Housing First, PIEs, and permanent supported housing

Housing First - the history

The term 'Housing First' (often abbreviated to 'HF') describes an approach which argues that it is more effective to 'fast-track' re-house homeless people with multiple problems such as substance abuse, trauma and mental illness, and then offer them treatment in and from their own homes, but on a purely voluntarist basis.

The origins of Housing First lie in the United States, and arose through a particular combination of circumstances there, in the 1980s and 1990s, which resulted in a flood of individuals into the major cities - New York in particular - whose characteristics and needs were significantly different to those of the previous populations at greatest risk of homelessness. For this new cohort, a new approach was needed.

HF had at first been seen as incompatible with, even antagonistic towards, ‘transitional housing’, at least for this particular group.  In contrast to the US, in Europe the welfare services, and gaps in these safety nets are very different; and Housing First England, for example, is taking a different stance, seeing Housing First as one of a range of positive approaches – one tool in the tool kit for meeting complex needs.

This difference undoubtedly reflects the far greater investment over several decades in the UK in improving the quality of “hostels” (NB: the UK term for “transitional housing”), both in terms of overall size of homelessness resettlement units, their physical condition (via, for example, the Places for Change programme) and, more recently, the psycho-social environment – currently expressed in the language of PIEs.

Staircases, Elevators and Cycles of Change by Johnsen & Texeria was one of the earliest to question the simple applicability of US-model HF to the UK context (and also to inquire about the particular needs of particular sections of 'the' homeless population.

More recently, the position in the US had become considerably more nuanced, with a growing recognition that there may be a legitimate and valuable role for 'transitional housing', even 'conditionality', for those with long-standings substance abuse problems. This form of more integrated and more communal support is now termed 'recovery housing'. .


Housing First, congregated and 'permanent' supported housing.

In the US and Canada, different models of HF are therefore  emerging, and especially different models of permanent supported housing (PSH), which is the accommodation element in HF’s rapid housing placement and support philosophy.  In particular, many areas are developing "congregated care sites" partly for reasons of costs (of support staff), and partly for concerns at the risks of loneliness and increased vulnerability for those housed alone, that are now being identified as a worrying problem for such provision in the US. (See the page on "PIEs,  'scattered site' and 'networked' housing"  HERE for a discussion of such issues).

But in the UK, permanent supported housing tends still to be seen as meaning individual, isolated tenancies (in the US and Canada, “scattered site PSH”), and 'congregated care sites are found primarily in our 'hostels'.    It would appear, then, that for the moment, we have an odd contrast. The PIE framework is more readily applicable in PSH in the US, and more applied in transitional housing in the UK.

This is in part a reflection of the short-termism – typically a maximum of 2 years - that has characterised “housing related support” in the UK, ever since the expansion of support services under the Supporting People programme.  This severely limits the extent of permanent support in housing, under the homelessness service umbrella, and now requires the proponents of Housing First to seek new funding partnerships for extended support episodes. These are currently proving as difficult to establish in the UK as they are in the US.

NB: Such short-termism in housing related support services' funding may also help to explain why the belief persists that being or becoming a PIE means having a psychologist to ‘do’ the informing. A trained psychologist is an expensive resource that must be targeted on the more immediate transitions, and in the UK, this more intensive resettlement work has mainly been offered in hostels.    (See the training video, “Does it take a psychologist to make a PIE?”, for a critique of this view).


NB: Here, 'pretreatment' is seen as the effective skill set for outreach work in Housing First - or any other programme with excluded and marginalised individuals. For details and examples, and further links see the section on this site devoted to Pretreatment.   For a preliminary analysis of the links between Housing First, PIEs, TIC, pretreatment and system change approaches, see Principles and practice in the psychology of homelessness, (2016 draft) by Robin Johnson

Further background reading/listening/viewing

PIElink pages

Housing First in the US : HERE

Housing First in Finland : HERE


Library items

Housing First England is the natural home for HF development in England; and has many links to news and project reports.

Staircases, Elevators and Cycles of Change (Johnsen and Texeria) : HERE

Principles and practice in the psychology of homelessness, (Robin Johnson) : HERE

How gaps in US services had evolved; a discussion with April Connolly and John Yaswinski : HERE




Video & audio

Research, impact and community; a discussion on Housing First developments in the UK a discussion with Glasgow Housing Network

 “Does it take a psychologist to make a PIE?” (

NB: cartoon version) for a critique of the assumption that it does.

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