Between 2005 and 2018, the share of single-family homes under construction built expressly for renting rose from 1.5% to 4.4% as the build-to-rent business model slowly gained momentum. The easy-money era during the pandemic, with cash-flush Wall Street firms seeking assets to buy, of course, only added fuel to the fire. By Q4 2022, Zelman & Associates estimates that build-to-rent made up 8.8% of single-family starts.
That 2022 figure will be a high-water mark for now, as spiked interest rates have translated into a pullback in build-to-rent projects that will be reflected in the data over the coming quarters.
“A lot of those [recent build-to-rent] starts were purchased and financed a year or two years ago,” Ivy Zelman, CEO of Zelman & Associates, a research firm which exclusively studies the housing industry, said in a recent chat with Oxbow Advisors. “We expect to see [build-to-rent] deceleration. It just isn’t penciling now. We’re seeing build-for-rent developers that are trying to sell a lot of communities to builders for the for-sale market because of the challenges with higher cost debt. We see that market right now under a lot of pressure.”
Zelman then added, “But don’t expect [build-to-rent] to go away.”
Charles Tourtellotte, founder and CEO of LaTerra Development, is one developer determined to move forward despite the industry pullback.
LaTerra, one of the largest real estate developers in the Southwest, specializing in multifamily residential and self-storage, has recently partnered with Revitate to commence construction on Bedrock. This new build-to-rent community in Albuquerque, New Mexico, will consist of 142 single-family detached homes and 202 townhomes. The community will offer various amenities, including coworking spaces, pet-friendly parks, barbecue areas, pools, fitness centers, and spas.
Why is LaTerra Development moving forward with this community despite the build-to-rent slowdown? One reason is that it isn’t loading up on debt—which is a barrier for many other projects—just yet.
“Funding is the story today,” Tourtellotte tells ResiClub. “It’s not exclusive to build-to-rent. It’s most [real estate] asset types including multi-family apartments, everything has about ground to a halt. It’s the cost of capital, it’s the capital flow, that has caused that to happen.”
While Tourtellotte says the company hasn’t elected to do debt financing on this build-to-rent community, it will eventually layer in some debt before it’s completed in 2025 or 2026.
“The common sentiment in capital markets is that there will be some relief in the coming year. When we see it’s a good time, we’ll put a loan on it,” Tourtellotte says.
A few years ago, Tourtellotte flew into Albuquerque from Los Angeles to look at an apartment property to buy. That’s when he first realized build-to-rent might make sense.
“Our price [on the apartment] wasn’t competitive, but when we were walking with the manager, he said, ‘Hey look, Charlie, you ought to consider, because we know you’re a developer. If you did build-to-rent I could lease them faster than you could build them.Just look around at this [apartment] building, it’s full of millennial families with kids and pets, and they’re all looking for something bigger,’” Tourtellotte recalls.
The fact that so many millennial families with strong incomes will be looking for more space over the coming decade is why Tourtellotte believes there will remain a need for more build-to-rent communities across Sun Belt markets. The only problem, he says, is that elevated interest rates make it hard to pencil.
Tourtellotte says interest rate relief is the primary thing that would have to occur to spur more build-to-rent projects.
New research has found a link between narcissism and holding a grudge. The findings indicate that people who exhibit vulnerable narcissism tend to hold onto feelings of hurt longer, especially if they also display traits of grandiose narcissism. This understanding sheds new light on the emotional complexities of grudge holding in interpersonal relationships. The research was published in The Journal of Social Psychology.
This research was motivated by a gap in understanding about how people respond to interpersonal conflicts and transgressions. While previous studies have focused on forgiveness and revenge in such situations, there has been a lack of understanding about the act of holding a grudge. The researchers aimed to fill this gap by exploring how different forms of narcissism – particularly vulnerable and grandiose narcissism – influence our tendency to harbor grudges after interpersonal transgressions.
Vulnerable narcissism is characterized by internal feelings of insecurity and inadequacy, hypersensitivity to criticism, and covert needs for validation, often manifesting in passive-aggressive behaviors and a sense of victimization. Conversely, grandiose narcissism is marked by overt expressions of self-importance, high confidence, a desire for attention and admiration, and dominant social behaviors.
While vulnerable narcissists internally struggle with self-esteem and are emotionally distressed by perceived slights, grandiose narcissists display an inflated sense of their abilities and accomplishments, often externalizing blame and maintaining an unbothered front in the face of criticism or failure.
“People experience interpersonal transgressions and find ways to manage them, often through holding a grudge, seeking revenge, and forgiving,” said study author Jingyuan (Sophie) Li, a PhD candidate in the Social & Personality Psychology program at York University in Toronto.
“My interest is largely in grudge-holding because we believe that it is common and important but understudied. At this point, we believe that grudge-holding has a self-protective role in the social motivation process. Some other work from our social motivation lab (Struthers et al., 2019, JEPA) shows that grudges are held when we have low social power and face ongoing threats of future transgressions.”
“Unlike forgiving, which can sometimes lead to repeated transgression if the offender does not suffer any consequence for their wrongdoings, or revenge, which might bring counter revenge, making things worse, holding a grudge can let people stay on guard without escalating the conflicts. Narcissism caught my attention because people with these traits handle interpersonal relationships in complex ways. They feel good about themselves, but their positive images can also be fragile. Those with vulnerable narcissism should be motivated to protect themselves and might harbor more grudges.”
