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Prevention is better than cure

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A shift from the crisis-oriented response to one based on prevention is at the heart of the Plan to End Homelessness (File photograph by Akil Simmons)

“An ounce of prevention is worth a pound of cure.”

Benjamin Franklin was talking about fire risks when he uttered this phrase in the 18th century, but it is equally apt for summing up the most effective response to homelessness in Bermuda today.

Too often in Bermuda, crisis management has been the default-mode approach for tackling homelessness. Failing to intervene before someone loses a home is an expensive option, as it calls upon emergency shelters, feeding services, emergency health services, police, courts and correctional facilities, among others.

While such services are critical for those experiencing homelessness, they have limited capacity to change the direction of a person’s life to drive a sustainable transition to independent living.

Studies carried out in Britain, the United States and Australia all found strong evidence attributing prevention of homelessness before it happens to be far less expensive than allowing homelessness to occur.

For example, a 2016 report by Crisis, the British homeless charity, concluded actions to prevent 40,000 people from becoming homeless in England for one year would reduce public spending by £370 million (about $465 million).

A shift from the crisis-oriented response to one based on prevention is at the core of the Plan to End Homelessness, which is due to be made public soon. Home has worked for more than two years on the plan and its development, involving collaboration with the Bermuda Government, other non-profits and helping services, as well as input from more than 400 people experiencing or at risk of homelessness in Bermuda.

A requisite for prevention is defining what homelessness is. While there is no set definition in Bermuda yet, the European Typology on Homelessness and Housing Exclusion offers helpful guidance. Ethos sets out three domains that constitute a home: physical (having an adequate dwelling place), social (being able to maintain privacy) and legal (having legal title to occupation). An absence of any one of these domains delineates homelessness.

Homelessness is much more multifaceted and complex than its stereotypical image. Although rough sleeping is what some homeless people experience, it is only one of 13 categories to describe the circumstances of homelessness. When Home carried out a survey in 2022 and found 650 people homeless on the island, we discovered people in every one of these categories:

• Living rough

• Staying in a night shelter

• Living in accommodation for the homeless

• Living in a women’s shelter

• Living in accommodation for immigrants

• Due to be released from institutions

• Receiving long-term support such as residential care owing to homelessness

• Living in insecure accommodation

• Living under threat of eviction

• Living under threat of violence

• Living in temporary or non-conventional structures

• Living in unfit housing

• Living in extreme overcrowding

By considering the circumstances of those in any of these situations, we can learn about what they need to return to a stable life and how their fall into homelessness could have been avoided. In each individual case, the mix of services needed may be different.

Rough sleepers may be living with addiction, mental-health problems, physical and intellectual differences, and may have a criminal history. Rough sleepers are most visible on Front Street, but people are living outside across the island, including bunkers along the South Shore, dry spots along the Railway Trail, the Botanical Gardens and other parks, and caves along the North Shore.

One less familiar category involves immigrants, whose legal time in Bermuda expires, but they do not leave. There are no designated accommodations for people in this situation. They may live in hidden spaces to avoid detection. Home found 17 people in these circumstances in our 2022 survey, but there are almost certainly more.

Consider also the challenges of people leaving institutions. An inmate set to leave Westgate after several years of incarceration has to compete for accommodation with people who have personal track records of employment and housing. Securing a home is a prerequisite for parole.

Similarly, for people who receive in-house, mental-health treatment at Mid-Atlantic Wellness Institute, securing a suitably affordable apartment can be all but impossible, unless they have support from a family member or close friend, employer, or their landlord.

Critical to prevention are insights leading to detection of at-risk individuals that can emerge in many settings not directly related to housing, such as the criminal justice system, healthcare and social care, schools, children’s services, feeding services and the workplace. This emphasises the importance of co-ordination across multiple sectors and services to achieve successful interventions.

Data, gathered and held by multiple social services and helping agencies, can play a leading role in prevention, as analysis can raise alerts of families and individuals headed for crisis. A systematic approach to tracking homelessness and its drivers, and monitoring interventions, is a key part of moving from a crisis-management to a preventive approach. Bringing together previously siloed data sets has found success in preventing homelessness in places including San Francisco and Maidstone, Kent.

In 2022, Home’s intervention prevented 70 cases of homelessness. The effects of inflation will inevitably heighten the risk for more families. Home has adopted a five-category homeless prevention typology developed in Britain, comprising:

Home’s five-category homeless prevention typology

Universal: activities to minimise homelessness risks across the population, such as provision of affordable housing

Targeted: focused on high-risk groups, including vulnerable people and those being discharged from institutions

Crisis: preventing homelessness likely to occur in the next six months

Emergency: support for those at immediate risk, especially sleeping rough

Recovery: focused on preventing repeat homelessness.

Home’s definition of a person at risk of homelessness is “someone who does not have sufficient resources or support to prevent them from becoming homeless within six months”. Data gathered in Britain has found that the roots of a housing crisis start months before a home is lost. This reflects the importance of monitoring those at risk of homelessness — including those living in poverty, with low-paid jobs, or in insecure housing.

Prevention is the basis for a sustainable response to ensure homelessness is rare or, when it does occur, brief. A broad-system approach centred on the individual’s needs — and all the collaboration that entails between the public, private and third sectors — will be key to making it work.

The can-do spirit we have seen in the immense collaborative effort to develop the Plan to End Homelessness shows it can be done.

Ending homelessness is within our reach. As a community, we must demand it because it’s the right thing to do.

Denise Carey is chief executive and executive director of Home, a charity with the purpose of ensuring that everyone in Bermuda has a safe, stable and sustainable place to live and that new cases of homelessness are prevented

• Denise Carey is chief executive and executive director of Home, a charity with the purpose of ensuring that everyone in Bermuda has a safe, stable and sustainable place to live and that new cases of homelessness are prevented. Contact her at denise@home.bm. For more information, or to donate, visit the Home website at www.home.bm

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Published December 12, 2023 at 8:00 am (Updated December 11, 2023 at 5:12 pm)

Prevention is better than cure

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