., 2017). The UK has always and perhaps not always appropriately responded to family homelessness with the provision of housing. Initially, when the homelessness laws were introduced in the late 1970s, this was social housing that offered low rents, generally relatively good physical and space standards and a secure tenancy for life. Over time, the legislation was modified to require only provision of temporary accommodation while settled housing (­which could include higher cost and less secure private rental housing) was secured, before diverging into different systems across England, Wales, Northern Ireland and Scotland. In Wales and England, the emphasis is now on preventing eviction where possible and rapid rehousing to stop family (­a nd other) homelessness from actually occurring. This approach did not take account of the high support needs that could exist among a minority of homeless families but this ­housing-​­based response to family homelessness, essentially responding to family homelessness by primarily offering housing rather than support, is broadly effective (­Fitzpatrick and Pleace, 2012). American experience with a rapid housing response to family homelessness has been similar, particularly when, as is the case in the UK, rehousing is combined with access to welfare benefits that largely or wholly cover the rent (­Gubits et al., 2015). This is not to suggest that families with support needs do not exist, nor that they will not require specialist support in order to effectively exit homelessness. There have been European experiments with Housing First services that focus on families or which can provide support to households with high and complex needs containing children (­Pleace et al., 2019), alongside work in North America (­Collins et al., 2019). One point around family homelessness among people with high and complex needs is the evidence around ­long-​­term and repeated homelessness among lone women, who, some evidence suggests, may be characterised by having children 187

Deborah Quilgars and Nicholas Pleace

removed or taken into care because of issues around addiction and mental health. In other words, the families that have the most complex needs may have disintegrated or been broken up by child protection services before homelessness occurs; this might filter out some families with high needs and partially explain why most families being helped by homelessness services have either no support needs or low support needs. It is important not to exaggerate any potential effect here; most homelessness is not ­long-​­term and does not involve people with high and complex support needs, outside a few countries with very extensive public health, welfare, social housing and homelessness systems where homelessness does have these associations but is also extremely uncommon (­O’Sullivan et al., 2020; Allen et al., 2020). The possibility exists, however, that earlier interventions and redesign of preventative systems could help stop these kinds of familial breakdowns and enhance effective strategic and service responses to both women’s homelessness and family homelessness.

References Allen, M., Benjaminsen, L., O’Sullivan, E. and Pleace, N. (­2020) Ending Homelessness in Denmark, Finland and Ireland. Bristol: Policy Press. ARA (­2021) Report 2021: Homelessness in Finland 2020. Helsinki: ARA. Baptista, I., Benjaminsen, L., O’Sullivan, E. and Pleace, N. (­2015) Local Connection Rules and Homelessness in Europe. Brussels: FEANTSA. Baptista, I., Benjaminsen, L., ­Busch-​­Geertsema, V. and Pleace, N. (­2017) Family Homelessness in Europe. Brussels: FEANTSA. Blunden, H., Zufferey, C., Spinney, A. and Zirakbash, F. (­2020) Supporting Families Effectively through the Homelessness Services System. Melbourne: AHURI. Boyle, F. and Pleace, N. (­2020) Analysis of Homelessness Presenters and Acceptances. Belfast: Northern Ireland Housing Executive. Bretherton, J. and Mayock, P. (­2021) Women’s Homelessness: European Evidence Review. Brussels: FEANTSA. ­Busch-​­Geertsema, V., Culhane, D. and Fitzpatrick, S. (­2016) Developing a global framework for conceptualising and measuring homelessness. Habitat International, 55, p­p. ­124–​­132. Bush, H. and Shinn, M. (­2017) Families’ experiences of doubling up after homelessness. Cityscape, 19(­3), p­p. ­331–​­356. Collins, C.C., Bai, R., Crampton, D. et al. (­2019) Implementing housing first with families and young adults: Challenges and progress toward ­self-​­sufficiency. Children and Youth Services Review, 96, p­p. ­34–​­46. Culhane, D.P., Metraux, S., Park, J.M., Schretzman, M. and Valente, J. (­2007) Testing a typology of family homelessness based on patterns of public shelter utilization in four US jurisdictions: Implications for policy and program planning. Housing Policy Debate, 18(­1), p­p. ­1–​­28. Department of Housing, Local Government and Heritage (­2021) Department of Housing, Local Government and Heritage: Monthly Homelessness Report May 2021. Available at https://­ www.gov.ie/­en/­publication/­­f bd27-­​­­homeless-­​­­report-­​­­m ay-​­2021/ (­accessed July 2021). Fitzpatrick, S. and Pleace, N. (­2012) The statutory homelessness system in England: A fair and effective ­r ights-​­based model? Housing Studies, 27(­2), p­p. ­232–​­251. Fitzpatrick, S., Pawson, H., Bramley, G. et al. (­2016) The Homelessness Monitor: Great Britain 2016. London: Crisis. Flatau, P., Conroy, E., Spooner, C., Edwards, R., Eardley, T. and Forbes, C. (­2013) Lifetime and Intergenerational Experiences of Homelessness in Australia. Melbourne: AHURI.

188

Children and families Grant, R., Gracy, D., Goldsmith, G., Shapiro, A. and Redlener, I.E. (­2013) ­Twenty-​­five years of child and family homelessness: Where are we now? American Journal of Public Health, 103(­S2), pp. e­ 1–​­e10. Gubits, D., Shinn, M., Bell, S., Wood, M. et al. (­2015) Family options study: ­Short-​­term impacts of housing and services interventions for homeless families. Washington, DC: U.S. Department of Housing and Urban Development, Office of Policy Development and Research, July 2015. Available at SSRN: https://­w ww.huduser.gov/­portal/­portal/­ sites/­default/­fi les/­pdf/­f amilyoptionsstudy_final.pdf Gultekin, L.E., Brush, B.L., Ginier, E., Cordom, A. and Dowdell, E.B. (­2020) Health risks and outcomes of homelessness in s­ chool-​­age children and youth: A scoping review of the literature. The Journal of School Nursing, 36(­1), p­p. ­10–​­18. Harvey, H., Dunifon, R. and Pilkauskas, N. (­2021) Under whose roof? Understanding the living arrangements of children in ­doubled-​­up households. Demography, 58(­3), p­p. ­821–​­846. Henry, M., de Sousa, T., Roddey, C. et  al. (­2021) The 2020 Annual Homeless Assessment Report (­A HAR) to Congress. Washington, DC: HUD. Mayock, P. and Parker, S. (­2020) Homeless young people ‘­strategizing’ a route to housing stability: Service fatigue, exiting attempts and living ‘­off grid’. Housing Studies, 35(­3), p­p. ­459–​­483. Meert, H. (­2005) Denmark 2005: Preventing and Tackling Homelessness: Synthesis Report Brussels: European Commission, DG Employment, Social Affairs and Equal Opportunities. Ministry of Housing, Communities and Local Government (­2021) Official Statistics Release Statutory Homelessness October to December (­Q4) 2020: England. London: MHCLG. Mitchell, F., Neuburger, J., Radebe, D. and Rayne, R. (­2004) Living in Limbo: Survey of Homeless Households Living in Temporary Accommodation. London: Shelter. O’Sullivan, E., Pleace, N., ­Busch-​­Geertsema, V. and Hrast, M.F. (­2020) Distorting tendencies in understanding homelessness in Europe. European Journal of Homelessness, 14(­3), p­p. ­109–​­135. Pleace, N., Fitzpatrick, S., Johnsen, S., Quilgars, D. and Sanderson, D. (­2008) Statutory Homelessness in England: The Experience of Families and ­16–​­17 Year Olds. London: Department for Communities and Local Government. Pleace, N. (­2016) Researching homelessness in Europe: Theoretical perspectives. European Journal of Homelessness, 10(­3), p­p. ­19–​­4 4. Pleace, N., Baptista, I. and Knutagård, M. (­2019) Housing First in Europe: An Overview of Implementation, Strategy and Fidelity. Brussels: Housing First Hub Europe. Quilgars, D. and Pleace, N. (­2003) Delivering Health Care to Homeless People: An Effectiveness Review. Edinburgh: HEBS. Schwan, K., French, D., Gaetz, S., Ward, A., Akerman, J., Redman, M. and Stirling, T. (­2018) Preventing Youth Homelessness: An International Review of Evidence. Cardiff: Welsh Government. Scottish Government (­2021) Homelessness in Scotland: 2020 to 2021. Available at https://­ www.gov.scot/­publications/­­homelessness-­​­­scotland-­​­­2020-​­2021/ (­accessed July 2021). Sheridan, S. and Hooey, D. (­2017) Survey of Families That Became Homeless in June 2017. Dublin: Focus Ireland. Shinn, M., Weitzman, B. C., Stojanovic, D.; Knickman, J. R., Jimenez, L., Duchon, L., James, S. and Krantz, D. H. (­1998) Predictors of homelessness among families in New York City: From shelter request to housing stability. American Journal of Public Health, 88, p­p. ­1651–​­1657. Shinn, M. and Khadduri, J. (­2020) In the Midst of Plenty: Homelessness and What to Do About It. Hoboken: Wiley Blackwell. Slimani, L., Cheruy, G. and Léna, M. (­2019) Family homelessness in ­France – ​­an overview Homelessness in Europe. FEANTSA Magazine, Autumn, p­p. ­4 –​­6. Sylvestre, J., Kerman, N., Polillo, A., Lee, C.M. and Aubry, T. (­2017) A profile of families in the emergency family homeless shelter system in Ottawa, Ontario, Canada. Canadian Journal of Urban Research, 26(­1), p­p. ­40–​­51.

189

Deborah Quilgars and Nicholas Pleace Welsh Government (­2020) Homelessness: April 2019 to March 2020. Available at https://­gov. wales/­­homelessness-­​­­april-­​­­2019-­​­­m arch-​­2020 (­accessed July 2021). Woan, J., Lin, J. and Auerswald, C. (­2013) The health status of street children and youth in ­low-​­and ­m iddle-​­income countries: A systematic review of the literature. Journal of Adolescent Health, 53(­3), p­p. ­314–​­321.