In the first study, researchers focused on a group of 121 undergraduate psychology students. They used a detailed questionnaire, the Brief-Pathological Narcissism Inventory, to measure the students’ levels of vulnerable and grandiose narcissism. Participants were asked to recall and describe a personal experience where they felt wronged by someone in the past six months. The Grudge Aspect Measure was then used to assess their grudge-holding tendencies, focusing on disdain for the transgressor, emotional persistence of the grudge, and perceived longevity of their negative feelings.
The results were intriguing. There were no clear links found between either form of narcissism and the aspects of grudge holding. However, a significant interaction was observed between vulnerable and grandiose narcissism in relation to emotional persistence. Specifically, participants who scored high in vulnerable narcissism reported stronger feelings of emotional persistence, especially if they also scored high in grandiose narcissism.
Building on the findings of the first study, the second study expanded the scope to include 118 adults from the general community. This sample allowed for a more representative understanding of the findings. The same methods were employed to assess narcissism and grudge holding, with an additional measure to gauge participants’ rumination – their tendency to continuously think about the transgression.
In this study, a clear relationship was found between vulnerable narcissism and two aspects of grudge holding: emotional persistence and perceived longevity of negative feelings. Interestingly, those with higher levels of grandiose narcissism also tended to view the transgressor with disdain.
Most notably, the second study found that rumination played a mediating role in the relationship between narcissism and grudge holding. This suggests that the more individuals ruminate about the transgression, the stronger the impact of their narcissistic traits on their grudge-holding behavior.
“Our research found that people who are sensitive or insecure but also think highly of themselves (vulnerable and grandiose narcissism) tend to hold onto grudges more because they ruminate about the transgression they experienced,” Li told PsyPost. “Basically, if someone has a big ego but is also easily hurt, they are more likely to hold a grudge when they can’t stop thinking about how they’ve been wronged.”
While these studies provide valuable insights, the researchers acknowledge certain limitations. The reliance on nonexperimental methods means that causation cannot be definitively established. The researchers suggest more controlled experimental studies to further investigate these relationships.
“One limitation of our study is that we can’t say that narcissistic traits cause grudge-holding; we only know they’re associated,” Li explained. “Also, we didn’t explore how these traits are associated with other responses like forgiveness or revenge. As noted above, previous work from our lab suggests that less powerful people are more prone to hold grudges rather than seek revenge. Future research investigating the role of social power would be important to determine whether vulnerable narcissism is related to feeling powerless and if that influences the motivation to hold a grudge over seeking revenge.”
“Every morning as I wait for the kids to get ready for school, I pull out a random volume and browse. I’ve refreshed my knowledge on many subjects and enjoy the deliberate stability of the information experience. I feel confident using it as an occasional personal reference as the online world slides further into AI-augmented noise. And it’s definitely more accurate than an AI large language model at the moment.”
Ibogaine shows promise in treatment of neuropsychiatric symptoms in veterans with traumatic brain injuries – Research from Stanford University. Too many wars; too many exposed to the effects of traumatic brain injuries; PTSD, excessive disabling anxieties, addictions being their only way of coping, not forgetting all those we have lost to suicide. We need a solution to help people not become what we see in US for the veterans left on the streets to fend for themselves in pure poverty.
Researchers at Stanford University have reported remarkable improvements in veterans suffering from traumatic brain injuries (TBIs) using a novel treatment protocol. The study, which involved a combination of magnesium and ibogaine, a naturally occurring psychedelic substance, showed significant reductions in disability and psychiatric symptoms, including post-traumatic stress disorder, depression, and anxiety. The findings have been published in the journal Nature Medicine.
The motivation behind this pivotal research stems from the urgent need to address the complex health challenges faced by veterans, particularly those with a history of TBIs, commonly resulting from military combat and blast exposures. These injuries often lead to debilitating neuropsychiatric symptoms, for which existing treatments are typically less effective. The Stanford team, understanding the gravity of these conditions, aimed to explore alternative and more effective treatment options.
Ibogaine is a naturally occurring psychedelic substance found in the root bark of the Tabernanthe iboga shrub, traditionally used in African spiritual and healing ceremonies. It has attracted scientific interest due to its unique pharmacological properties, exhibiting moderate to weak affinity for various neurotransmitter receptors and increasing the transcription of neurotrophic factors, which are crucial for brain health.
“The Stanford Brain Stimulation Lab is interested in research and innovation in novel treatment models, including psychedelics, to improve outcomes for populations who are not effectively treated through currently available interventions,” said study author Kirsten Cherian, a postdoctoral research fellow at Stanford Medicine.
“As a neuropsychologist, I am particularly interested in interventions with high efficacy and safety for people who are struggling with impairments in cognition, mood, and function as a result of neuropsychiatric conditions and TBI.”
“Members of our study population, Special Forces Veterans, have been living with TBI in addition to other challenges to healthy functioning, including PTSD, depression, anxiety, substance use disorders, suicidality, and other medical sequelae of repeated blast and combat exposures. Currently, available treatments can be less effective for individuals with this kind of presentation of multiple and multifaceted conditions.”
“Some veterans have been crossing the border to access ibogaine treatments not currently legal in the United States. Although ibogaine is currently being accessed therapeutically, the field is early in investigating its treatment potential and safety profile. We were first to provide prospective clinician assessed data about ibogaine treatment efficacy, mechanisms, and safety for TBI and other sequelae of repeated exposure to blasts and combat.”
