Outline of the study

This evidence note examines what we know about preventing homelessness among people being discharged from institutional settings like prisons, hospitals, and care homes. These groups face particularly high risks of homelessness when they leave these settings, often because their previous accommodation arrangements have broken down and/or they lack the support networks that help others to maintain housing.

The research reviews evidence on the scale of the problem across different institutional settings and evaluates which interventions work best to prevent homelessness during these critical transition periods. This includes integrated models that combine housing with other support , and specialised interventions for people leaving prison, care leavers and other groups. .

The research draws from systematic reviews and individual studies from around the world to identify what works, highlighting promising approaches and noting significant gaps in the evidence base for certain groups and interventions.

Findings in brief
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• About 5% of households assessed as homeless by local authorities in Scotland and England each year are people who have left prison, hospital, or care
  
  

• In 2020 12% of people experiencing street homelessness had left a hospital or prison
  
  
• Between 24 - 27% of the adult prison population are care experienced
  
  
• In 2020/21, 9% of prison leavers (5,954 people) became homeless on release and 3% (1,600) became street homeless on release
  
  
• There is a link between leaving institutions and long-term homelessness. For example, 33% of long-term rough sleepers in London were prison leavers, compared to only 15% of those new to the streets People leaving prison who become street homeless are significantly more likely to re-offend than people in permanent housing
   

• People leaving care are more likely to have poor outcomes around education, employment or training than all 18 year olds 17% of people leaving hospital who are homeless are re-admitted within 30 days, compared to 10% of the general population
  
  

• Systematic review of 13 studies found that hospital discharge interventions generally improve housing stability and reduce future hospitalisations
  
  
• Multiple evaluations of Critical Time Intervention (CTI), a nine-month programme with three phases, indicate substantial reductions in homelessness
  
  
• Provision of respite care indicates substantial reductions in future hospitalisations across multiple studies
  
  
• Extending foster care to age 21 resulted in large reductions in homelessness among young people in Washington state.

Recommendations in brief
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• Expand the use of integrated models, including: Critical Time Intervention (CTI) programmes-and 're-entry programmes' for prison leavers, that coordinate housing with comprehensive support services, restorative justice approaches and drug courts
  
  
• Develop protocols between prison, hospitals and leaving care services, to prevent people being discharged without suitable accommodation
  
  

• Ensure people leaving prison have access to mainstream accommodation with holistic support ,including drug and alcohol treatment, education and employment services
  
  
• Pilot Individual Placement and Support (IPS) for people leaving prison who have complex complex needs
  
  

• Integrate Pathway specialist homeless healthcare teams into hospital discharge pathways
  
  
• Create 'housing-led' step-down services for people who need recovery time but cannot return home and expand respite care
  
  
• End hospital discharge without suitable accommodation in place and provide funding to develop pathways
  
  

• Explore raising the age for young people leaving care from 18 to 23 years old
  
  
• Seek to provide intensive support models for people leaving care, rather than independent living programmes
  
  
• Adapt CTI and re-entry programme principles for young people leaving care
  
  

• Seek to reduce loss of current accommodation loss during remand or custodial prison stays through better coordination between prison, probation and local authority homelessness services
  
  
• Improve homelessness Duty to Refer processes to ensure all vulnerable people are included within this legal requirement
  
  
• Strengthen data collection to better understand the scale of homelessness following discharge from institutions
  
  

• Conduct additional evaluations of interventions, focusing on areas of limited evidence, such as people leaving care and ‘Through the Gate’ services
  
  
• Assess the long-term impacts of interventions on employment, re-offending and other outcomes beyond housing.

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