190

17 MIGRATION AND ETHNICITY Teresa Consoli

Introduction Recent data on migration show that the number of forcibly displaced people both living within countries and who have crossed international borders, as a result of persecution, conflict or generalised violence, has grown by over 50% in the last ten years and by the end of 2019, there were 79.5 million forcibly displaced people (­Lancet, 2018, ­p. 2606; UNHCR, 2019). The number of refugees worldwide exceeded 26 million and over 2 million individual asylum applications were registered by the end of the 2019 (­U NHCR, 2020). Migrant homelessness has become more and more visible in recent years and migrants, despite all data limitations concerning both migration and homelessness, actually make up a significant percentage of the homeless people. The increasing proportion of migrants as a subgroup of Europe’s homeless population has been described by academic research and reports (­FEANTSA, 2002; ­Busch-​­Geertsema et al., 2010; Pleace, 2012; FEANTSA, 2013; ­OPVAG-​­FEANTSA, 2015) and data collected about this phenomenon show that migrants are experiencing homelessness at a disproportionate rate, even if there are still many differences among countries, very different national policy responses to migration and, again, a severe lack of accurate data on homelessness among immigrants. In Europe, evidence shows that there are specific destitution processes applied to both third country nationals, economic migrants and asylum seekers but homelessness is also affecting mobile EU citizens and ethnic minorities (­Mostowska, 2013; Reichenbach, 2018). These processes can also be enforced by the migration policy and the “­m igratory regime” of each state as welfare and housing services are used as tools of immigration control, especially after the latest humanitarian crisis and the ongoing migration into Europe. As a result, EU citizens, asylum seekers and refugees suffer delays and face strict eligibility criteria to housing and welfare DOI: 10.4324/9781351113113-20

191

Teresa Consoli

services that can lead to homelessness (­Hermans et al., 2020). Recently, in many countries, growing discrimination and criminalisation campaigns are compelling an increasing number of migrants to become irregular and undocumented. This group probably constitutes the most poorly protected and it actually represents a hidden part of homelessness population.

Data about migrant homelessness Since the economic crisis in 2008, there has been an increase on homelessness in almost all industrialised countries and a growing proportion of migrants in homeless population has been registered across the world. In Australia, for example, the latest Australian Bureau of Statistics figures show that in 2016 people who arrived in the country over the previous five years accounted for 15% of homeless people and research reveals that many young people of refugee backgrounds are experiencing homelessness at an increasing rate. In the USA, ethnic minorities and Black people experience homelessness at a higher rate as racial discrimination still negatively affects the health and the ­well-​­being of people. Researches conducted on people’s pathway into homelessness and experiences of homelessness differ substantially among Black, White and Hispanic populations, including undocumented people (­Moser Jones 2016; Padgett, 2016). More recently, many European countries have faced a significant migratory flow coming first from the ­so-​­called “­Jasmine revolution” in 2011 from Tunisia and Maghreb, later from the Syrian conflict and more recently coming conspicuously from S­ ub-​­Saharan African countries. In Norway, the last survey reports that among the people staying temporarily in the country (­living rough, staying with friends or whose place to stay is unknown), 30% are Africans and 20% are Asian (­D yb and Lid, 2017; Hermans et al., 2020). In Austria, the latest data on registered number of homeless people show that 44% are n ­ on-​­Austrian citizens (­Fink, 2019) and almost half of the counted persons and families registered in Sweden as homeless had a migrant background in 2017 (­Hermans et al., 2020). South European countries, in particular, are registering high numbers of migrants arriving and a growing proportion of migrant homelessness. In Italy, according to the latest Caritas Report, 67% of people using homelessness services are migrants (­Caritas, 2018). On top of that, the latest law n.132/­18 recently dismantled the Italian reception system for asylum seekers pushing migrants who have not been admitted to the reception centres onto the street, definitely compromising their security. In Spain, as in many other EU member states, migrants can face structural barriers to securing affordable and suitable housing and a research conducted in the main Spanish cities counted that approximately 63% of those living rough were foreign nationals (­­Bosch-​­Meda, 2010). Latest FEANTSA report on Spain states that the number of migrants decreased but data still showed that many migrants and undocumented migrants were excluded from services (­FEANTSA, 2019). In Greece, the national welfare system is not adequately equipped to host and support recognised refugees as both locals and newcomers already suffer the lack of any social housing provision. The increased influx of refugees and Syrian asylum 192

Migration and ethnicity

seekers has worsened the situation and the policy responses seem inadequate. Still no statistical data are available but it is clear that, together with a “­new generation” of homeless people, due to effect of the fiscal crisis and austerity measures which affected the economy and social life in the last years in Greece, homelessness among immigrants is a major issue (­Theodorikakou et al., 2013). In England, homelessness has increased and in 2016 the UK adopted legislation defining sleeping rough by migrants as an “­abuse of the right of residence” and enabling the local authorities to organise the administrative repatriation of EU citizens and their family members. Between September 2016 and September 2017, more than 5,000 EU citizens were returned to the country of origin (­FEANTSA, 2018, ­p. 81). EU citizens emerged as one of the most vulnerable groups facing deep housing difficulties and destitution especially in the UK, but also in Italy, Germany and France. Across the EU, recent migrants can often be at a heightened risk of social and economic exclusion, usually facing difficulties centred around language, unfamiliarity with welfare systems, job application procedures and barriers to the labour market. It is clear that there are different routes in and out homelessness for migrants who are asylum seekers, compared to people who are newly granted refugee status and refused asylum seekers, recent migrants, undocumented migrants and, across Europe, also mobile EU citizens. It is therefore important, but very difficult, to consistently distinguish who is considered as a migrant in which context and to which services they can access. Generally, a migrant is considered a person who changes his or her country of usual residence; a refugee is a person who is outside his country of origin for reasons of feared persecution, conflict or generalised violence. But in order to legally live in a country, specific procedures have to be fulfilled as a foreigner/­m igrant citizen (­contract of work, permits of stay, visa, etc.) or as a refugee (­a sylum seekers procedures) and therefore intermediate conditions are commonplace, as applicants wait for decisions and, finally, many people remain in irregular positions (­failed asylum seekers, overstayers, undocumented people).

Migrant homelessness in the EU FEANTSA’s first report on European Homelessness and Migration reported a strong linkage between discrimination and homelessness and that immigrants seeking out homelessness services are usually in great need (­FEANTSA, 2002). The first book on the issue was based on a series of national reports and reviewed the state of knowledge in the 15 member states in 2004 (­Edgar, et al., 2004). Homelessness among migrants was found to be a major concern in some member states (­the UK, the Netherlands and Germany), but in others it was deemed a modest problem (­Sweden) and even a n ­ on-​­issue in others (­Hungary). In 2010, Pleace suggested an interesting and useful typology of different forms of migrant homelessness: a b

people seeking asylum and refugees; failed asylum seekers and undocumented migrants; 193

Teresa Consoli

c women and children from outside the EU; d ­A-​­10 economic migrants who have become homeless in member states; e Ethnic and cultural minorities who appear to be at a disproportionate risk of homelessness, but who are not recent migrants (­Pleace, 2010, p­p. ­147–​­149). The typology exemplifies the most relevant trends in migrants’ homelessness and profiles the differences among new EU members, recent migrants and asylums seekers but the author was well aware of the changes occurring and the necessity to have better data on this growing phenomenon. In 2012, FEANTSA organised a large European event on migration and since then the issue has grown and has received growing academic and public attention. In 2016, the European Observatory on Homelessness published a report exploring whether the recent humanitarian crisis has had an impact on homelessness service (­Baptista et  al., 2016). The research was based on 12 member states and concentrated on three subgroups: asylum seekers, refugees and people whose asylum applications have been refused. In most of the 12 states, asylum seekers, refugees and undocumented migrants who had not been granted asylum were not present in large numbers in the homelessness services. There were considerable variations, but basically only France, Italy and Greece reported a growing pressure on homelessness services, but some effects of the humanitarian crisis appeared in the following years. Policy for asylum seekers and refugees does not really bind the EU member states to making sure that newly recognised refugees do not become homeless. Usually a maximum length of stay is provided in accommodation centre, but if they do not find a place within the period allowed, they become homeless. At present, for asylum seekers and refugees, the risk of becoming homeless is increasing. But for migrants, and especially for undocumented migrants, homelessness can be a hidden condition as they prefer to sleep rough and not refer to homeless services because of the deportation risk. Women, for example, represent a small, albeit growing, proportion of the general homeless population and specifically of the migrant homeless population. Internationally, research has established an association between g­ ender-​­based violence and homelessness among women, including migrant women (­Mayock et al., 2012). Domestic violence and abuse are generally the causes of homelessness for women but for many of migrant women residence permits can be dependent on a violent partner. Whether they are with children or without, women often rely on informal support and their experience of homelessness often remains hidden referring to services as a last resort (­Mayock and Bretherton, 2016). For migrant women, the possibility of losing children and their legal status is a deep threat and may keep them away from homelessness services. Levels of child homelessness are rising. The Swedish National Board of Health and Welfare registered that there were between 10,550 and 15,000 homeless children in 2017. The majority of them are children of single mothers or parents born in ­non-​­EU countries (­FEANTSA, 2018). Children, usually protected in all member states, can lose that protection if they are with their undocumented families, facing high risks of homelessness and living rough. P ­ oor-​­quality, insecure, inadequate and unsanitary housing has an impact on their physical and mental 194

Migration and ethnicity

development, and creates health risks (­such as asthma, lead poisoning or carbon monoxide intoxication) and lack of continuity and routine at school. In France, 33% of people in homeless accommodation were under 18 years making them the largest group of homeless people (­FEANTSA, 2018). As literature and research reveal, irregular migrants are mainly undocumented overstayers. Their lack of administrative status prevents integration and access to housing, welfare and other services. There is nowhere in the EU where undocumented migrants can legally access social housing, access to homeless shelters is not guaranteed and basic welfare benefits are simply not available to an undocumented person. Migrant homelessness is therefore the result of policies on migration governance and control and housing policy which usually does not guarantee equal access ( ­Johnsen et al., 2018). States should provide reception, at least for asylum seekers and refugees, but conditions for access to housing are narrower and more and more migrants are pushed onto the streets. Also EU citizens are facing a lot of discrimination in access to housing and it is still possible to register high differences among member states to which social benefits they are entitled. There are also multiplying factors as concerning the Roma population usually experiencing higher expression of housing deprivation and spatial segregation (­FEANTSA, 2020). According to many authors, migration can be considered as a new emerging structural factor causing homelessness and when referring to migrant homelessness, it is therefore necessary to focus on the interplay between welfare and immigration regimes and the ways in which exclusion and inclusion patterns are strictly intertwined (­Kennet, 1999; Bommes and Geddes, 2000; Bommes and Sciortino, 2011; Zufferey, 2019).