To conduct this study, the researchers engaged 30 male veterans, all of whom had a history of mild TBIs and repeated blast exposures. These participants were experiencing severe psychiatric symptoms and functional disabilities at the time of the study. The treatment involved administering a specific dosage of oral ibogaine, followed by a thorough evaluation of its effects.
Following the initial assessments at Stanford, the participants traveled to a clinic in Mexico run by Ambio Life Sciences. There, under careful medical monitoring, they received oral ibogaine combined with magnesium. The magnesium was added to help prevent potential heart complications associated with ibogaine use. After receiving the treatment, the veterans returned to Stanford for post-treatment assessments.
“The study protocol included rigorous screening and magnesium co-administered with ibogaine as a cardioprotective agent,” Cherian explained. “Treatment providers ensured participants were well prepared, both from medical and psychiatric perspectives, and monitored the participants closely throughout treatment in order to optimize safety and reduce risk for treatment recipients.”
At the beginning of the study, the participants were experiencing clinically significant levels of disability. This was measured using the World Health Organization Disability Assessment Scale 2.0, which assesses disability across six functional domains: cognition, mobility, self-care, getting along, life activities, and community participation. The scale of the participants’ challenges was evident: 23 met the criteria for post-traumatic stress disorder, 14 for an anxiety disorder, and 15 for alcohol use disorder. Additionally, 19 participants had experienced suicidal thoughts in their lifetimes, and seven had attempted suicide.
The primary measure was the World Health Organization Disability Assessment Schedule, which gauges the level of disability. Additionally, standardized scales like the Clinician-Administered PTSD Scale for DSM-5, the Montgomery–Åsberg Depression Rating Scale, and the Hamilton Anxiety Rating Scale were employed to assess changes in PTSD, depression, and anxiety symptoms. These assessments were conducted at baseline, immediately after treatment, and one month following the treatment.
The researchers observed a significant decrease in the disability scores, indicating a substantial reduction in the severity of the participants’ conditions. Remarkably, this improvement persisted and was even more pronounced one month after the treatment. In terms of psychiatric symptoms, there were notable reductions in the severity of PTSD, depression, and anxiety, with the improvements remaining consistent over time. Moreover, neuropsychological tests revealed enhancements in cognitive functions, particularly in processing speed and executive functioning, without any negative impacts on other cognitive areas.
“Ibogaine is a powerful psychoactive medicine and has real potential as a treatment for trauma, both physical (repeated TBI) and psychological (repeated combat exposure). We saw rapid and durable (up to at least one month) treatment effects on function, symptoms of PTSD, depression, and anxiety, and cognition,” Cherian told PsyPost.
“Approval of ibogaine as a legal focus of research in the United States would allow us to study ibogaine and other psychedelic medicines more rigorously, in order to better delineate treatment efficacy and safety for those most in need. This study’s findings support such further research.”
In terms of safety, the study reported no serious or unexpected side effects. While some participants experienced mild side effects like ataxia, headache, and nausea, these were transient and resolved within 24 hours. This aspect is particularly important, as it suggests the treatment is not only effective but also safe for use in this vulnerable population.
“I was surprised at how rapid and durable the effects of ibogaine were for the majority in the study (ie. up to one-month post-treatment),” Cherian said. “I could feel a powerful difference in the room with individual participants when comparing my assessments with them prior to treatment to assessments only one week later, after they had undertaken one dose of ibogaine treatment.”
“Currently, available treatments often require individuals to undertake months, if not years, of sometimes expensive and often emotionally difficult treatment (for example, exposure therapy for PTSD). Ibogaine demonstrated strong effects within days after treatment for most participants.”
“Some participants had been extremely limited by the issues they were living with,” Cherian added. “Most participants felt they were impaired in their function in life. We saw Veterans who had not been able to continue working, who wouldn’t leave their homes, and who withdrew from family and other social connections.”
“Some were notably struggling with suicidal ideation and many had ready access to means for suicide. Some veterans shared with complete certainty that they felt that ibogaine saved their lives. The effects of ibogaine were not only healing from a psychological perspective, but also appear to have contributed to improvements in cognition and significant reductions in suicidality.”
Despite these promising results, the study is not without its limitations. One significant limitation is that it was not a randomized controlled trial (RCT), which is considered the gold standard in medical research. This means that the possibility of placebo effects or other biases cannot be entirely ruled out. Additionally, the participants in this study self-selected for the treatment and traveled to Mexico for it, which may have influenced the outcomes due to expectancy or other factors associated with the treatment setting.
Looking to the future, the researchers emphasize the need for further studies, particularly placebo-controlled RCTs, to solidify these findings. Such studies would help to establish the true efficacy of this treatment protocol, free from the potential biases of expectancy or self-selection.
The study, “Magnesium–ibogaine therapy in veterans with traumatic brain injuries“, was authored by Kirsten N. Cherian, Jackob N. Keynan, Lauren Anker, Afik Faerman, Randi E. Brown, Ahmed Shamma, Or Keynan, John P. Coetzee, Jean-Marie Batail, Angela Phillips, Nicholas J. Bassano, Gregory L. Sahlem, Jose Inzunza, Trevor Millar, Jonathan Dickinson, C. E. Rolle, Jennifer Keller, Maheen Adamson, Ian H. Kratter, and Nolan R. Williams.
Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing
Let’s file this under unsurprising news: the COVID pandemic prompted the biggest spike in alcohol consumption seen in 50 years. Illnesses, hospitalizations, and deaths linked to alcohol misuse rose as well.
Yet even before the pandemic sparked disruptions, losses, stress, and isolation, alcohol use among older adults had been trending upward. And a quarter of people 18 and older reported heavy drinking (five or more drinks for men, four or more for women).
If you’re feeling sober curious or simply ready to cut back, consider joining millions of others who abstain from alcohol during Dry January. Your heart, liver, memory, and relationships could be all the better for it.
Why try Dry January?
If you’d like to cut down your alcohol consumption or start the new year with a clean slate, join in the Dry January challenge by choosing not to drink beer, wine, or spirits for one month. Dry January began in 2012 as a public health initiative from Alcohol Change UK, a British charity. Now millions take part in this health challenge every year.
While past observational studies suggested a link between drinking a moderate amount of alcohol and health benefits for some people, more recent research has questioned whether any amount of alcohol improves health outcomes. And heavier drinking or long-term drinking can increase physical and mental problems, especially among older adults. Heart and liver damage, a higher cancer risk, a weakened immune system, memory issues, and mood disorders are common issues.
Yet, cutting out alcohol for even a month can make a noticeable difference in your health. Regular drinkers who abstained from alcohol for 30 days slept better, had more energy, and lost weight, according to a study in BMJ Open. They also lowered their blood pressure and cholesterol levels and reduced cancer-related proteins in their blood.
Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovascular disease, cancer, type 2 diabetes and other conditions. Get simple tips to fight inflammation and stay healthy — from Harvard Medical School experts.LEARN MORE
A month may seem like a long time, but most people can be successful. Still, you may need assistance to stay dry in January. Here are some tips:
Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, soda, or mocktails (non-alcoholic cocktails.) Non-alcoholic beer or wine also is an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. “Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar,” says Dawn Sugarman, a research psychologist at Harvard-affiliated McLean Hospital in the division of alcohol, drugs, and addiction.
Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your non-alcoholic drinks with you.
Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.
Use the Try Dry app. This free app from the UK helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices.
Don’t give up. If you slip up, don’t feel guilty. Just begin again the next day.
Check your feelings
Sugarman recommends people also use Dry January to reflect on their drinking habits. It’s common for people to lose their alcohol cravings and realize drinking need not occupy such an ample space in their lives. If this is you, consider continuing for another 30 days, or just embrace your new attitude toward drinking where it’s an occasional indulgence.
If you struggle during the month, or give up after a week or so, you may need extra help cutting back. Talk to your doctor about getting the help you need.
The Rethinking Drinking site created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is also an excellent resource. For the record, NIAAA recommends limiting alcohol to two daily drinks or less for men and no more than one drink a day for women.
Be aware of problems that might crop up
Dry January can reveal signs of potential alcohol problems, including symptoms of alcohol withdrawal ranging from mild to serious, depending on how much you usually drink.
Mild symptoms include anxiety, shaky hands, headache, nausea, vomiting, sweating, and insomnia.
Severe symptoms often kick in within two or three days after you stop drinking. They can include hallucinations, delirium, racing heart rate, and fever.
“If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help,” says Sugarman.
Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing
Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio
But is it really phone addiction we’re experiencing?
Illustrations: Edward Steed
There is no standard diagnosis for ‘phone addiction’, and a debate rages about whether there should be. But will medicalizing a behavior help or harm those suffering from it?
Ananya Jain never planned on becoming addicted to TikTok.
Jain, who is 24 years old, downloaded the app right during the peak of Covid. She had heard about TikTok’s data privacy issues, so she promised herself that she wouldn’t post or comment on anything – just watch a few videos and call it a day. That lasted less than a month.
“It just pulled me in because I was so lonely,” Jain said. “I was looking for friends.”https://interactive.guim.co.uk/uploader/embed/2023/12/archive-zip/giv-13425ksgWa3YL3uOT/
And TikTok delivered. A huge Harry Potter fan, Jain was roped into the BOOKtalk community. She was struggling with acne, but dancing dermatologists told her about over-the-counter skincare products. Later, #polo and #horsesoftiktok became enthralling since she could live vicariously through the players – from underneath her covers. Whenever Jain felt the loneliness creep in, the platform gave her a quick dopamine hit.
Innocuous 15-second videos would lead to two hours of scrolling. Soon, Jain would watch TikToks during work breaks to de-stress, or in her bedroom as she was trying to go to sleep. The app became the source of all her social and entertainment needs. Yet she also felt lonelier than ever.
“I was addicted to my phone, I had the worst mental health possible that you can imagine,” Jain said. Her online friends were anonymous strangers, after all, not the kind of people you’d ask to pick you up from the airport or call up in the middle of the night. It was a vicious cycle: TikTok fed her loneliness but was also what she used to try to alleviate it.
Jain is the founder of mental health startup FullCircle. Running it was all-consuming work, but now she could barely concentrate. Her co-founder, Ankit Kukadia, began noticing how Jain was increasingly retreating to her phone, sneaking off during meetings to scroll through TikTok and neglecting her responsibilities. So, he staged a two-day protest to get Jain to delete the app, giving her an ultimatum that he’d refuse to work with her if she didn’t put a stop to her obsession. “The minute you think about opening up TikTok,” Kukadia said, “give me control of your phone.”
