Transformative Community Mental Health Interest Group



Volume 51 Number 1 
Winter 2018

Transformative Community Mental Health Interest Group

The HOME_EU Project

Researching to End Homelessness in Europe

Written by Maria Vargas-Moniz, ISPA – IU, Lisboa Portugal and José Ornelas, ISPA – IU, Lisboa Portugal

The Home_EU: Reversing Homelessness in Europe Project ( is a Horizon 2020 research grant (2016-2019) to mainstream individualized, scattered and permanent Housing First programs as a social policy aimed at ending long-term homelessness that persisst in EU countries. This project was approved within a highly competitive grant line  ̶  only 2 out of 400 proposals were financed (  ̶  and it was structured and inspired in the community psychology principles and guidelines of participation, collaboration, promoting social justice, critical reflection, empowerment, and mastery (Kloos, Hill, Thomas, Wandersman, Elias, Dalton, 2012; Ornelas, 2008).

In the European Union territory, it is estimated that 122 million people are at risk of poverty and social exclusion, corresponding to 24.4% of the EU population (Eurostat, 2015). The EU is one of the world’s wealthiest regions, yet about 410,000 people every night sleep outdoors or in temporary/emergency shelters (μ = 4, 1 million homeless people p/year, FEANTSA, 2015). Example estimates by country demonstrate that in Italy 50,724 (0.24% of the population) is homeless (ISTAT, 2015); France 140,000 (0.21% of the population, INSEE, 2012); Ireland 3,808 persons (0.1% of the population, CSO, 2011).

Furthermore, it is important to acknowledge that within the homeless population some individuals (the long-term Homeless) tend to be persistently “left behind” (Dennis, D.; Locke, G.; Khadduri, J., 2007). “Traditional” programs have failed to end long-term homelessness. The persistent explanation for the failure of these programs to end long-term homelessness is the lack of focus on problems such as addiction, severe psychiatric disorders, extreme poverty, or other social disadvantages (Busch-Geertsema, 2014; Ornelas, Duarte & Jorge-Monteiro, 2014; Greenwood, Schaefer, Winkel, & Tsemberis, 2006; Lavanco and Santinello, 2009; Bokszczanin, Toro, Hobden & Tompsett, 2014).

Housing First not only achieves housing stability for the long-term homeless, it also reduces health problems (as compared to traditional approaches (Tsemberis, Gulcur & Nakae, 2004; Lancione, 2015). The Housing First model was originally developed in the United States to resolve chronic (long-term) homelessness, for people with serious mental health problems and co-occurring substance abuse (Tsemberis & Eisenberg, 2000). In Canada the action research program At Home/ Chez Soi (Aubry, Nelson, Tsemberis, 2015), was crucial to consolidate Housing First, and the first country to assume it as a national social policy.

See comment in PubMed Commons belowWhile several studies investigated the effectiveness of Housing First on consumers’ health and housing stability, less is known about its effects on their level of social and community integration and capabilities gains (Patterson, Rezansoff, Currie & Somers, 2013; Ornelas, Martins, Zilhão & Duarte, 2014; Pleace and Quilgars, 2013; Tsai et al., 2012, Goering et al., 2011; Shinn, 2015). Moreover, most of the studies in the field evaluated individually-based treatments for homeless people but did not take into account changes in the socio-political environment that can affect individual well-being (Patterson et al., 2013).

With an ecological and context-based research approach, a consortium of 12 partners from nine EU Countries (Fig. 1), is probing to fill this gap in our knowledge of the ways that Housing First, not only benefits marginalized people, but also reduces social inequalities and promotes innovative community-based science.


Figure 1 – The Consortium composed by six Universities, one Research Institute, three NGO’s, one Foundation and one Municipality

The global aims of this project are to provide a comprehensive understanding on how the Europeans perceive, tolerate and contest the extreme inequality of Homelessness. They are to be attained in five levels of analysis:

1) To develop a continuum indicator from Tolerance to Contest capacity of EU Citizens towards long-term homelessness, and to identify variability among the different countries;

2) To analyse the opinions and perceptions of people who are currently homeless and people who have been integrated in Housing First Programs on their capabilities gains, the service efficacy and social policies;

3) To understand the perspectives of service providers about the ways that their organizations effectively reverse homelessness, promote capabilities, and contribute toward the (in)formation of social policies;

4) To analyse social policies on homelessness in terms of result orientation toward housing policies aimed at reversing homelessness through Housing First and Community Integration;

5) To establish a dialogue of the four precedent ecological levels of analysis: a) EU Citizens perceptions; b) people who are currently long-term homeless, and people that have been integrated in Housing First Programs; c) service providers for the currently Homeless, and those in Housing First Programs; d) key-stakeholders on policy development and EU social policies, all intended to respond to homelessness in order to profile each partner country on the key elements of program efficacy;

As shown in Figure 2, the Project Perth Diagram probes to demonstrate how the different studies are distributed by the consortium.