Migratory regimes and homelessness The history of immigration in the different countries expresses trends and characteristics that are deeply connected to their colonial past and their present welfare regimes (­Sainsbury, 2012). Homelessness, on the other side, is deeply embedded in a shortage of housing and especially poor housing affordability but also to weak labour market conditions, poor welfare and social services provision (­Fitzpatrick et al., 2012; Pleace, 2016; Gerrard, 2017; O’Sullivan, 2020). The ways in which migrant homelessness unfolds itself in specific contexts is the result of the crossing of these structural factors with individual conditions. Migrants (­regular, irregular, refugees and asylum seekers) are at the borders of each national “­system”; they live on the legal, cultural and social borders of the incoming societies. Migrants can be “­invisible” to most of the population and are spatially segregated in many countries and cities (­Maloutas and Fujita, 2012). Migrants who are visibly homeless in many cases also become an object of criminalisation and repatriation (­Sassen, 2016). The lack of regular and secure employment, often caused by discrimination in access to the labour market and to fair working conditions, is the main cause of homeless among migrants and they rarely get access to decent housing. Southern 195

Teresa Consoli

European countries, for example, are predominantly “­homeowner societies” and the social rented sector amounts to a very small portion of the general rental market. In all EU countries, “­w ithout exception, foreign nationals are overburdened by housing costs and experience more overcrowding than nationals, especially in Belgium, Ireland, Austria, Sweden, Slovenia, Luxemburg, Portugal, Spain, the Netherland, Poland, France and Greece” (­FEANTSA, 2018). There is also growing evidence of discrimination against migrants in the private rental markets in the EU countries (­­Bosch-​­Meda, 2010; Mugnano and Costarelli, 2018). Furthermore, securitisation policy against migrants has pushed many into “­forced irregularity” (­Ferraris, 2008) and this condition generates a weak position in the housing market. Undocumented migrants across Europe are excluded from subsidised housing and support and thereby relegated to the margin of the private housing market. Notwithstanding the fact that is relegated to the informal labour market and therefore earn much less than other workers, they are often charged above the usual market rates for inadequate accommodations. The informal housing market for undocumented migrants is usually characterised by poor, overcrowded and substandard condition at exploitative rates. Research financed by the European Union Agency for Fundamental Rights (­EUAFR, 2011, ­p. 63) reports the criminalisation of landlords and the risk of punishment they may incur for leasing to irregular migrants. Facilitating an irregular stay by a migrant is considered a criminal offence in most member states (­PICUM, 2014). Finally, on the side of the homeless service providers, an unconditional right to accommodation has been strongly questioned by national and local governments. Providers are under great pressure to identify and facilitate repatriation of homeless people who have been denied asylum. A growing pressure is registered on shelters and accommodation providers to participate in identification and repatriation procedures and national laws are changing to exclude migrants and EU citizens more and more from social assistance. Migrants whose irregular status prevents them from accessing emergency shelters and other temporary housing solutions are often faced with no choice but to sleep rough. In many cities, there is criminalisation of begging, sleeping rough and the banning homeless people from public spaces. When migrants have no option but to sleep rough, across the world, regulation of public spaces has increased. The linkage between migration and homelessness can therefore be considered as one of the more insidious as it also includes an enormous amount of discrimination, spatial segregation and persecution. As a tentative conclusion, besides ­work-​­related reasons and residence status, migrants’ homelessness can also be due to specific transformations in welfare states: unequal access to the housing market, administrative procedures, prejudice and inequality and an increasing risk of destitution that can disproportionately afflict migrant populations. Recently in some member states, thousands of EU citizens have become homeless and the higher risk can be connected to multiple exclusion, restricting immigration policy, limiting social rights and difficult access to welfare service (­Fitzpatrick et al., 2012; Allsopp et al., 2014). European welfare states are also ­re-​­profiling their 196

Migration and ethnicity

response to migrants, sometimes deeply curtailing social citizenship rights and not granting access to basic services (­Lafleur and Vintila, 2020).

Conclusion People on the move, ethnic minorities, asylum seekers, economic migrants and undocumented people are particularly vulnerable to a range of human rights violations and one of the most perpetuated is the right to adequate housing. The threats for the migrant population are basically connected to their legal and administrative status, their length of stay and the presence of family networks. Some migrant groups and ethnic minorities are at a higher risk of homelessness than others, facing segregation processes that can progressively push into homelessness and force migrants into living rough. Services are not well equipped to deal with this kind of homelessness and in many countries the criminalisation policy against migrants forces them to become “­invisible” and not even use homeless services. Data about homelessness already face a lot of limitations and are rarely comparable, but these limitations are a particular issue with reference to growing migrant homelessness. It is very difficult to know the characteristics of migrant homeless people and especially the undocumented migrant are rarely described in statistics and governments do not intend to count them as homeless. Data collected by homeless services register a high increase in migrants, the limited capacity of existing services and an increasing risk of street homelessness for regular (­documented) migrants. Some specific needs should be met outside the homeless sector and homelessness services should not be used to compensate inconsistent or even intolerant migration policies. There is a need for services tailored to the specific needs of homeless migrant groups as traditional homeless agencies and services cannot cope. For example, victims of violence deal with severe trauma and mental health services should be readily available especially for minors and undocumented migrants (­­OPVANG-​­FEANTSA, 2015). It is also clear that traditional homeless shelters are simply not suitable for the increasing numbers of children and migrant families experiencing homelessness. Finally, changes in migration are more complex than the simple narrative of a rise in numbers. “­Overall mobility patterns are highly regional and context specific, with less wealthy nations hosting disproportionate numbers of forcibly displaced population” (­Lancet, 2018, p­ . 2610). From 2014 to 2050, the proportion of people living in urban areas, largely because of climate change and migration from rural area, is expected to increase from 48% to 64% in Asia and from 40% to 56% in Africa (­Lancet, 2018, ­p. 2614). Accelerating urbanisation can be considered as a significant trend in contemporary human migration especially in l­ow-​­income countries where the majority of migrants reside (­Lancet, 2018), but all cities are “­facing challenges in providing sufficient social and affordable housing and the necessary number of beds in emergency accommodation” (­H RW, 2017). The Homeless Bill of Rights is a worldwide campaign to encourage European cities to recognise the right of homeless people. A growing number of migrants are among them. 197

Teresa Consoli

References Allsopp, J., Sigona, N. and Phillimore, J. (­2014) Poverty among Refugees and Asylum Seekers in the UK. Birmingham: Institute for Research in to Superdiversity. Baptista, I., Benjaminsen, L., ­Busch-​­Geertsema, V., Striano, M. and Pleace, N. (­2016) Asylum Seekers, Refugees and Homelessness: The Humanitarian Crisis and the Homelessness Sector in Europe. Brussels: FEANTSA. Bommes, M. and Geddes, A. (­2000) Immigration and Welfare: Challenging the Borders of the Welfare State. London: Routledge. Bommes, M. and Sciortino, G. (­2011) Foggy Social Structures. Irregular Migration, Euroepan Labour Markets and the Welfare State. Amsterdam: IMISCOE and Amsterdam University Press. ­Bosch-​­Meda, J. (­2010) Homelessness among migrants in Spain. European Journal of Homelessness, (­4), ­139–​­154. ­Busch-​­Geertsema, V., Edgar, W., O’Sullivan, E. and Pleace, N. (­2010) Homelessness and Homeless Policies in Europe: Lessons from Research. Brussels: FEANTSA. Caritas, Italiana (­2018) La povertà in attesa. Rapporto 2018 su povertà e politiche di contrasto in Italia. Santarcangelo di Romagna: Maggioli. Dyb, E., and Lid, S. (­2017) Homelessness in ­Norway-​­2016 a ­survey – ​­NIBR Report Oslo. Edgar, B., Doherty, J. and Meert, H. (­2004) Immigration and Homelessness in Europe. Bristol: Polity Press. EUFRA (­2011) Fundamental Rights of Migrants in an Irregular Situation in the European Union. Brussels: EUFRA.FEANTSA (­2002) Homelessness in Europe. Brussels: FEANTSA. FEANTSA (­2013) Homelessness among Immigrants in the ­EU – ​­A Homelessness Service Providers’ Perspective. Brussels: FEANTSA. FEANTSA (­2018) Third Overview of Housing Exclusion in Europe 2018. Brussels: FEANTSA and Abbé Pierre Foundation. FEANTSA (­2019) Fiche Report SPAIN, https://­w ww.feantsa.org/­public/­user/­Resources/­ country_profiles/­­ES_-​­_Country_Profile_2019.pdf FEANTSA (­2020) Roma Experiences on Homelessness in Europe, https://­w ww.feantsa.org/­en/ ­newsletter/­2020/­12/­18/­­homeless-­​­­i n-­​­­europe-­​­­m agazine-­​­­w inter-​­2020 Ferraris, V. (­2008) L’obbligata illegalità: l’impervio cammino verso un permesso di soggiorno. Studi sulla questione criminale, 3, ­25–​­4 4. Fink, M. (­2019) National Strategies to Fight Homelessness and Housing Exclusion. Austria. Brussels: European Social Policy Network. Fitzpatrick, S., Johnsen, S. and Bramley, G. (­2012) Multiple exclusion homelessness amongst migrants in the UK. European Journal of Homelessness, 6(­1), ­31–​­58. Gerrard, J. (­2017) The interconnected history of Labour and Homelessness. Labour History, (­112), ­155–​­174. ­ ovak-​­Zezula, S. and Trummer U. (­2020) Migration Hermans, K. Dyb, E. Knutagard, M. N and homelessness: Measuring the intersections. European Journal of Homelessness, 14(­3), ­13–​­34. Housing Right Watch (­2017) Homeless Bill of Rights, http://­w ww.housingrightswatch.org/ ­billofrights Johnsen, S., Fitzpatrick, S. and Watts, B. (­2018) Homelessness and social control: A typology. Housing Studies, 33(­7 ), ­1106–​­1126. Kennet, P. (­1999) Homelessness, citizenship and social exclusion in Homelessness. Exploring the new terrain. Bristol: Policy Press, p­p. ­37–​­54. Lafleur, J. M., and Vintila, D. (­2020) Migration and Social Protection in Europe and Beyond, Comparing Access to Welfare Entitlements. New York: Springer. Lancet (­2018) The ­UCL-​­Lancet Commission on Migration and Health: The Health of a World on the Move. Available at: https://­w ww.thelancet.com/­commissions/­­m igration-​­health Maloutas, Th. and Fujita, K. (­eds) (­2012) Residential Segregation in Comparative Perspective. Making Sense of Contextual Diversity. Farnham: Ashgate.