Three tries and 38 days after her first attempt, Jain finally deleted the app for good. The experience was excruciating: living alone, she would find herself sitting at the dining table, anxious and fidgety, not knowing how to fill up the time. She’d lie in bed at night, twisting and turning, the loneliness that had fuelled her TikTok habit burning hotter than ever.
“Your brain behaves differently when it’s addicted to something,” Jain said quietly. “I don’t want to say it was like trying to quit alcohol, but I empathize with people who are trying to quit an addiction because it really is an uphill battle.”
In its simplest form, addiction is the tipping point at which compulsion turns into dependency, when a person’s behavior or drug use spirals out of control despite harmful consequences. Think having the occasional glass of wine versus repeatedly showing up to work hungover.
With no standard diagnostic criteria, the line between excessive phone use and addiction is blurry. Nevertheless, researchers have been exploring this question for the past two decades, and a recent summary of all the best scientific evidence – 82 studies across 150,000 participants – estimated that over 25% of people worldwide had “smartphone addiction”.
The authors of this review demurred on a specific definition, accepting 14 different “commonly used screening tools”. Nevertheless, they showed that the problem of excessive phone use has been getting worse over time, with studies in 2020 and 2021 reporting smartphone addiction at much higher rates – around 35%. A recent survey from the Pew Research Center similarly found that 95% of teens had a smartphone, and almost half reported they were online “almost constantly” – up from 24% nearly a decade ago.
In May, concerns about phone use were brought to the forefront when the US surgeon general, Vivek Murthy, issued an advisory on social media’s harms to youth mental health, drawing upon decades of scientific research. Arguing that individual action was necessary but insufficient, Murthy called for safety standards for tech platforms, similar to those for toys and car seats. He also called for greater social infrastructure to promote in-person connections, such as parks, libraries and volunteer organizations.
The report suggests that phone and social media use overstimulates the brain’s reward center and can trigger pathways similar to addiction, but other mental health experts and policymakers have been more explicit. Mandy Saligari, clinical director of Charter Harley Street in London, compared giving children smartphones to “giving them a gram of cocaine”, while the Stanford psychiatrist Anna Lembke described phones as “the modern-day hypodermic needle”, offering digital heroin at the ready.
Meanwhile, in a congressional hearing, Senator Bernie Sanders described how social media companies “keep coming up with new ways to get teenagers addicted”, while the Republican senator Tommy Tuberville called phones “the biggest drug we got”, more so than even fentanyl.
‘To be an addictive disorder, you need impairment in daily functioning and psychological distress,’ said Dar Meshi. Photograph: OcusFocus/Getty Images/iStockphoto
How much of this rhetoric is fearmongering? Technically speaking, “phone addiction” isn’t a real medical condition, at least according to the bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM). And that’s largely because scientists aren’t sure if phone use has crossed that critical tipping point into social harm. “To be an addictive disorder, you need impairment in daily functioning and psychological distress,” said Dar Meshi, a cognitive neuroscientist at Michigan State University. “There’s a high bar to be set.”
Whether excessive phone use deserves to be called an “addiction” is more than just simple semantics or a debate between academics. By creating a new mental health diagnosis, we risk pathologizing an unfortunate but normal aspect of the human experience.
On one hand, a diagnosis could legitimize the suffering that some people face and enable treatment. But on the other, with all the cultural and historical baggage surrounding “addiction”, the label could misrepresent phone overuse as the absence of free will and do more harm than good.
The history of addiction is one of two competing forces – criminalization and medicalization. In the US, opiates and cocaine were first banned in 1914, followed by alcohol between 1920 to 1933. Drug consumption was seen as a mark of depravity, and treatment options were nearly nonexistent, leaving incarceration the primary recourse.
But as drug addiction began spreading among white middle-class youth in the 1960s, medicine – and a grassroots movement of free clinics – increasingly came to serve these more sympathetic victims. The rise of healthcare had enduring effects: when Richard Nixon declared a “war on drugs” in 1971, what he really meant was developing a crime-control strategy for urban minority neighborhoods, and a public health approach for the white suburbs.
We evolved to find social interaction rewarding
Within this segregated system, George HW Bush pushed forward the medical project, anointing the 1990s as the “decade of the brain”. He called for a renaissance of research into this mysterious organ, delving in particular “into how people become addicted to drugs”.
The idea was to go beyond grounding addiction in character flaws and social influences, instead finding “root causation in some kind of genetic or neurophysiological defect”, said Helena Hansen, a psychiatrist at the University of California Los Angeles. New advances in brain imaging aided this quest, and by 1997, the National Institute on Drug Abuse had officially rebranded addiction as a “chronic relapsing brain disease”.
The goal was destigmatization, Hansen added, but it ended up painting the brain as a universal, disembodied organ devoid of social or environmental influences. Correspondingly, stressors like racism, poverty and state violence were largely bypassed, and pharmaceutical treatment was elevated as the solution to this neural defect.
Over 25 years later, this has remained the official party line for nearly all addictions.
To date, there has been only onelongitudinal study about how social media affects brain development, according to Meshi, the Michigan State neuroscientist. Following 189 Dutch adolescents over five years, the researchers reported baseline differences in the brains of high and low social media users – and that high users had accelerated thinning in parts of their brains responsible for decision-making and social awareness. But the researchers also cautioned that these findings were subtle at best with “little evidence for severe negative consequences of social media use on brain development”.