Figure 2 – The Project Perth Diagram with the Scientific and Technical Workpackage

Considering the quantitative/qualitative combinations of the selected measures, including telephone surveys, in-vivo surveys, interviews, focus-groups and photo voice, the first months of project implementation were dedicated to the translation and cultural adaptation of all the measures (30) of the several studies, including scales, interview guides and protocol guidelines, that constitute at this stage a portfolio of measures in English, Dutch, French, Italian, Polish, Portuguese, Spanish and Swedish, that constitute a relevant “tool box” for future use within further research endeavors.

How are we using HOME-EU to influence national policies in our countries?

Some of the attained achievements may be summarized as:

  • A series of efforts made by partners to disseminate the project aims and the Housing First Interventions in each country;
  • Document the systematic interactions with national bodies and other services spreading the visioning that long-term homelessness is a solvable human rights social problem;
  • The identification of legislative pieces across the partners’ countries that are coherent to the specific characteristics and domains that the HOME_EU foresees;
  • Gathering a significant sample of EU citizens on their opinions to build an indicator on the need for further social and political intervention to transform homelessness into a social emergency;
  • Systematize the voices of the service users and the professionals to understand the crucial personal and contextual dynamics of the homelessness experience and the effectiveness of Housing First, providing evidence for the argument for the resolution of homelessness.


 Aubry, T., Nelson, G., & Tsemberis, S. (2015) Housing first for people with severe mental illness who are homeless: A review of the research and findings from the At Home-Chez soi Demonstration Project. Canadian Journal of Psychiatry, 60 (11), 467-474.

 Bokszczanin, A., Toro, P.A., Hobden, K., & Tompsett, C.J. (2014). Post-traumatic stress disorder among homeless adults in Poland: Prevalence and predictors. Open Journal of Psychiatry, 4, 9-15.

 Busch-Geertsema, V. (2013). Housing First Europe Final Report. Brussels: European Union Programme for Employment and Security.

 Central Statistics Office (2011). Census 2011 Results.,persons,in,Ireland,A,special,Census,report.pdf

Dennis, D., Locke, G., & Khadduri, J. (2007). Toward understanding homelessness: The 2007 national symposium on homelessness research.

Eurostat (2015). Europe 2020 indicators: poverty and social exclusion. Retrieved from 

Goering, P., Streiner, D., Adair, C., Aubrey, T., Barker, J., Distasio, J., . . . Zabkiewicz, D. (2011). The Associated with document Ref. Ares (2016) 4021467 - 01/08/2016

 Greenwood, R.M., Schaefer-McDaniel, N., Winkel, G., & Tsemberis, S. (2005). Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology, 36 (3/4), 223-238

Institut National de la Statistique et des Études Économiques (2012). Conditions de vie-Société: Logement. Retrieved from 

ISTAT Istituto nazionale di statistica (2015). Italia in cifre: edizione 2015.

Kloos, B., Hill, J., Thomas, E., Wandersman, A., Elias, M.J., Dalton, J. (2012) Community Psychology: Linking Individuals and Communities. Belmont, CA: Wadsworth

Lancione, M. (2015). Housing First: successo, modelli e sfide politiche. Psicologia di Comunita', 2, 23-40. doi:10.3280/PSC2015-002003 

Lavanco, G, & Santinello, M. (2009). I senza fissa dimora. Analisi psicologica del fenomeno e ipotesi diintervento. Milano: Paoline Editoriale Libri.

Ornelas, J. (2008) Psicologia Comunitária [Community Psychology]. Lisboa: Fim de Século

Ornelas, J., Duarte, T., & Jorge-Monteiro, F. (2014). Transformative organizational change in community mental health. In G. Nelson, B. Kloos & J. Ornelas (Eds), and Community psychology and community mental health: Towards a transformative change (pp. 253-277). New York: Oxford University Press.

Ornelas, J., Martins, P., Zilhão, M.T., & Duarte, T. (2014). Housing First: An ecological approach to promoting community integration. European Journal of Homelessness, 8 (1), 29-56.

 Patterson, M., Rezansoff, S., Currie, L., & Somers, J. (2013). Trajectories of recovery among homeless adults with mental illness who participated in a randomized controlled trial of housing first: a longitudinal, narrative analysis, BMJ Open 3 (9), 1-8.

Pleace, N., & Quilgars, D. (2013). Improving health and social integration through Housing First: A review. Brussels: FEANTSA.

 Shinn, M. (2015). Community psychology and the capabilities approach. American Journal of Community Psychology, 55 (3/4), 243–252.

 Tsai, J., Mares, A., & Rosenheck, R. (2012). Does housing chronically homeless adults lead to social integration? Psychiatric Services, 63 (5) 427-434.

Tsemberis, S. and Eisenberg, R. (2000) Pathways to Housing: Supported Housing for Street-Dwelling Homeless Individuals with Psychiatric Disabilities, Psychiatric Services 51 (4) pp. 487-493.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with dual diagnosis. American Journal of Public Health, 94 (4), 651-656.