Hard News by Russell Brown

4

Housing, homeless and drugs: an interview with Moira Lawler

A while ago, Moira Lawler got a concerned call from Wellington.

Something bad had happened with a Housing First tenant and government officials in Wellington were very unhappy. There would have to be a no-surprises policy around anything that might be risky, the caller said. Be careful what you wish for, she replied.

"I said, we're going to have to agree a list then, because every day something risky happens in our programme and I'm pretty sure you don't want to hear about all of them!" recalls Lawler, the CEO of Lifewise Trust, which operates the Housing First programme in central Auckland, in partnership with Auckland City Mission.

That list might include deaths, drug busts, fires and assaults. They've all happened in the past year and a half.

"This is unusual work," Lawler observes.

Politicians love Housing First, the way the words sound. When she announced $9 million of new funding to help house vulnerable New Zealanders in 2016, Paula Bennett declared herself "particularly pleased" that $3 million of the new money was going to establish Housing First. (Of that Lifewise and the Mission received $500,000 to run the first two years of the programme in central Auckland.) For the current government, Housing First is the touchstone of its promise that no one would need to be homeless this winter.

But what is it, exactly? Housing First is a social policy developed about 20 years ago in the US, focused on getting the most vulnerable homeless people into stable accommodation, without preconditions, as a first step to addressing any of their other problems. It explicitly holds that any of the things that might be disqualifying in other housing schemes – in particular, substance abuse – are not a barrier to being housed.

Nearly all the people housed in central Auckland have "complex needs" and for most of those their needs involve substance abuse.

"The programme is a harm minimisation programme," says Lawler. "You can use the language of Housing First but unless you're applying the model as it was intended to be applied, then you won't necessarily get the outcomes the evidence suggests. One of the central tenets of Housing First is that it's harm minimisation.

"We will house people regardless of their current mental or physical wellbeing and regardless of their history of substance abuse. And it's really important that people on the street understand that, because obviously everybody has the best chance of success if that's openly disclosed."

This might seem jarring coming from the head of a religious organisation, which is what Lifewise is. It's one of three charitable trusts, along with Methodist Mission Northern and Airedale Property Trust, operated by the Methodist church and the church's "theological principles", emphasising dignity and respect, are outlined on its website.

"We got Housing First off the ground because, like City Mission, all of our work with homelessness has been self-funded for 50-plus years. So for a long time we didn't have anyone saying 'if you don't do this, you won't get your money'. Well, you haven't funded us anyway, so we're going to do it.

"Having government come on board is a massive bonus, but also a constraint. We need them to understand what we're trying to do, not treat it like a bog-standard programme – because it isn't."

Lawler herself comes from a secular background. She worked for 13 years for the Porirua City Council, rising from a community development role to become the council's general manager of strategy and planning. She worked alongside Lifewise's sister trust, Wesley Community Action (which provides resources to the gang women behind the New Zealand P Pull group that supports people and families getting off meth) and she's clear on the fact that Lifewise's independence is crucial to the conversations that Housing First requires.

"It means you can have really practical conversations," she says. "We did a lot of design work before we started with people with lived experience – and got really kind of gnarly sometimes.

"At the time, the major concern was P use. If you're going to use, what would it look like for you to sustain your tenancy? Really practical stuff, like people use P inside because it's hard to light. Okay, that's a practical consideration. If we need you to use outside of your unit, does that mean we have to give you a covered balcony? Or should we consider a garden shed? 

"Because you're going to use, but we don't want you to use inside. That was when meth testing was the big concern. Now it's been shown, as we always thought, that that's bollocks anyway. But nonetheless, if that's the thing that’s going to get you evicted, how do we deal with that?

"We had people who said 'I need a sign on my door that says my unit is meth-tested monthly, so that I can point my friends to that and say, look, here's why you can't smoke inside'. Or you might want to do testing yourself. We had tenants who would do their own testing, we gave them little kits, so they knew when they had to do a wash-down themselves.

"It's just trying to keep it really practical. We're not here to judge about your lifestyle, we're here to make sure you're housed. And then once people really trust that that's the case, then of course most people think, man, I should do something about my use. That's what the evidence shows – that that will come later. If you have built people's confidence that you're not trying to compel them to do something, you're not trying to make them jump through hoops and you are going to stick with them in the housing space. That’s what Housing First does."