That’s a key point when distinguishing between phone and drug use, according to Gabriel Rubio, a psychiatrist at the Complutense University of Madrid who researches cravings and dependence. He argued that excessive phone use might not change our brains’ structure like alcoholism does but might change how our brains function. Namely, phones affect how our brains deal with internal emotions (eg boredom, loneliness) and external stimuli (eg seeing someone else pull out their phone).
“As in all addictive behaviors,” Rubio wrote in an email, “the biological substrate is the brain’s reward circuit.” In other words, phones mess with our brain chemicals to make us feel good and ensure that we keep on using them.
These functional changes aren’t necessarily problematic on their own. “We evolved to find social interaction rewarding,” said Meshi, and the need to belong is one of the most powerful, universal human drives. Imagine the pleasure of receiving a compliment – the flurry of happiness, warmth on your cheeks – “and then along comes technology that can tap into that drive, that biological hardwiring”, offering a nearly limitless supply of dopamine bursts at any time of the day. “Just you nodding while I’m talking activates that reward system,” Meshi said. “Now I can get 100 people nodding and giving me a like.”
In his own work, Meshi has shown that decision-making is similarly impaired with excessive social media use and drug addiction, and that overusing social media is associated with decreased real-life social support, as well as greater mental illness and social isolation.
But Meshi is quick to note that research into phone and social media use is in its infancy, with potential harms still poorly understood. “The decision-making stuff and most of my work is all correlational,” said Meshi. “Nothing is causal.”
Social scientists have a word for labels like addiction: they call it an “empty signifier”, bearing no specific meaning beyond what’s been imposed on to it. “Folks can have a mutually intelligible conversation about ‘addiction’ and believe they’re talking about the same thing,” said Jennifer Carroll, a medical anthropologist at North Carolina State University, “and they’re really not.”
When the American Society of Addiction Medicine and other medical organizations talk about addiction, they’re usually referring to the DSM-5 criteria and addiction as a chronic brain disease. But for the everyday person, “addiction” has become something of a metaphor, referring to something they enjoy, do a lot and feel is unhealthy. “I like ice-cream a lot, so I used to tell everyone I’m an ice-cream addict,” said Meshi. “The average person uses addiction in a different way than a clinician uses it.”
But over the past two decades, the lines between professionals and the public have become increasingly blurred – particularly after the DSM-5 reclassified excessive gambling as an “addiction” in 2013. Although some experts criticized the lack of evidence and consensus, the controversy wasn’t really about gambling itself, but the seismic shift this decision signaled.
For the first time, a non-substance addiction – a behavior – had become a psychiatric diagnosis by the highest medical court in the land, fueling concernsthatnow “virtually almost everything may be considered pathological”, according to Antonio Maturo, a sociologist at the University of Bologna.
If we start lowering that bar, then it’s like everything can be an addictive disorder
And these premonitions have slowly begun to materialize. Within the hallowed halls of academic literature, researchers have been coining all sorts of new addictions to shopping, fortune-telling, selfie-taking and more. “For the substance use addictions, there’s a well-worked out pharmacologic substrate, you can see receptors, drug-metabolizing enzymes upregulated, downregulated,” said David Jones, a psychiatrist and historian of science at Harvard Medical School. For many of these “conditions”, however, there’s none of this – just a catchy new label.
In the case of “phone addiction”, however, a similar dismissal feels overly flippant, if only because the term has become a part of everyday discourse. From Reddit forums to the halls of Congress, omnipresence, rather than judicial decree, has begun to reify this issue.
In fact, in a June Senate health committee hearing on the youth mental health crisis, phones and social media were all anybody could talk about. Murthy, the surgeon general, condemned social media companies’ “utter lack” of accountability and offered support for an electronic warning label on social media, like those already on cigarette packages. The Democratic senator Chris Murphy similarly spoke about his bill to rein in social media’s addictive practices, with his colleagues offering other testimonies on the unique harms of this technology.
“Instead of our children talking to their friends, their colleagues, their teachers, their coaches, they talk to social media; that’s their best friend,” said the Republican senator and OB/GYN Roger Marshall. “I look at social media today as worse than pornography.”
‘It’s a really slippery slope – this idea of technology as a tool sliding into technology infiltrating every part of your life and structuring reality,’ said Stacy Torres. Photograph: Dominic Lipinski/PA
Beyond such theatrical comparisons, some scientists have also sought to legitimize phone addiction by surrounding the phrase with a cast of characters. For his part, Rubio offered up “textaphrenia” (the phantom sense of receiving a text), “ringxiety” (anxiety over getting a phone call), and “nomophobia” (a portmanteau of no mobile phone and phobia) as a few examples. After all, how can there be a diagnosis without symptoms?
Meshi is sympathetic toward these efforts; he told me how he had to fire a research assistant who couldn’t stay off Facebook. But he’s also worried that this discourse is running ahead of the evidence and could cheapen the death and devastation of nicotine, opioids and other drugs.
“If we start lowering that bar, then it’s like everything can be an addictive disorder,” he said. “I don’t want to go down that path.”
In general, Americans probably overstretch medical terms – for example, the simultaneous “pandemics” of disinformation, loneliness and poverty. It’s probably innocuous and maybe even helpful to drive attention to important social issues. However, for many experts I spoke with, the overuse of “addiction” isn’t the same value-free proposition.
