Harbour Housing Room

Transform is a founding member of the Enhanced Harm Reduction Housing (EHRH) Network with five homelessness charities delivering this approach, while Kevin Flemen developed it, including training housing providers. We are now playing a leading role expanding it UK-wide, connecting and persuading housing providers, politicians, health and drug services to support its use.

About this life saving approach

What is Enhanced Harm Reduction Housing?

Enhanced Harm Reduction Housing (EHRH) recognises many homeless people currently use drugs in hostels or on the street alone, and die from overdoses, or rush injections causing other harms. EHRH instead encourages people planning to use in their own rooms to tell staff first so they can be checked on and treated. Policies are carefully worded and delivered to ensure the provider and staff do not breach the Misuse of Drugs Act (MDA).

This approach has already saved many lives and can save many more.

Why is it needed?

On any given night, 20,000 people are staying in hostels or similar supported accommodation, with 3,000 more people sleeping rough and numbers are rising. Over 60% of these people have drug-related problems. 259 homeless people died from drugs in England & Wales in 2021. Many were using alone and in secret in their homeless accommodation because drug use wasn’t allowed. Or on the street as they had been excluded - or perhaps were trying to avoid exclusion - from housing services which prohibit drug use.

Simon Community Scotland: Saving lives

After Simon Community Scotland introduced this approach, they saw drug-related deaths among residents fall from 17 in 2020, to 1 in 2021. This short video also underlines how the relationship between residents and staff is changed by this approach.

Ben and Hilary's story

Hilary whose son Ben died in a toilet in a hostel in Portsmouth said “Caring for someone who is dependent on drugs is one of the most exhausting, emotional and confusing experiences, it’s like living on a rollercoaster that you can’t get off of, you are constantly full of hope one minute and the next you are sick with worry.

My rollercoaster ride ended on 18th May 2018, I was woken up by the phone ringing constantly, “hello” I answered sleepily, it was the intensive care unit at Queen Alexandra hospital. “Is that Hilary? Your son Ben has just been admitted”, suddenly I was awake. It transpired Ben had overdosed on heroin in a toilet at the hostel he was staying at, but wasn’t found for some time. The paramedics had revived him, and 3 weeks followed on a life support machine but sadly the brain damage was too severe, and we had to make the heartbreaking decision to turn the machine off.

I am sure that if Ben hadn’t felt he had to hide his drug use behind a locked toilet door, and someone had checked on him after he used in his room instead, he could have been saved.”

Image: Hilary, member of our Anyone's Child campaign, at Westminster

Hilary Anyones Child

How it works

Research shows people almost always survive overdoses when they are able to use their drugs where people who are trained and equipped can respond if things go wrong. EHRH ensures people who use drugs, and live in homeless accommodation, have that help available.

People using drugs in their rooms in hostels are encouraged to tell staff or other residents beforehand. They are then checked on shortly afterwards, and treated if they have overdosed. Sterile needles and the opioid antidote Naloxone can be more readily made available on site. This ‘eyes-wide open’ approach is not just ‘turning a blind eye’ as many hostels do.

When done correctly, EHRH is legal, effective and cheaper than many other interventions, and is happening and proven on a small scale in the UK already, often with the full support of local police, though this isn’t vital.

Clear detailed policies and procedures laying out what is and isn’t allowed, and responses to drug possession and use can ensure providers stay within the law. For example the Misuse of Drugs Act explicitly requires landlords to take action against people committing supply offences on the premises. There is, however, no requirement to take action against residents suspected of committing other drug possession and use offences in the privacy of their own rooms.

This approach works best in conjunction with separate properties people move to if wanting to be abstinent, but they can be open about any relapses, and return to the property that checks on people using again if need be, until they are ready to try again.

Naloxone Emergency Box on a hostel wall

The benefits

Not only are overdoses treated much more rapidly, saving lives, this approach helps build trusting relationships because staff are no longer effectively asking residents to lie about their drug use. People can talk about what they are using, how often, and what triggers them to use more freely. And they may be more likely to share information on dangerous batches, or other useful intelligence on local drug markets to keep others safer too.

The potential for improving trust also helps staff engage people with other services including treatment and psychological support. This is all far more effective when a conversation starts with recognising people will be using drugs and “we want to do what we can to keep you safe”, rather than a contract saying no drug use is tolerated, and they will be evicted if caught.

Finally, people working in homeless accommodation are less likely to face trauma from finding people they work with dead. This increases their wellbeing and chances of staying working in the sector.

Legal regulation of drug markets

Expanding Enhanced Harm Reduction Housing is crucial to save lives. But like other important harm reduction measures, or decriminalising the possession of drugs for personal use, it cannot prevent drugs being adulterated, and of unknown potency, or take the drug market out of the hands of organised crime. Only legally regulated supply can do that - for example through Swiss-style Heroin Assisted Treatment clinics.

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