"Recovery Housing' in the US & the UK

The term ‘recovery’ has two distinct but overlapping meanings; and the phrase ‘recovery housing’ is used in quite different ways as between the UK and the US, reflecting that difference.

Generally the term is used to mean an aspiration for ‘being the best you can be, despite on-going vulnerability’ rather than, for example, ‘being cured’.   

At this point however two meanings diverge.

In the US ‘recovery’ is associated primarily with the drug and alcohol world – where, arguably, its roots in fact do lie. (The phrase ‘alcoholic in recovery’ is very widely used and understood by the general public.)

In the UK, the term has also been adopted by the ‘mental health survivor’ movement. Here it identifies those who no longer hope for a psychiatric ‘cure’ – and are often highly critical of power relationships in psychiatry – yet with the same stress on living well, and being as autonomous as possible, despite illness.

Recovery is conceived of as being a very individual thing, and what it may mean in individual cases may vary. In both countries, recovery is a term that has arisen from and within the user or survivor movement; and partly as a result there is some resistance to professionals and policy makers adopting the term, and defining what it should mean in practice.

 

In the US, however, being primarily associated with substance abuse, user-led recovery-based services had developed which tended to stress – or insist upon – abstinence or sobriety; and it was normal for recovery housing to make this a condition of residence. Temporary short-stay ‘transitional’ accommodation was created for those ‘drying out’ or in early stage recovery, alongside more permanent housing for those needing more on-going support to maintain abstinence.

Such ‘conditionality’ however ran directly counter to the fundamental principles of Housing First; and through HF’s stress on a rapid track to permanent supported housing, reliance on short term housing was also frowned upon. Reconciling these principles with those of HF has therefore been problematic; and the existence of an articulate user movement, organised through these service, alongside an ‘opioid crisis’ meant that some reconciliation was urgently needed.

In the policy statements from the US, HUD the Dept of Housing and Urban Development, has attempted to find a balance and a compromise. HF can now be seen as an overall strategy, rather than a prescription that must apply to all services. Where there is a demand from users for conditionality that must be respected; and yet, some ‘elasticity’ in tolerance must be seen – at least in any service that HUF supports financially.

HUD has attempted to impose this definition using the policy levers and funding mechanism at its disposal. But blanket implementation of this directive has then caused difficulties for other kinds of recovery housing, such as women’s refuges, aa the US use of ‘recovery ‘does not include recovery from trauma, or abuse from others; and so these are not covered by HUD’s exemption clauses for substance abuse recovery services..  

 

By contrast, in the UK, the term ‘recovery’ in supported housing encompasses similar issues of empowerment and personalisation but otherwise, as it covers a far wider range of mental health issues, it is far less prescriptive. The recovery philosophy here is an option; but it is especially well suited to those with long-standing personality difficulties, with or without mental ‘illness’, where substance abuse is secondary – issues which are more characteristic of the entrenched homeless population in the UK.

There is also no insistence from central government on the adoption of Housing First, and (as in France)) what HF programmes there are – so far, mainly pilots – are seen as running alongside a wide range of other possible ways to work. It may be too soon to say, but it seems currently unlikely that we will see, in the UK, the kind of draconian enforcement of HF practice that has been seen in the US.

Further reading

Housing First and PIEs in the US and the UK HERE

Housing First and PIEs in the UK     HERE

Recovery Housing Policy Briefing HERE

A US commentary on HUD's Recovery Housing Policy brief HERE

A European commentary on HUD's Recovery Housing Policy brief     HERE

Intersections between the domestic violence and homelessness programs  HERE

The characteristics of successful supported housing projects   HERE

"Sobriety housing and peer support' (podcast

Recovery is for all: Hope Agency and Opportunity in Psychiatry  HERE

Packed with questions HERE

Housing First: addressing the community dimension HERE

More for Less? Using PIEs and Recovery to Improve Efficiency in Supported Housing   HERE