"Recovery Housing' in the US & the UK

NB: There is currently a very significant shift in US policy towards homelessness and homelessness services, as indicated by policy documents released in December 2022: 'Transforming Approaches to Shelter'.

This shift will require - and offers the opportunity for - a major overhaul of all discussions on the 'American PIE' sections of this site. Whilst this is being undertaken - and whilst US policy and practice evolved - much of the content of this site will need considerable re-drafting to bring out the opportunity that this creates.


Common ground and divergence

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

Generally the term 'recovery' is used to mean an aspiration for ‘being the best you can be, despite on-going vulnerability’ rather than, for example, ‘being cured’. In both countries, recovery is a term that has arisen from and within the user or survivor movement; and is often wary or downright critical and opposed to 'mainstream approaches'.

At this point however two meanings diverge.

In the US ‘recovery’ is associated primarily with the drug and alcohol world – which is where, arguably, its roots in fact do lie. (The phrase ‘alcoholic in recovery’ is certainly 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 the thinking of those who no longer hope for a psychiatric ‘cure’ – and who are often highly critical of power relationships in psychiatry, and especially an excessive reliance on medication, with social support and constructive activity seen as equally or more important.

In the UK, there is the same stress on living well, and being as autonomous as possible, despite (in this case) illness. But recovery is conceived of as being a very individual thing, and what it may mean in individual cases may vary. Partly as a result there is some resistance to professionals and policy makers adopting the term, and defining what it should mean in practice, and especially in policy.


Recovery housing in the US

In the US, however, being originally 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 transitional housing as part of the preparation stage 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, the Dept of Housing and Urban Development, HUD, had initially attempted to impose the Housing First philosophy of user choice using the policy levers and funding mechanism at its disposal.

HUD has since 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 now be respected. Yet even so, some ‘elasticity’ in tolerance must be seen – at least in any service that HUD supports financially.

But blanket implementation of this modified directive has still caused difficulties for other kinds of recovery housing, such as women’s refuges, as 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.


Recovery housing in the UK

By contrast, in the UK, the term ‘recovery’ in supported housing raises and encompasses similar issues of empowerment and personalisation. But otherwise, as it covers a far wider range of mental health issues, there is far less attempt to impose a definition, and UK policy is far less prescriptive, with recovery housing being simply located within the over-all philosophical position of all housing-related support.

Adoption of the recovery philosophy here is therefore 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.

The newer US policy concept of 'interim housing' brings back into the fold many of the kinds of supported accommodation that we in the UK had included under the overall description of PIEs. It is possible that this change in US policy may now make room for the introduction of the broader concept of PIE to a US audience.

Further reading

PIElink pages on Housing First and PIEs

Housing First and PIEs - how do they work together? : HERE

Is Housing First itself a PIE approach? : HERE

(Balancing) principles and pragmatism in PIEs and HF : HERE

Housing First and PIEs - where parallel lines meet? : HERE

Housing First, PIEs and the Pizazz (Special Interest Group) : HERE

Housing models, Housing First and PIEs in the US and the UK : HERE

Housing First and PIEs in Europe : HERE

Housing First in the 'new world' : HERE


Other related PIElink pages

American PIE : HERE

'Recovery Housing' in the US and the UK : HERE

PIEs, 'scattered site' and 'networked' housing : HERE

Outreach, in-reach and pathways : HERE




Library items

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 :  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

Engaging adults experiencing homelessness in Recovery Education  : HERE