There is only one rule.

"You have to agree to visits from the team. The nature of those visits, what the team assists you with, you create with them, but you have to agree to be visited."

The visits are key to the other important part of the Housing First model: the wraparound support.

"Very intensive, skilled wraparound," Lawler explains. "And I don't mean necessarily clinically or professionally skilled, I mean skilled in terms of the right values and approaches and creativity. By definition, people who need our programme have been through every other programme, so there's no point offering them a bog-standard social work response, because they've seen that and it didn't work."

Lifewise has funding to work with 93 people and at the time I spoke to Lawler had 63 in housing.

"Our biggest fear is that if we had 40 tenants say all at once, okay I'm done with my substance abuse, I want addiction support now, there's nowhere for them to go. So it's all very well to say they shouldn't be using substances – what's the pathway we're offering people?

"There's not enough of it, it's not creative enough. We offer the one thing – would you like to come and do what's essentially a 12-Step programme. But what if they've done that twice before and it didn't work?"

Even with limited funding, Housing First, as implemented in Auckland, has had its successes. Fifty three people, including the first person housed in the scheme, have been moved to permanent housing. A woman who left the programme ("she didn't feel safe indoors") recently returned for another try.

"And that’s a success story from my point of view. They know they can come back and give it another go after everyone's had a chance to reflect. That's what Housing First is. There is no point at which we'll say, 'that's it, we're done'.

"We have another story that's sad but beautiful. We had a man who was a chronic alcoholic. He was in late-stage cirrhosis of the liver, had spent a lot of time in hospital, but every time he left hospital he was on the street. People were really concerned about him.

"He was housed and he did really well – he loved his house. He continued to drink and was told at hospital that he probably didn't have long to live. He reconnected with family down country he hadn't seen in years, and they said, come home. They nursed him. He died, but he died with them, with family. What else could you want, really?"

Lifewise was developing its programme when a developing problem with synthetic cannabis use suddenly became acute.

"The figures being reported are an undercount," says Lawler. "We've had three or four deaths just in our little project, but they're not reported as synthetics deaths because no one's really sure.

"Synthetics are really cheap. We've had one of our whanau arrested and charged with dealing and one of the things the police said that really stuck with me was that their unit was full of coins. You don't make your fortune dealing synthetics. It's a small-change drug.

"But people use it because it's all they can afford. So if you ask people, would you rather use clean, commercially-grown beautiful marijuana from Gisborne or the Far North, most people would say yes, of course they would. But they can't afford it. They can't afford a drug that isn't going to kill them, only a drug that they know over time will kill them. It's a poverty issue.

"Lawyers aren't killing themselves using synthetics. They can afford cocaine."

Lawler says a key part of the Housing First programme is that it's a "scattered site" model. The Airedale trust (which also manages the asset income that allows Lifewise to operate) rents apartments in the general community and Lifewise places tenants in them. These are, she says, "adult tenancies in the adult world". Tenants can be evicted – there's just no such thing as a last chance.

That means the two church trusts embracing a non-trivial level of risk – notably in the case of the ground floor of Housing NZ's Grey Avenue apartments, which Lifewise took over while the government agency's panic over supposed "meth contamination" was still in motion.

Greys Avenue is, she says, "our most challenging site". Tenants who'd previously been evicted were wary about going back and the property managers who'd had to evict them weren't wild about seeing them again either. Some Housing First tenants simply believed it was too risky for them. It's a symptom, says Lawler, of the profound change in the past three or four decades in who can actually access pubic housing.

"High-functioning communities have a mix of people. There's the older couple who can look after others, there's the young mother who's got a bit of energy – there are levellers. In a lot of those intense Housing NZ sites now there's isn't that blend any more – just a lot of really vulnerable people trying to survive and not necessarily having the capacity to support each other."

That’s why Lawler believes "scattered sites" is a stronger concept than the "congregate model" of placing vulnerable people on a single site.

And yet, the City Mission has opted for that congregate model in the shape of its widely-praised Mission Homeground development on Hobson Street.

"The support housing model, a place you can live where there are onsite staff 24-7, is suitable for some people. Not for everyone, but for some people. In particular it's suitable for people who do not have strong confidence in their decision-making, who want24-7 support, who struggle to make decisions in their own interests. But we have to make available the choice to people to live independently in the community too. Otherwise we're just institutionalising people."