198

Migration and ethnicity Mayock, P. and Bretherton, J. (­2016) Women’s Homelessness in Europe. London: Palgrave Macmillan. Mayock, P., Sheridan, S. and Parker, S. (­2012) Migrant women and homelessness: The role of g­ ender-​­based violence. European Journal of Homelessness, 6(­1), ­59–​­82. Mostowska, M. (­2013) Migration and homelessness: The social networks of homeless Poles in Oslo. Journal of Ethnic and Migration Studies, 39(­7 ), ­1125–​­1140. Mugnano, S. and Costarelli, I. (­2018) Residential patterns of immigrants: Trends and transformations in Milan. Mondi Migranti, (­1), ­27–​­48. O’Sullivan, E. (­2020) Reimagining Homelessness. A Blue Print for Policy and Practice. Bristol: Policy Press. ­OPVANG-​­F EANTSA (­2015) Homeless Migrants in the European Union: Case Studies. https://­ www.opvang.nl/­fi les/­homeless_migrants_in_the_eu_case_studies.pdf Padgett, K. D. (­ed.) (­2016) Homelessness in America. In D. K. Padgett. B. F. Hendwood and S. J. Tsemberis (­eds) Ending Homelessness, Transforming Systems and Changing Lives, p­p. ­16–​­29. Oxford: Oxford University Press. PICUM (­2014) Report on Housing and Homelessness of Undocumented Migrants in Europe. Developing Strategies and Good Practices to Ensure Access to Housing and Shelter. Brussels: Picum. Pleace, N. (­2010) Immigration and homelessness. In E. O’Sullivan, V. B ­ usch-​­Geertsema, D. Quilgars and N. Pleace (­Eds.) Homelessness Research in Europe, p­p. ­143–​­162. Brussels: FEANTSA. Pleace, N. (­2016). Researching homelessness in Europe: Theoretical perspectives. European journal of homelessness, 10th anniversary issue, 10(­3), ­19–​­4 4. Reichenbach, M.T. (­2018) Homelessness of mobile ­EU-​­citizens as one effect of a ­national-​ ­European conflict. Insight into an ethnography of participation in Europe using the example of Germany European Journal of Homelessness, 12(­1), 4­ 1–​­60. Sainsbury, D. (­2012) Welfare States and Immigrants Rights: The Politics of Inclusion and Exclusion. Oxford: Oxford University Press. Sassen, S. (­2016) Expulsions: Brutality and Complexity in the Global Economy. Harvard: Harvard University Press. Theodorikakou, O., Alamanou, A. and Kotsadoros, K. (­2013) ­Neo-​­homelessness and the Greek crisis. European Journal of Homelessness, 7(­2), ­204–​­210. UNHCR (­2019) Desperate Journeys. Refugees and Migrants Arriving in Europe and at the Europe’s borders. UNHCR. UNHCR (­2020) Global Trends: Forced Displacement in 2020. Available at: https://­w ww. unrefugees.org.uk/­­w p-​­content/­uploads/­­Global-­​­­Trends-​­2020.pdf Zufferey, C. (­2019) Homelessness and Social Work: An Intersectional Approach. London: Routledge.

199

18 RURAL DIMENSIONS OF HOMELESSNESS Mark Bevan

Introduction Addressing homelessness in rural and remote areas needs to be ‘­done differently’ compared with services provided in urban contexts. Although the underlying causes of homelessness are similar across rural and urban areas alike, commentators draw attention to uniquely rural factors that exacerbate and shape homelessness in rural environments (­K arabanow et al., 2014). Nevertheless, whilst there has been a steady stream of research over the years, Schiff et al. (­2014) rightly caution against generalising findings across different rural areas and ascribing characteristics to localities or countries outside of the specific rural contexts in which studies are located. Partly, this relates to the different policy contexts that exist in various nations across the Global North, but also to the diverse and heterogeneous environments and circumstances within rural areas. Even so, a recurring and pervasive theme that underpins discussions about rural homelessness is that it remains a hidden or invisible problem (­M ilbourne and Cloke, 2006). This theme of hidden and invisible homelessness is referenced in a variety of ­w ithin-​­country studies, including Australia (­Zufferey and Chung, 2015), the United States (­Fitchen, 1992), Ireland (­Simon Communities of Ireland, 2014), England (­Cloke et al., 1999; Evans, 1999) and Wales (­Gibbons et al., 2019). This chapter begins by exploring how and why this theme resonates so strongly in diverse narratives across the Global North.

Hidden homelessness in rural areas Several factors combine to underpin the notion of homelessness in rural areas as a hidden or invisible phenomenon. A key argument is about perception and a view that homelessness is largely portrayed as an urban problem (­National Health Care for the Homeless Council, 2013; Sloan et al., 2015; Snelling, 2017; Demaerschalk 200

DOI: 10.4324/9781351113113-21

Rural dimensions of homelessness

et al., 2019). Other factors play into this perception, including the measurement of homelessness, as well as the way that homelessness is experienced in rural areas. ­Long-​­standing research in England has critiqued the method used by central government to measure the number of rough sleepers in rural areas (­Robinson, 2004). For example, Robinson and Reeve (­2002) identified much higher levels of rough sleeping in North Lincolnshire than official counts suggested was the case. The dispersed nature of rough sleeping in rural areas makes quantification difficult, with research highlighting a range of locations used by rough sleepers in the open countryside, including garages, sheds and ­out-​­houses, churchyards, barns, parks, fields and woods (­Evans, 1999). In the same way, the difficulties of identifying rough sleepers in rural areas have also been highlighted in national research in Wales (­Bevan, 2000). Studies at the local level in Wales have highlighted not only the dispersed nature of rough sleeping but also the hidden numbers of people that sleep rough in rural areas (­Blythe, 2006). A similar issue is apparent in the US and Canada, where a range of reports have highlighted the limitations of traditional methods for recording numbers of homeless people, especially the poor translation of urban approaches such as Point in Time Counts to the rural context (­Abedin, 2017; City of Kingston Housing and Social Services Department, 2018; Yousey and Samudra, 2018). The limitations of using counts have also been acknowledged for rural areas in England, and instead estimates based on survey results from services for homeless people in rural areas can be used (­Homeless Link, 2018). However, the paucity of these services in rural areas affects the veracity of counts and measures that use surveys to derive an estimate of the extent of homelessness. Instead, alternative approaches to estimating levels of homelessness have been variously proposed to reflect the specific circumstances in rural contexts of countries such as England (­Robinson, 2002) or Canada (­Abedin, 2017). A further dimension is the number of people living in ­non-​­secure accommodation or otherwise precarious living situations. In part, this may relate to people ‘­sofa surfing’ or ‘­doubling up’ with friends or family (­h idden homelessness) (­Rollinson, 2011). Robinson and Coward (­2003) highlighted how people in their study were much more likely to have only stayed with friends and family in a rural area compared with urban areas. This point was also picked up in a study of rural homelessness in the US by Trella and Hilton (­2014) who noted that the coping strategies that people use in rural areas to deal with homelessness differ from coping mechanisms used in urban areas, especially with regard to support from ­non-​­homeless family and friends. A range of studies have also noted the precarious living arrangements of people living in trailers, caravans and mobile homes in Australia (­Beer et al., 2003), the United States (­Salamon and MacTavish, 2006) and Scotland. Local housing needs studies in the latter country, for example, regularly uncover households living in caravans and mobile homes (­see, for example, Rural Housing Scotland, 2014; Rural Housing Scotland, 2015). Understanding these different coping mechanisms is important in tailoring interventions that are attuned to the specific contexts of rural areas and working ‘­w ith the grain’ of how people in rural areas manage and deal with their experiences of housing precarity and homelessness. 201