For one, it risks creating a two-tiered system for patients, similar to how opioid addiction treatments have long been segregated, according to the UCLA psychiatrist Hansen. Methadone is dispensed in clinics regulated by the Drug Enforcement Administration and located almost exclusively in low-income neighborhoods, while buprenorphine is prescribed in private doctors’ offices, “removed from poverty, ethnic minorities and street crime”. The aggressive regulation of methadone – with its daily observed dosing and frequent urine checks – simply wouldn’t do for the white middle class.
For Hansen, “there’s no question” that creating a diagnosis around phone addiction would promote a similar kind of segregation. Specifically, she envisioned a future in which social media and phones themselves become racialized. “Whatever platforms, whatever software tends to be used by poor Black and brown people, that’ll be demonized first,” said Hansen, with minorities subsequently labeled as “sicker” and “more diseased”.
This racial profiling might seep into the potential remedies as well, Hansen predicted. Namely, the well-off will channel their children to bucolic summer detox camps costing up to $11,000 while the marginalized are relegated to underfunded, crowded public clinics.
Some of these decisions might even be taken out of the hands of parents and into the courts, according to Carroll, the medical anthropologist. With the brain disease model ingrained over decades, addiction has increasingly been seen as a lack of rationality and inability to make authentic choices, which has enabled all sorts of violations of people’s agency and autonomy.
In Massachusetts, for instance, any person with an addiction can be coerced into treatment under the state’s Section 35 law. Family members, police officers and healthcare providers can all ask a judge for a warrant to take patients into custody.And if the judge agrees they are a danger to themselves or others, patients are then sent for addiction treatment – often in prison – and held against their will for up to 90 days. From 2011 to 2018, 42,853 Massachusetts residents were involuntarily committed in this way; about 38 states have similarly coercive policies.
It’s a really slippery slope – this idea of technology as a tool sliding into technology infiltrating every part of your life and structuring reality
Under a label of addiction, excessive phone use could be employed in a similarly dehumanizing logic: “You can’t make the choice to go on your own, so I have to make the choice for you,” said Carroll. While the research is clear that compulsory drug treatment doesn’t actually work (and might even do more harm than good), these programs remain incredibly popular because they seem like a compassionate response to someone’s brain being fundamentally compromised.
“I hear it used all the time – things ‘hijack your brain’ – which is an incredible metaphor if you think about it,” Carroll added. “It’s like Ratatouille, but it’s TikTok.”
Regardless of whether addiction is the right term, everyone I spoke with agreed that our growing reliance on phones is a real problem.
Never before in history have we had such immediate, infinitesimal access – with literal supercomputers in our pockets. “It’s a really slippery slope – this idea of technology as a tool sliding into technology infiltrating every part of your life and structuring reality,” said Stacy Torres, a sociologist at the University of California San Francisco. “We’re in a brave new world.”
Torres herself has been trying to hold on to the past: at the age of 43, she has never used social media or owned a smartphone. Poverty made her a late adopter; she got her first phone – a prepaid Nokia brick – when she was 26. But her fear of addiction, given a long family history of alcoholism, kept her away from anything more advanced.
Of course, not everyone who uses a smartphone will have a problem, but it’s easy to understand why some might. For these people, a medical diagnosis would probably help, validating their suffering and ensuring they get the care they need.
“The moment you call something an ‘addiction’, the move is to medicalize it, to push policy in the direction of treatment, to push social reactions from judgment and condemnation towards empathy and patience,” said Jones, the Harvard historian of science. Despite the risks, there’s real promise in moving beyond a status quo where patients languish alone.
Even Hansen acknowledged that a label of “addiction” could spread awareness about how repetitive, compulsive screen use can ruin people’s lives. She’s seen it first-hand: her brother-in-law flunked out of college because he couldn’t stop playing video games.“He had friends who were rushed to the ER for rehydration after the release of one of their favorite video games,” Hansen added. “They could not pull themselves away from the screen to drink water.”
However, if society is going to medicalize phone use, Hansen wants to make sure we’re pointing our fingers in the right direction – away from brain disease notions that “people are a slave to their own habits and behaviors”. The real problem, Hansen argues, are the social and environmental drivers, from schools cutting arts and physical education programs to tech companies’ increasingly aggressive business schemes.
Hansen thus argues that excessive phone use shouldn’t be called an addiction but instead something like “manufacturer-induced compulsive behavior”. It’s a mouthful, yes, but getting the language right is critically important since it implies something about causation, and where the solutions ought to begin.
In other words, rather than punting the problem to the healthcare system, Hansen believes that we should be regulating how software is developed and what’s permitted to come to market. There’s a reason why social media apps are often compared to slot machines, with their bright designs, infinite scrolling and pull-to-refresh feature suspending our brains in anticipation. You can mitigate some of these effects by changing your screen to grayscale or turning off notifications, but it’s almost impossible to win on your own, suggested Jones, because we live in such highly engineered environments.
Population collapse is the biggest threat to civilization. Here’s what’s happening in the world:
• South Korea’s Record-Low Fertility Rate To Fall Further, Warns Government
• China’s fertility rate is estimated to have touched a record low of 1.09 last year. Births were below 10mn for the first time. This year, expect a third straight year of decline with births a tenth lower to well below 9mn.
• Japan’s 18-year-olds slip to record-low 1.06m on falling births
• Singapore’s birth rate is at a record low
• Vietnam’s low birth rate keeps falling
• Pope Francis Expresses Concern About Italy’s Low Birth Rate
• Fertility rate in the Netherlands drops to record low
• Indiana’s birth rate fell dramatically, dropping from 14.1 births per 1,000 people to 11.7, per new CDC data.