Lawler believes – while emphasising that she doesn't have the hard data – that most of the people Lifewise works with develop their severe substance abuse problems because of their homelessness rather than the reverse.

"No one asks: were you a substance abuser before you become homeless, or is your substance abuse a function of your homelessness? And I suspect increasingly it's the latter. Because that's one of the ways you survive, by using whatever's cheap and handy to blunt your day. People are being made unwell in a very dangerous way by their homelessness."

She's encouraged by the new building in public housing and hopeful that "the tide is turning" for approaches like Housing First. She says the average time on the street of the people Lifewise is housing is 14 years.

"And most of them have complex issues. This is the group that people thought didn't want to be housed and would never be housed. We've proven it's possible.

"But the bulk of the government funding is still in the emergency space. So we haven't won yet over the view that Housing First is some boutique thing for a few people and everyone else can be in a motel for a month and then their lives will improve. There's no evidence that that's an effective way to spend money. That's the challenge. We need to tip that money into a sustainable housing approach."

The local Housing First programme has received a $300,000 top-up to take it through to November and Lifewise is currently in talks with the Ministry of Social Development about future funding. She thinks between 300 and 500 people could benefit from the service if funding was available. But it will, says Lawler, take more than just money to really address their problems.

"This is often an intergenerational issue – so how do we stop thinking about it as an individual fault? We have this mentality where we want to fix individuals and we won't fix you unless you comply and you agree to stop doing things. It's all a little bit Victorian.

"Everything we know about addiction says you can't make someone not be an addict. No amount of wanting it to happen is going to make it happen. They have to do things on their own terms. So how do we make that more possible for people?"

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As you may have noticed, this interview also appeared earlier today on The Spinoff. They've kindly agreed to its republication here, so we can talk about it. I've also added a few things I couldn't fit into the orignal word-count ...

How are the police with this?

 "In the city centre, the police have been great, actually. They've always been on board, they've always had a mature approach to this. They have some of the same issues we have. Someone will be picked up in a cell and they may need a mental health assessment or a detox assessment. We're all struggling to access services."

On Lifewise's work in Rotorua:

"Lifewise is also a mental health and addictions provider in Rotorua, where we work mainly with Māori whanau. We have a tikanga Māori programme there that does what they call pre-and-post. So it's not clinical detox, it's how do you get stabilised and ready for a clinical programme – and then once you've been in that programme, how are you thinking about how you're going to live in the community? Where, with who, doing what?

"From that I guess we have learned a bit about the world of addictions and what works and what doesn't work. My own view is that harm minimisation is not well-understood in New Zealand. We have a very narrow range of addiction support options and most of them are compliance-focused.

"I'm not a medical expert or an addictions expert, so all I'm giving you is my own observation. Which is that we don't do this particularly well. We have a population with a very high level of substance abuse, that it also marginalised, and so by definition lacks access to most things. And we have to come up with some better solutions."

Evidence-based approaches are often a hard sell to the system. Was that your experience with Housing First?

"Oh yeah. And to everyone– to our own staff! We talked to them about Housing First, here's the model and they went yeah, that looks good. And then we went okay now, we're in a design process and we're going to look at how we implement this – and there was an element of, what, you mean we're really going to do this?

"So those of us who've been in the sector for a long time get used to one way of doing things. And in the homeless community. One of our peer support workers, even people who are homeless, went 'that won't work, you can't just put addled people into housing and expect them to do well'. But it does."

With synthetics, have you been in a position where you've been able to say to people in your care, there's a bad batch, avoid it? Because when you look at the pattern, synthetics deaths are always clustered, because someone's over-dosed it.

"They know that. So that conversation happens amongst the groups. We have had a couple of conversations with people around synthetics and what they want to do. And that's ended up being conversations about medical advice and how to look after people. Will the ambulance come if you call? Initially there was a bit of scuttlebutt on the street saying if you call the ambulance and it's synthetics, they won't come. It's not true.

"I was at a stakeholder meeting yesterday. I tell everyone. They'll say, oh, we walk past people and we're not sure if they're alright. And I say, well, stop and ask. Are you okay, should I call an ambulance? And if they don't answer you, call an ambulance. It's as simple as that. Because people are dying."

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