Mark Bevan

Attitudes towards rural homelessness within rural communities and across the wider population, as well as by practitioners and policymakers, also play a crucial role in this problem being ‘­h idden’. A number of reasons have been put forward as to why there should be so much resistance to the idea of homeless people within rural areas. A central argument is the ­non-​­coupling of ‘­r ural’ and ‘­homelessness’ (­Cloke et al., 2000a; Robinson, 2004). In this respect, a body of research has examined the power relations that exist between different groups in rural areas and concludes that homelessness has been submerged in the way that the countryside is represented by powerful groups (­Cloke et al., 2000b). Thus, Cloke et al. (­2002) have further argued that the idea of the rural idyll has translated into practices by dominant groups within local policymaking in an attempt to deny the existence of homelessness within rural communities and thus the need to devote resources to its alleviation. Resistance is also apparent amongst representative bodies within local governance structures in rural areas, although it is important to recognise the varied responses of these bodies. For example, some parish councils in England have been instrumental in supporting the delivery of solutions to housing and homelessness problems, whereas others have refused to cooperate with rural housing enablers in the face of evidence of relatively high levels of housing need within their communities (­Yarwood, 2002). Other research has also picked up on this issue and Evans (­1999) described how younger homeless people felt isolated and socially rejected in rural communities. Similarly, Oldman (­2002) also reported antipathy towards attempts to set up services for homeless young people in several rural communities in England. Research in Wales has drawn attention not only to the physical difficulties of measuring homeless people in dispersed locations across rural areas but also the way that some homeless people prefer to actively remain hidden and preserve their anonymity within rural places in response to feelings of shame and stigma within tightly knit communities (­Blythe, 2006). Other studies also discuss stigma and anonymity in small communities, including small towns, especially in areas where deeply conservative traditions and perspectives dominate (­Edwards et al., 2009). However, whilst individuals in some rural localities may experience social isolation and exclusion, research also points towards a cultural predisposition towards ­self-​­help and ­self-​­reliance within rural areas that may lead other communities to support homeless people within their midst. Edwards et al. (­2009) frame this apparent contradiction as one of a number of paradoxes that defines how homelessness amongst young people can be experienced in one rural County in America. How far particular attitudes prevail within specific communities to either support or oppress people who are homeless, linked with approaches of formal organisations, as well as configurations of c­ ommunity-​­based, voluntary or charitable activities has led Edwards et al. (­2009) to describe the response in rural areas as a fragmented safety net. This point is echoed by Cloke et al. (­2007) who also highlight a patchy and sporadic response to homelessness in rural areas of England. Whilst both sets of authors identified the bounded and c­ ontext-​­specific nature of their evidence bases, their conclusions nevertheless serve to illustrate common themes with regard to the 202

Rural dimensions of homelessness

varied response to homelessness both within rural communities, and more broadly in the way that national policy and practice respond to this issue. The hidden nature of rural homelessness, and the extent to which it is articulated and recognised as requiring a response, or denied and ignored, can perhaps be conceptualised using plural theories of justice. Here, a just society can be framed as one where redistributive justice eliminates inequality through redistribution of goods, as well as recognition justice which recognises the dignity of individuals, including marginalised groups (­Honneth, 2004). The latter notion of recognition justice embraces a more nuanced understanding of social identity such as shame and stigma. The latter facet of recognition has been applied in the context of youth homelessness to define the experience of stigma and misrecognition of homeless people by dominant groups in society such that the needs of the people experiencing homelessness are emasculated (­Watson and Cuervo, 2017). This potential for emasculation or ­non-​­recognition, over and above arguments for distribution of resources, offers a helpful tool in describing the distinctive experiences of homeless people in diverse rural localities in terms of responses to this issue. Watson and Cuervo (­2017) have also argued that a socially just approach to homelessness needs to take into account the coexistence of stigma with intersecting social structures (­such as age, gender, class, ethnicity/­race, sexuality, ability, religion and place). The next part of the chapter explores how intersections between social structures and rurality combine to produce distinctive experiences of homelessness, particularly in relation to gender.

Intersectionality and rural homelessness Rural geographies have an impact not only on individual pathways into and out of homelessness, but also the way in which different groups in society may experience homelessness, as well as potential solutions. A number of studies have highlighted intersections in the experience of homelessness for diverse groups in rural places, including ethnic groups and indigenous populations, LGBTQ+ communities, women and children fleeing violence, rural youth, immigrants, refugees and older people (­Waegemakers Schiff et al. 2015; Kauppi et al, 2017). Particular attention has been paid to the experiences of homeless young people in rural areas across the Global North (­Beer et al., 2003; Karabanow et al., 2014; Morton et al., 2018). Research has also drawn attention to the way that structural causes of homelessness may intersect with gender in specific rural contexts, leading to high rates of poverty in f­emale-​­headed households in parts of the rural US (­Rollinson, 2011). This author also highlights the experience of family violence (­domestic abuse) amongst homeless households in the rural areas they studied (­Rollinson and Pardeck, 2006). Other researchers in the US and Canada highlight how policy deficits in recognising violence, housing precarity and poverty compound the hidden and invisible experience of women living with homelessness in rural areas (­Forchuk et al., 2010; Waegemakers Schiff et al., 2015; Yousey and Samudra, 2018). A recent study in England goes further, and as well as drawing attention to the poor policy response to domestic abuse in rural areas of this country, it also argues 203

Mark Bevan

that conservative attitudes in many rural areas exacerbate the difficulties faced by women living with abuse within these communities (­National Rural Crime Network, 2019).

Rural homelessness and climate change The need to attend to the health and social risks that global climate change poses for homeless populations is becoming increasingly urgent (­K idd et al., 2020). Ortiz et al. (­2019) detail not only the effect of natural disasters on the poorest and most vulnerable members of communities in the United States that are at the most immediate risk of events due to climate change, but also the subsequent impact on these populations of the destruction of the already limited affordable housing stocks within these communities. Evidence points to the way that natural disasters such as wildfires, floods, extreme cold weather events and hurricanes not only cause homelessness in rural areas, but have a significant impact on people in rural areas who are already homeless (­see, for example, Waegemakers Schiff et al., 2016; Troisi, 2018). The latter research by Waegemakers Schiff et al. (­2016) focuses on the specific implications of natural disasters on homelessness in rural areas in Canada, and concludes that a detailed consideration of the impacts of disasters on homelessness should be pursued to examine the ­longer-​­term effects of disasters on rural communities and consider impacts in future planning and emergency preparedness work.

Responding to homelessness in rural areas The need for future planning and emergency preparedness also lay at the heart of a recent conclusion to a review of the impact of the C ­ OVID-​­19 pandemic on homeless populations in rural Canada (­Schiff et al., 2020). This review highlighted how the impact of the pandemic amplified l­ong-​­standing weaknesses and gaps in funding, support and provision for homeless people in the rural and remote areas of Canada. A key ongoing barrier to responding to homelessness in rural areas remains the relatively low level of service provision available within these areas that individuals can draw upon. In addition to low levels of affordable housing, homelessness services are also in limited supply within rural areas. These difficulties are not just confined to housing but also reflect provision across a range of services in many rural localities such as health and social care, and especially provision for treatment and recovery such as mental health, addiction services, training and w ­ ell-​­being. Research also points to difficulties for service providers in terms of recruitment and retention of staff in rural areas as well as challenges for operating in rural and remote areas (­Dellemain et al., 2017). Although there are many potential models of services for homeless people, their applicability to the diverse range of circumstances that exist in rural and remote areas requires close examination. Thus, whilst models of service provision geared towards urban environments are unlikely to translate to rural contexts, it is also the 204

Rural dimensions of homelessness

case that bespoke rural models may also not necessarily be replicable across all rural areas. Over the last couple of decades, there have been various reviews of models of service provision specifically for homeless people in rural areas (­Streich et al., 2002; Beer et al., 2003; ­Briheim-​­Crookall, 2007; S­ kott-​­Myhre et al., 2008). Whilst the specific policy contexts in which these models have been implemented may have been superseded, nevertheless the underlying principles upon which the services are based may still have value in taking forward effective and nuanced responses in rural localities. Further, a recent study by Weal (­2020) had the explicit aim of highlighting transferable lessons from a range of approaches in rural areas of the United States to the rural context in the UK. This study identified a range of generic principles, including, amongst others, programmes and services embedded and integrated within local communities. Certainly, a feature of more recent reviews and practice guidance is an emphasis on c­ ommunity-​­led activity (­Snelling, 2017; United States Interagency Council on Homelessness, 2018; United States Department of Housing and Urban Development, 2021). Recent guidance on tackling the specific challenges of youth homelessness in rural areas of the United States in the context of the C ­ OVID-​­19 pandemic emphasises community strength and resilience at the core of successful responses (­United States Department of Housing and Urban Development, 2021). This renewed focus on community networks and local knowledge risks the kind of patchy and fragmented support for homeless people, in the face of potentially hostile attitudes, that was found by Cloke et  al. (­2007). Nevertheless, prevailing attitudes at one point in time are not necessarily fixed forever. There is some evidence to suggest that raising awareness of homelessness in the countryside can achieve positive results in facilitating the development of locally based services. Indeed, one scheme reported that it was worth persisting in working with communities to turn around negative attitudes towards homeless people as this had eventually resulted in the development of practical local solutions within these communities (­Ransley, 1996). This is not to say that such an approach will always necessarily succeed in overcoming the views of dominant groups who downplay or ignore homelessness, for whatever motive, but the approach is more about trying to realise the latent potential that may exist within rural communities over and above the action that is already taking place. Whatever the response at the local level, Weal (­2020) argues that what is singularly lacking in England, at least, is the political will from central government to adequately resource the range of approaches that would help alleviate homelessness in rural localities. Researchers in other countries have also drawn attention to fragmented service provision in response to the needs of homeless households in rural and remote areas (­Zufferey and Chung, 2015). In contrast to the situation in England, however, the research in rural and remote areas of Australia concluded that fragmented delivery was due to a centralised, t­op-​­down policy response that was rooted in a culturally inappropriate approach to the needs of local communities. Such instances of similar fragmented outcomes, that belies the very different ­socio-​­political contexts in which people are experiencing homelessness, illustrate the caution noted by Schiff 205

Mark Bevan

et al. (­2014) to take care when ascribing experiences and responses to homelessness beyond the rural contexts in which studies have taken place. Increasing attention has also focused on the application of ­housing-​­led and Housing First approaches in rural areas, and the way in which the Housing First model has been adapted to meet the challenges found in the specific rural environments (­Brown and Goss Gilroy Inc, 2012). Much of the evidence thus far has come from the US and Canada, such as an assessment of the costs of using permanent supportive housing (­Housing First) in rural areas to tackle homelessness amongst disabled people in the US (­Mondello, 2009). It is perhaps telling that in their review of ­housing-​­led approaches in rural areas within the European context, Owen (­2013) also draws upon evaluations of Housing First in rural areas of the US, in the absence of a strong evidence base from rural areas in Europe. The latter ­US-​­based research highlighted the key role of wider services in rural areas in helping people living with homelessness, especially those with mental health problems (­Henwood, Melekis and Sefancic, 2014). Analysis by Stefancic et al. (­2013) discusses the use of a hybrid model of Housing First to overcome caseloads dispersed over wide geographic areas, as well as the use of technology by service users to link with workers. However, Schiff et al. (­2014) argued that this solution would have limited potential in remoter areas with poor access to broadband. Research in Canada has instead highlighted the implementation of a number of innovative rural Housing First schemes across rural communities, which leverage existing community resources to deliver case management, housing location, rent supports and permanent housing (­Waegemakers Schiff, and Turner, 2016). Waegemakers Schiff and Turner (­2016) noted a range of challenges to implementation, namely, lack of funding for implementation, lack of local clinical expertise, insufficient housing stock for ­scattered-​­site approaches and inability to reach efficiencies of scale due to low client numbers. This familiar list of difficulties in applying models within rural contexts was also echoed in a report on ­housing-​­led approaches in rural areas of Ireland, which notes the challenges of developing new models of delivery in the face of financial constraints and wider cuts to services (­Simon Communities of Ireland, 2014).

