From Rat Park to Housing First

To mark their 20th anniversary, DHI are running The Vision Project. Through a series of articles, podcasts and events during 2019, they are inviting people to contribute their ideas of how society can end social exclusion over the next 20 years.

In 1990, a fresh faced graduate working for a London PR consultancy, every morning I would walk down Cricklewood Broadway, witnessing a rapidly growing Irish homeless population, fuelled by the end of a building boom. Living in insecure crowded rented accommodation, away from family, many drank to overcome boredom and disappointment, ending up on the street or in hostels.

I started volunteering at Cricklewood Homeless Concern, and eventually got a paid job there. Eventually I became tired of the sticking plaster we offered, so when I saw the opportunity to run a project called the Drugs and Homeless Initiative in Bath, setting up a dry house that sought to bridge the gap between drug treatment and housing, I jumped at it. I was then fortunate to be given free rein to broaden its scope. And so began DHI in 1999, a charity that seeks to turn around the lives of those who face multiple disadvantage, by focusing on the clustering of serious social harms such as homelessness, substance misuse, mental ill health, violence, abuse and poverty.

20 years on; and where are we? Treating drug addiction will always be an uphill battle while they remain illegal, since the law is by nature always one step behind the criminals. Drug related deaths are sadly heading upwards, and the young, the vulnerable and the poor are those most likely to be caught up at the rough end. Yet, whatever your view of current drug policy or funding, treatment is in a much better place than it was: better understood, better funded and more joined up. Having shifted the paradigm from viewing addiction as a moral failing, to the disease model of the 70s, this too was challenged, largely thanks to the insights of psychologist Bruce Alexander and an experiment called ‘Rat Park’.

When the disease model was first gaining ground, evidence was thought to come from the fact that rats, given unlimited access to cocaine, would take it relentlessly, even to the point of death. What explanation could there be for an animal neglecting basic needs? The answer seemed to be that drugs were so powerful they could override evolutionary instinct. But rats are highly social animals like us. Wondering why no one thought it noteworthy that the disease model was based on experiments with rats removed from their family groups and kept isolated for the course of the experiment in small cages, with nothing but cocaine, Alexander constructed his own experiment: Rat Park.

Alexander took morphine dependent rats out of their isolated cages and put them in rat park, a naturalistic setting where rats were able to cohabit and reproduce. His overwhelming finding, since corroborated, was that if given a choice between drugs and either sugar, saccharine or same sex snuggling, the rats addicted to drugs chose the sugar, saccharine or snuggling over the morphine. Rats in the isolated cages took cocaine until they died, because without it, there was nothing but suffering in that environment.

Of course, people are not rats, but the basic lessons still apply. Fortunately, treatment services no longer view those struggling as morally bankrupt or helpless addicts, or ignore the wider determinants of a person’s drink or drug use. For the men on Cricklewood Broadway, lacking opportunity to prove their self-worth through work, and without family or love, the alcohol served to anesthetise the pain.
To really understand and treat addiction, we need to understand what drugs do for people in general, and in particular when they are suffering, where the alternatives are of limited help. People need self-worth and a sense of purpose in order to want to change, and this requires a basic level of material and financial security. Talk to any of DHI’s staff, and you’ll hear that housing is the single biggest barrier our clients face in attempts to turn their lives around. For the majority, this is not the street homelessness of the headlines (no, that is the canary in the mine; worryingly on the rise), it is the daily grind of living insecurely, be that on a friend’s sofa, a hostel or through the weekly struggle to make ends meet to pay the rent.

In light of this, the relentless physical and mental battle of living in poverty must be tackled if we are to address social exclusion. Universal credit may be well intentioned but the process is stressful, starts and ends with the presumption that everyone is work ready, IT literate, robust and capable, and doesn’t take account of people’s vulnerabilities. Moreover, it pushes people into debt. Meanwhile, the biggest single cost pressure for the vast majority of us – housing - is simply unaffordable for far too many people.

But this isn’t about houses – it’s about people, and a home is not just a physical space: it provides roots, identity, security, a sense of belonging and a place of emotional wellbeing. Lack of affordable housing, including housing to rent at benefit levels, creates inequality, stress and ill health. It impoverishes and increases the pressure on our precious public services when we can ill afford to do so.

Housing First has recently been put forward as a model of good practice in the UK in helping rough sleepers fully move away from a street lifestyle by providing stable housing as a platform from which to begin recovery. It holds to the principle that housing is a basic human right. But there is nothing new in this. Way back in 1943, Abraham Maslow offered a way of looking at human needs: Maslow’s Hierarchy of Needs. At its heart Maslow’s hierarchy is both simple and profound. It states that all people must have their basic needs for food and shelter met in order to be able to address other needs effectively. Only then can they achieve their potential. Poor physical and mental health, substance misuse, domestic abuse, lack of educational attainment and poor employment prospects – these are all closely associated with poverty, and housing sits at the heart of this. To end social exclusion in 20 years’ time, we must make sure everyone can afford a decent place to live and be able to put down the foundations for achieving their potential.

Secure affordable housing may not be the end game, but it is most certainly the entry ticket!

Rosie Phillips has been a Fellow of the RSA since 2004. In 2006, DHI won an RSA Coffee House Challenge Award for ‘MailCoach’. This project set up a PO Box system for homeless people, so that they were still able to receive important mail – helping to overcome one major barrier to social inclusion. This piece is an extract from Rosie’s blog, which can be read in full here.