Conclusion A common strand that links much of the writing on rural homelessness across the Global North is an emphasis on its lack of visibility. The narrative of rural homelessness as a hidden problem has drawn on diverse sources, including not only the way in which homelessness in rural localities is experienced, defined and measured but also encapsulates the social and cultural influences that heavily contest the presence of homelessness in these localities. One way of conceptualising this issue might be to draw on plural theories of justice that emphasises not only justice in terms of the distribution of resources across society, but also the way in which specific groups are marginalised through misrecognition or ­non-​ r­ecognition by dominant groups both within rural localities and across wider policy communities. 206

Rural dimensions of homelessness

A steady stream of publications over the years have reflected on rural homelessness in academic and policy domains, providing the basis for a more nuanced consideration of the intersections between people’s unique experiences of oppression and disadvantage in these contexts. Discussion of recognition justice within wider homelessness debates (­see Watson and Cuervo, 2017) suggests further potential for examining not only the visibility of homelessness in rural areas but also how a focus on identity could lead to a reconfiguration of service models that align more closely with how individuals experience homelessness in rural localities. Distinctive and tailored approaches to tackling rural homelessness have emerged and a range of these local responses have been drawn together and highlighted in a series of ‘­best practice’ reviews that have sought to raise the profile of rural homelessness. Whilst these reviews highlight the role that communities themselves can play in helping to provide solutions to this issue, the nature of practice implementation has been characterised as patchy and fragmented depending on the response due to local ­socio-​­political contexts. Underpinning these local responses is the bigger question of the recognition of homelessness in rural areas within national policy communities and adequate resourcing of service models configured to rural and remote localities. Of increasing urgency, however, is attention to the risks faced by people living with homelessness or at risk of homelessness to the rapidly emerging impacts of climate change, and the specific intersections of this issue with rural dimensions as part of the wider challenge across society.

References Abedin, Z. (­2017). Rural Homelessness Estimation Project: ­Step-­​­­by-​­Step Guide to Estimate Rural Homelessness. Edmonton, Alberta: Alberta Rural Development Network. Beer, A., Delfabbro, P., Natalier, K., Oakley, S. and Verity, F. (­2003). Developing Models of Good Practice in Meeting the Needs of Homeless Young People in Rural Areas. A position paper. Melbourne: Australian Housing and Urban Research Institute. Bevan, P. (­2000). Rough Sleeping in Wales. Cardiff: National Assembly for Wales. Blythe, H. (­2006). The Stigma of Rural Homelessness in Wales. Cardiff: Wallich Clifford. ­Briheim-​­Crookall, L. (­2007). Supporting Homelessness Agencies to Deliver Services in Rural Areas. London: Homeless Link. Brown, J. and Goss Gilroy Inc (­2012). ‘­Taking Care of Our Own’ A Model of Service Delivery Designed to Meet the Unique Needs of Individual and Families at Risk of and/­or Experiencing Homelessness in Rural Newfoundland & Labrador. Marystown, Newfoundland and Labrador: Burin Peninsula Housing and Homelessness Committee and NL Housing & Homelessness Network. City of Kingston Housing and Social Services Department (­2018). 2018 Rural Homelessness Enumeration County of Frontenac and Rural Kingston. Kingston: City of Kingston Housing and Social Services Department. Cloke, P., Johnsen, S. and May, J. (­2007). The periphery of care: Emergency services for homeless people in rural areas. Journal of Rural Studies, 23(­4), ­387–​­401. Cloke, P., Milbourne, P. and Widdowfield, R. (­1999). Homelessness in rural areas: An invisible issue? In Kennett, P. and Marsh, A. (­eds) Homelessness: Exploring the New Terrain. Bristol: The Policy Press, p­p. ­61–​­9 0. Cloke, P., Milbourne, P. and Widdowfield, R. (­2000a). Homelessness and rurality: “­­Out-­​ ­­of-​­place” in purified space?’. Environment and Planning D: Society and Space, 18, ­715–​­735.

207

Mark Bevan Cloke, P., Milbourne, P. and Widdowfield, R. (­2000b). The hidden and emerging spaces of rural homelessness. Environment and Planning A, 32, ­111–​­133. Cloke, P., Milbourne, P. and Widdowfield, R. (­2002). Rural Homelessness: Issues, Experiences and Policy Responses. Bristol: Policy Press. Dellemain, J., Hodgkin, S. and Warburton, J. (­2017). Time, terrain and trust: Impacts of rurality on case management in rural Australia. Journal of Rural Studies, 49, ­50–​­57. Demaerschalk, E., Hermans, K., Steenssens, K. and Van Regenmortel, T. (­2019). Homelessness merely an urban phenomenon? Exploring hidden homelessness in rural Belgium. European Journal of Homelessness, 13(­1), ­99–​­118. Edwards, M., Torgerson, M. and Sattem, J. (­2009). Paradoxes of providing rural social services: The case of homeless youth. Rural Sociology, 74(­3), ­330–​­355. Evans, A. (­1999). They Think I Don’t Exist. The Hidden Nature of Rural Homelessness. London: CRISIS. Fitchen, J.M. (­1992). On the edge of homelessness: Rural poverty and housing insecurity. Rural Sociology, 57, ­73–​­193. Forchuk, C., Montgomery, P., Berman, H., ­Ward-​­Griffin, C., Csiernik, R., Gorlick, C., Jensen, E. and Riesterer, P. (­2010). Gaining ground, losing ground: The paradoxes of rural homelessness. Canadian Journal of Nursing Research, 42(­2), ­138–​­152. ­ adoc-​­Jones, I., Ahmed, A., Jones, K., Rogers, M. and Wilding, M. (­2019). Gibbons, A., M Rural Homelessness: Prevention Practices in Wales. Salford: University of Salford. Henwood, B.F., Melekis, K. and Sefancic, A. (­2014). Introducing Housing first in a rural service system: A multistakeholder perspective. Global Journal of Community Psychology Practice, 5(­1), ­1–​­13. Homeless Link (­2018). Counts & Estimates Toolkit 2018: Introduction & Intelligence Gathering. London: Homeless Link. Honneth, A. (­2004). Recognition and justice: Outline of a plural theory of justice. Acta Sociologica, 47(­4), ­351–​­436. Karabanow, J., Naylor, T. and Aube, C. (­2014). From place to space: Exploring youth migration and homelessness in rural Nova Scotia. The Journal of Rural and Community Development, 9(­2), ­112–​­127. Kauppi, C., O’Grady, B., Schiff, R., Martin, F. and Ontario Municipal Social Services Association (­2017). Homelessness and Hidden Homelessness in Rural and Northern Ontario. Guelph, ON: Rural Ontario Institute. Kidd, S., Greco, S. and McKenzie, K. (­2020). Global climate implications for homelessness: A scoping review. Journal of Urban Health. Available at: https://­doi.org/­10.1007/­­s11524-­​ ­­020-­​­­0 0483-​­1 [Accessed 28 May 2021]. Milbourne, P. and Cloke, P. (­2006). Rural homelessness. In Milbourne, P. and Cloke, P. (­eds) International Perspectives on Rural Homelessness. London: Routledge, p­p. ­79–​­96. Mondello, M. (­2009). Cost of Rural Homelessness: Rural Permanent Supportive Housing Cost Analysis. State of Maine: Corporation for Supportive Housing, Maine Housing. Maine Department of Health and Human Service. Morton, M. H., Dworsky, A., Samuels, G. M. and Patel, S. (­2018). Missed Opportunities: Youth Homelessness in Rural America. Chicago, IL: Chapin Hall at the University of Chicago. National Health Care for the Homeless Council (­2013). Rural homelessness: Identifying and understanding the ‘­h idden homeless.’ In Focus: A Quarterly Research Review of the National HCH Council, 1(­4). Available at: InFocus_ June2013.pdf (­flywheelsites.com) [Accessed 28 May 2021]. National Rural Crime Network (­2019). Captive & Controlled: Domestic Abuse in Rural Areas. Harrogate: National Rural Crime Network. Oldman, C. (­2002). Support and Housing in the Countryside: Innovation and Choice. Wetherby: The Countryside Agency. Ortiz, G., Schultheis, H., Novack, V. and Holt, A. (­2019). A Perfect ­Storm -​­Extreme Weather as an Affordable Housing Crisis Multiplier. Washington: Center for American Progress.

208

Rural dimensions of homelessness Owen, R. (­2013). ­Housing-​­Led Solutions to Homelessness in Rural Areas. Brussels: FEANTSA. Ransley, S. (­1996). Developing Effective Responses to Rural Homelessness. The Report on Shelter’s Rural Housing Aid Conference. London: Shelter. 2002). Estimating Homelessness in Rural Areas: A ­ Step-­​­­ by-​­ Step Guide and Robinson, D. (­ Sourcebook of Information and Ideas. Sheffield: Centre for Regional Economic and Social Research, Sheffield Hallam University. Robinson, D. (­2004). Rough sleeping in rural England: Challenging a problem denied. Policy & Politics, 32(­4), ­471–​­486. Robinson, D. and Coward, S. (­2003). Your Place, Not Mine: The Experiences of Homeless People Staying with Family and Friends. London: CRISIS. Robinson, D. and Reeve, K. (­2002). Homelessness and Rough Sleeping in North Lincolnshire. Sheffield: Centre for Regional Economic and Social Research, Sheffield Hallam University. Rollinson, P. (­2011). Homelessness in rural America. In Marcouiller, D., Lapping, M. and Furuseth, O. (­eds) Rural Housing, Exurbanisation, and ­Amenity-​­Driven Development. Burlington: Ashgate, p­p. ­223–​­236. Rollinson, P. and Pardeck, J. (­2006). Homelessness in Rural America: Policy and Practice. New York: The Haworth Press. Rural Housing Scotland (­2014). Eigg Housing Needs Survey Report. Edinburgh: Rural Housing Scotland. Rural Housing Scotland (­2015). Craignure/­L ochdon Housing Needs Survey Report. Edinburgh: Rural Housing Scotland. Salamon, S. and MacTavish, K. (­2006). ­Quasi-​­homelessness among rural trailer park households in the United States. In Milbourne, P. and Cloke, P. (­eds) International Perspectives on Rural Homelessness. Abingdon: Routledge, p­p. ­57–​­74. Schiff, R., Turner, A. and Waegemakers Schiff, J. (­2014). Rural Aboriginal Homelessness in Canada. Available at: http://­ion.uwinnipeg.ca/~epeters/­Workshop%20Papers/­Schiff%20 et%20al.pdf [Accessed 28 May 2021]. ­ OVID-​ Schiff, R., Buccieri, K., Waegemakers Schiff, J., Kauppi, C. and Riva, M. (­2020). C ­19 and pandemic planning in the context of rural and remote homelessness. Canadian Journal of Public Health, 111(­6), ­967–​­970. Simon Communities of Ireland (­2014). Left Out in the Cold: A Review of Rural Homelessness in Ireland. Dublin: Simon Communities of Ireland. ­Skott-​­Myhre, H. A., Raby, R. and Nikolaou, J. (­2008). Towards a Delivery system of services for rural homeless youth: A literature review and case study. Child Youth Care Forum, 37, ­87–​­102. Sloan, M., Ford, K. and Merritt, D. (­2015). Shifts in practice based on rapid ­re-​­housing for rural homelessness: An exploratory study of micropolitan homeless service provision. Contemporary Rural Social Work Journal, 7(­2), ­127–​­134. Snelling, C. (­2017). Right to Home? Rethinking Homelessness in Rural Communities. London: IPPR. ­ awrence-​­Gomez, R. Stefancic, A., Benjamin, M., Henwood, F., Melton, H., Shin, S., L and Tsemberis, S. (­2013). Implementing housing first in rural areas: Pathways Vermont. American Journal of Public Health, 103, ­S206–​­S209. Streich, L., Havell, C. and Spafford, J. (­2002). Preventing Homelessness in the Countryside: What Works? A Guide for Local Authorities and the Voluntary Sector Demonstrating Effective Practice. Wetherby: The Countryside Agency. Trella, D. and Hilton, T. (­2014). “­They can only do so much”: Use of family while coping with rural homelessness. Contemporary Rural Social Work, 6, ­16–​­39. ­ oint-­​ Troisi, C. (­2018). Houston, Pasadena, Harris, Fort Bend, and Montgomery Counties 2018 P ­­in-​­Time Homeless Count & Survey Report. Houston: Coalition for the Homeless. United States Department of Housing and Urban Development (­2018). Balance of State Continuum of Care Toolkit. Washington: U.S. United States Department of Housing and Urban Development.

209

Mark Bevan United States Department of Housing and Urban Development (­2021). Overcoming Rural Specific Obstacles to Ending Youth Homelessness. Available at: Overcoming Rural Specific Obstacles to Ending Youth Homelessness (­hudexchange.info) [Accessed 28 May 2021]. United States Interagency Council on Homelessness (­2018). Strengthening Systems for Ending Rural Homelessness: Promising Practices and Considerations. Washington: U.S. Interagency Council on Homelessness. Waegemakers Schiff, J., Schiff, R., Turner, A. & Bernard, K. (­2015). Rural homelessness in Canada: Directions for planning and research. The Journal of Rural and Community Development, 10(­4), ­85–​­106. Waegemakers Schiff, J., Schiff, R. and Turner, A. (­2016). Rural homelessness in Western Canada: Lessons learned from diverse communities. Social Inclusion, 4(­4), ­73–​­85. http://­d x.doi.org/­10.17645/­si.v4i4.633 Waegemakers Schiff, J. and Turner, A. (­2016). Housing First in Rural Canada. Calgary: University of Calgary. Watson, J. and Cuervo, H. (­2017). Youth homelessness: A social justice approach. Journal of Sociology, 53(­2), 4­ 61–​­475. Weal, R. (­2020). Out of the Woods? Lessons from the United States on Tackling Rural Homelessness. London: Winston Churchill Memorial Trust. Yarwood, R. (­2002). Parish councils, partnership and governance: The development of exceptions housing in Malvern Hills District, England. Journal of Rural Studies, 18(­3), ­275–​­291. Yousey, A. and Samudra, R. (­2018). Defining homelessness in the Rural United States. Online Journal of Rural Research & Policy, 13(­4), 1­ –​­24. Zufferey, C. and Chung, D. (­2015). ‘­Red dust homelessness’: Housing, home and homelessness in remote Australia. Journal of Rural Studies, 41, ­13–​­22.

210

19 VETERAN HOMELESSNESS Stephen Metraux and Emily Moore

Introduction Over the past decade, veteran homelessness in the US has witnessed a steady decline. Annual point in time counts by the US Department of Housing and Urban Development (­H UD) estimate that 74,087 veterans were homeless on a given night in 2010, compared to a count of 37,252 for 2020 (­Henry et al., 2021). This decline has far outpaced that of the overall US homeless population and comes after the goal of ending veteran homelessness was declared a federal policy priority. In contrast, there is a lack of research on veteran homelessness across the rest of the globe (­Wilding, 2020), and no other nation can even provide a systematic estimate of the number of veterans who are homeless. While there has been a concern expressed in some nations about the extent to which veterans are vulnerable to homelessness, no other nation has identified veterans as a priority for services among the homeless population, let alone resolve to end homelessness among this group. In short, the US is conspicuous globally in the extent to which it has cast veterans as a distinct homeless subpopulation and responded to their housing and service needs. In this overview, we examine veteran homelessness from a global perspective. In doing so, we first take a look at the US exceptionalism in this area, with attention to the social context around the concern for this homeless subpopulation, as well as to the approach taken toward ending this particular aspect of homelessness. This chapter continues with a review of studies in three other countries that have made some forays into examining homelessness among their veterans and finally identifies two general situations where homelessness among veterans may be a salient issue in other nations that do not currently focus on veteran homelessness.

DOI: 10.4324/9781351113113-22

211

Stephen Metraux and Emily Moore

Veteran Homelessness in the US The extent to which veteran status confers identity to a segment of the homeless population is unique to the US. In a country stung by the disregard initially shown to veterans returning from the Vietnam War, there is now ­near-​­universal regard and support for people who have served in the military, and public dismay at the injustice of homelessness among veterans that contrasts sharply with the dissection of the personal shortcomings that often befall n ­ on-​­veterans who experience homelessness. This connection has led to bipartisan political support for ensuring veteran ­well-​­being, and has led to a substantial expansion of homeless services for veterans that contrasts with the more lukewarm support provided to homeless services in general. As a result, levels of veteran homelessness have been cut roughly in half over the past decade (­Henry et al., 2021), proffering a prototype for how the US might make broader reductions among other segments of its homeless population. Public concern for veteran homelessness is grounded in the perception of homelessness as a sequela of war. There has been a conspicuous presence of veterans among homeless populations in the aftermath of all major wars in which the US has been involved (­Tsai, 2019a). With the rise of contemporary homelessness in the 1980s, Robertson’s (­1987) monograph identified veterans as an overrepresented subgroup and documented the high proportion of these veterans who had served ­ ell-​ in the Vietnam War. The 1980s were also a time when concern grew for the w b­ eing of Vietnam veterans who served honorably in an unpopular war and then faced difficulties in readjusting to civilian life. Homelessness symbolized an extreme manifestation of such readjustment problems, and as the awareness of p­ ost-​ t­raumatic stress disorder (­PTSD) increased, this diagnosis became a shorthand in public discourse for the military precursors to homelessness. This narrative, where factors related to combat and, more generally, military service are associated with an increased risk for homelessness among veterans, has driven the framing of veteran homelessness. Despite such conventional wisdom, this connection has not been supported by subsequent research. There is an element of paradox in how veterans became homeless at higher rates than ­non-​ v­ eterans and were overrepresented among the homeless population (­Fargo et al., 2012), despite their having lower rates of poverty, and higher levels of education and employment than ­non-​­veterans (­Rosenheck et al., 1996). However, risk fac­ on-​ tors for homelessness among veterans are primarily the same as those among n v­ eterans (­Balsham, Christensen  & Tuepker, 2011). This notion of PTSD being the key mediating factor between homelessness and veteran status, as suggested by Robertson’s study, has never been conclusively supported in the research literature (­Rosenheck & Fontana, 1994; Metraux & Smith, 2019). Furthermore, Rosenheck and colleagues (­1994) found that the cohort of US veterans with the most significant risk of homelessness were those who served during the early years of the extended peacetime era that followed the Vietnam War. This was a time when military service was unpopular, and conscription mandates had just ended, resulting in lowered military entrance standards to counter recruiting shortfalls. This, they argued, brought in a higher number of recruits 212

Veteran homelessness

with factors such as behavioral health issues and criminal histories that would predispose them to a higher risk of homelessness over their p­ ost-​­military life course. These differing perceptions of veteran homelessness extend to the most recent veteran cohort, which included military personnel returning from wars in Afghanistan and Iraq. Here, media accounts have described a “­tsunami of homelessness” occurring among these new veterans, while systematic research shows rates of homelessness among this cohort as staying roughly consistent with rates among older groups (­Metraux & Smith, 2019). As public support for returning veterans has continued to be strong, so has public outcry at the inherent injustice of veteran homelessness. This led the incoming Obama Administration, in 2009, to make ending homelessness among veterans one of the VA’s policy priorities. The resulting effort led to an estimated a 49% reduction in veterans who were homeless on a given night from 2010 to 2020 (­Henry et  al., 2021). One key to this reduction has been ongoing bipartisan political support for this issue during a time of sharp political divisiveness, and a steady expansion of housing and services for homeless veterans during a time when overall social spending remained flat. Also key is the monolithic health and social services structure provided by the US Department of Veterans Affairs (­VA), consisting of a nationwide network of 172 VA Medical Centers and over 1,000 community clinics that annually provide healthcare services to approximately 6.7 million eligible veteran patients. In a country that is resistant to “­socialized medicine” and leaves large segments of the population lacking access to basic healthcare coverage, the VA ensures that veterans have ­near-​­universal access to a comprehensive healthcare system (­Longman, 2012). The VA has mobilized its large, nationwide services capacity to implement a “­f ront ­door – ​­back door” approach to reducing homelessness. The “­front door” component of this approach focuses on keeping veterans from entering into sustained periods of homelessness. The critical program here has been the VA’s Supportive Services for Veterans and Families (­SSVF), which contracts with ­non-​­profit service providers across the US to provide prevention services, which seek to keep veterans with housing emergencies from becoming homeless, and rapid rehousing services, which quickly resituate veterans who have become homeless back into permanent housing. SSVF, launched in 2011, has since grown into a $420 million program that served 70,596 veterans in 2019. SSVF has been effective in enabling large numbers of veterans to regain stability with this ­t ime-​­limited assistance (­Silverbush, Kuhn & Thompson, 2021; Perl, 2022). The “­back door” of the VA’s homeless services consists of moving smaller numbers of veterans experiencing l­ong-​­term homelessness into permanent supportive housing (­PSH), which combines rent supports with case management services. The flagship PSH program comes through a partnership between the VA and the federal government’s Department of Housing and Urban Development (­H UD) to create the ­H UD-​­VA Supportive Housing program (­Bell, 2021). Known as ­H UD-​ ­VASH, this program emerged in the early 1990s, substantially expanded in 2008, and in 2021 has grown to provide over 100,000 housing vouchers and $540 million in funding for case management services (­National Alliance to End Homelessness, 2021). In 2014, ­H UD-​­VASH took on a Housing First model (­Padgett, Henwood & 213

Stephen Metraux and Emily Moore

Tsemberis, 2018) and became by far the most extensive such program in the world. ­H UD-​­VASH has demonstrated a high retention rate on a scale that has enabled it to account for much of the recent decline in veteran homelessness (­O’Connell & Rosenheck, 2019; Evans et al., 2019). Between the timely diversion of veterans from the homeless services system and the transfer of chronically homeless veterans to H ­ UD-​­VASH, an array of other VA and allied programs provide further services. Prominent among these other programs are the ­VA-​­funded Grant and Per Diem program, under which a nationwide network of ­non-​­profit agencies provides temporary and transitional housing services, and the VA’s Healthcare for Homeless Veterans program, where VA outreach workers seek to engage homeless veterans in homeless and other needed services. Taken together, VA expenditure obligations specifically for homeless services have grown steadily since 2009 from $376 million in the fiscal year 2009 (­October 2008 through September 2009) to more than $1.5 billion in the fiscal year 2017. Over the same time, healthcare expenditures specifically for homeless veterans increased from $2.5 billion to $5.3 billion. While homelessness among veterans still exists, albeit, at lower levels, a growing number of jurisdictions have documented that they have functionally ended homelessness among veterans. This came about because of coordinated local campaigns that were organized through a national effort headed by then First Lady Michelle Obama. Here, agencies worked together to ensure that veteran homelessness is “­rare, brief and ­non-​­recurring.” Practically, this meant reaching a goal of “­f unctional zero” where all homeless veterans were identified on a local “­by name list” and connected with the necessary resources to regain permanent housing. In this framework, those veterans who were homeless at any given point were either transitioning back to housing or steadfastly refusing services. Eliminating homelessness in this fashion is subject to a formal HUD audit, after which localities are certified to have ended veteran homelessness (­US Interagency Council on Homelessness, 2017). This prioritization of veterans among homeless subgroups, through public and political support, expanded services, and local services coordination have resulted in veterans serving as a prototype for eliminating homelessness more generally in a US context. Veteran homelessness remains a poorly understood phenomenon, as it remains unclear what the specific mechanisms are by which veterans are at a higher risk for homelessness and what contributions, if any, military service has to an increased propensity for subsequently experiencing homelessness. Nonetheless, adequate mobilization of housing, healthcare, and other services have reduced levels of veteran homelessness substantially. Elements of this approach could be applied to different targeted homeless subpopulations, or the more general homeless population. As such, addressing veterans as a specific homeless subpopulation has helped demonstrate what works to end homelessness. However, a closer examination of the successes among this homeless subpopulation also underscores the challenges to extending the VA approach to address homelessness more generally. Homeless veterans are not only able to access a set of ­veteran-​­specific homeless services, but 214

Veteran homelessness

they also have access to a much broader set of healthcare services, financial benefits, and other supports that are not available to many n ­ on-​­veterans while they are homeless. As Perl (­2022) has documented, VA healthcare expenditures alone for homeless veterans far outweigh expenditures specifically set for homeless services. These ancillary supports are a vital component of addressing veteran homelessness, and similar supports (­in addition to specific housing and homeless services) would in many cases need to be established for homeless ­non-​­veterans. The second factor that limits the generalizability of this approach is that veteran status provides the basis for popular and political support that is unobtainable to most other segments of the homeless population. For most persons experiencing homelessness, to be homeless in the US is to face scrutiny over one’s character and the contributions of perceived character flaws in becoming homeless. Additionally, some of the veterans who are most vulnerable to homelessness are those who lack access to these extensive VA supports. Veterans who have not successfully completed their military service, or those who were discharged early, are ineligible for VA services. This creates a relatively small but conspicuous group who have more significant difficulties with reintegrating into civilian life, who are substantially more likely to become homeless (­Gundlapalli et al., 2015) and who cannot ­ A-​­eligible veterans receive. Veterans access much of the targeted assistance that V are also overrepresented among persons convicted of sex offenses (­Seamone, Holliday & Sreenivasan, 2018), who, due to their criminal records, have a higher risk for homelessness, face restrictions to where they could live, and have restricted access to VA assistance (­Byrne et al., 2022). As the overall number of homeless veterans declines, the proportion of remaining homeless veterans who face such barriers will increase.

Veterans Homelessness in the UK, Canada, and Australia The US is unique in the extent to which it considers veteran status as the basis for a distinct subgroup among the homeless population. The only other nations which have undertaken any substantial examination into links between veteran status and homelessness are also primarily ­English-​­speaking: the UK, Canada, and Australia. Compared to the US, the links between these two attributes in each of the countries have proven more tenuous. In the UK, though there are no definitive estimates of the number of veterans’ homelessness, the prevalence of homelessness among veterans is substantially lower than that of the US. There is no evidence that, at 2­ –​­3%, veterans are overrepresented in the homeless population, though their presence may be undercounted (­Wilding, 2020). Policy toward homelessness in the UK does not differentiate homeless veterans from the more general homeless population, although there are various charities that focus specifically on providing aid to homeless veterans (­Lowe & Dybicz, 2019). In the most systematic studies of UK veteran homelessness, the University of ­ ilitary-​­related risk factors York researchers found a lack of evidence for specific m leading to homelessness beyond possible difficulties some veterans experience with 215

Stephen Metraux and Emily Moore

returning to civilian society, and that “­single veterans are not significantly ­over-​ r­epresented in the ­d ata-​­sets on housing need” ( ­Jones et al., 2014, ­p. 109). They go on to describe v­ eteran-​­specific housing as a “­n iche sector” that is funded by a group of charity organizations active in veteran issues (­Quilgars et al., 2018). While some providers made a case for the need to expand housing specifically targeting homeless veterans, researchers instead found a need to better link existing housing resources to homeless veterans (­Quilgars et al., 2018; Rolfe & Anderson, 2022). Little is known about homelessness among veterans of the Canadian armed forces (­Ray & Forchuk, 2011). The first systematic study of veteran homelessness did not come until 2015 (­Segaert & Bauer, 2015). This federal government study, based upon a national administrative dataset of homeless services records, found veterans to have comprised 2.7% of the adult homeless population, and found few differences between homelessness as experienced by veterans and ­non-​­veterans; veteran status was, however, associated with older age and increased likelihood of experiencing episodic patterns of homelessness. Forchuk and her colleagues (­2022) cite a series of c­ ity-​­specific surveys and counts across Canada as showing veterans to comprise as much as 13% of the homeless population, indicating both that veterans are undercounted and overrepresented within the homeless population. Beyond these counts, there has been no clear basis for addressing veterans as a distinct subgroup among the Canadian homeless population, and housing and services that specifically target homeless veterans are few, despite indications that adopting ­veteran-​­centric approaches leads to better outcomes among homeless veterans. In Australia, the vulnerability of former members of the Australian Defence Force (­A DF) has, as in the US, drawn renewed public and media concern in the wake of Australia’s military involvement in Afghanistan and Iraq. An initial estimate in 2009 of 3,000 homeless veterans at a point in time (­Thomson Goodall Associates, 2009) was undercut by subsequent studies that estimated this subpopulation to a number less than 500 (­Foreign Affairs Defense and Trade Committee, Department of the Senate, 2016; Flatau et al., 2018). In response to growing concern about this issue expressed in the media, Australia’s Department of Veterans Affairs (­DVA) commissioned a major study to systematically estimate the number of homeless veterans in Australia and provide evidence about pathways into homelessness for veterans, service usage patterns, and ways to improve service responses. The result was a much higher estimate, 5,767 “­recently transitioned veterans,” over the course of a year, but one that uses a much more expansive definition of homelessness, as it includes living situations that, in a US context, would be considered as “­unstably housed.” Based on this estimate, the report concluded that veterans are substantially overrepresented in the Australian homeless population (­H ilferty et al., 2021). In contrast, a contemporary report on recipients of federally funded “­specialist homeless services” reports a substantially ­ omeless-​ lower number (­1,300) and proportion (