Generative AI could radically alter the practice of law. If it can do in 20 seconds a task that would have taken a dozen associates 50 hours each, then why would big legal firms continue hiring dozens of associates? https://econ.st/3tk806P
An important judgment concerning application of the Assisted Decision Making Capacity Act – judge appoints independent decision-makers instead of siblings to make decisions for woman with dementia
South Africa has filed a case at the International Court of Justice in the Hague, accusing Israel of committing genocide in Gaza. International law expert Francis Boyle, who has argued successfully at the ICJ, says he believes "South Africa will win an order against Israel." pic.twitter.com/4Ebz02vxVc
Skimping on homeless services “doesn’t work”. The State is about to pay more for them
Beyond immediate shelter, more and more people need complex assistance to escape entrenched homelessness. Price competition between charities has pushed the sector to the brink, but procurement policy is now changing.
In 2019, the Peter McVerry Trust secured Ireland’s largest-ever State-funded contract for homeless services after bidding €10 million below the cost estimated by the authorities. In December, the State began a bail-out of the cash-strapped charity, which may cost taxpayers up to €15 million by the end of March.
There is no direct link between these two figures. They do, however, illustrate a shift in national policy after years underpaying the organisations to which the Government outsources support for the growing homeless population.
In the meantime, Ireland has seen workers in the voluntary sector threaten strike action and the country’s largest homeless charity teeter on the brink of insolvency. Now the State stands to pay significantly more to help those who fall out of its dysfunctional housing market.
Based on tender documents, insider interviews and correspondence obtained through freedom of information request, this is the story of Ireland’s slow realisation that the procurement of its assistance to the homeless was broken.
*****
The Housing First contract for the Dublin region is the starting point of this story. It is worth dwelling on it because it is the largest on record through which the State has so far outsourced supports to help people out of homelessness (as opposed to just providing them with temporary shelter). It also constituted a tipping point where competition on price triggered a bitter row among those working to deliver these services.
Housing First, a policy developed by Dr Sam Tsemberis in the US, is often regarded as the gold standard in tackling homelessness. It aims to break the chicken-and-egg situation where people suffer from both lack of housing and separate but related difficulties, by addressing all issues at the same time with specialist social and health workers.
Rob Lowth is the national director of Housing First at the Housing Agency, a new office established in March 2022. He has long previous experience procuring homeless services for Limerick City and County Council. In an interview with The Currency, he recalled: “We could provide emergency accommodation, but what was the exit?” he recalled.
“Unfortunately, people with addictions, with mental health issues, with behavioural issues were deemed unplaceable in normal societal systems,” whether that was social housing or other forms of long-term accommodation. On the other hand, they could not recover from those issues because they were living in “chaotic emergency accommodation,” Lowth added. “That’s where Housing First fits, that fills the gap in terms of the solutions nationally.”
Focus Ireland and the Peter McVerry Trust ran an initial five-year Housing First programme in Dublin from 2014 at a contracted cost of €2.3 million (all costs in this article are quoted excluding Vat). Housing First funding, which comes from the Department of Housing and the HSE via local authorities, doesn’t cover the direct cost of accommodation, which is financed separately.
Housing First then became national policy to address complex cases and local authorities rolled it out by contracting implementing organisations in eight regions from 2018. This was before Lowth’s national office was established and the Housing Agency had no role in it at that point.
After public tendering, lead local authorities awarded the Housing First regional contracts to voluntary bodies in 2019. The Currency has obtained key data on some of those contracts, as well as other examples of homeless services contracted out since 2017. There have been other State-funded contracts awarded during this period but no data is available about them and not all local authorities contacted have responded to requests for information.https://datawrapper.dwcdn.net/6J6b1/5/
The Dublin Region Homeless Executive (DRHE) is a unit of Dublin City Council co-ordinating homeless services on behalf of all local authorities in Co Dublin. It invited tenders in November 2018 to deliver and manage at least 405 Housing First tenancies across Cio Dublin over the following three years, estimating the cost of this service at €16.4 million.
The Dublin contract was awarded “on the basis of the most economically advantageous tender” and ultimate cost was the most important of six selection criteria, weighing 30 per cent of each tender’s final score.
Few organisations in Ireland are capable of achieving the contract’s requirements. Other Housing First regions for which The Currency obtained tender details received just two offers, while the Dublin contract attracted four bidders.
In February 2019, the DRHE decided to award it to the Peter McVerry Trust after the charity offered to deliver the service for €6.3 million. At less than 39 per cent of the official estimated value, this was the lowest bid of all homeless services contracts analysed by The Currency in the last five years.
Asked how the local authorities expected the Peter McVerry Trust to make up the shortfall, a spokesperson for Dublin City Council told The Currency: “The successful tenderer for the 2018 Housing First tender made provision for funding from their own resources and fundraising, to go towards the running of the service.”
The spokesperson also provided the figures below on payments made under the contract so far. They remain below the initial cost estimate, even after a two-year extension. https://datawrapper.dwcdn.net/G8rwX/1/
Tender documents specified that a “minimum of 405 new and additional Housing First tenancies MUST be provided and managed in the Dublin region” in the period from June 2019 to June 2022, with detailed targets rising from 125 new tenancies in year one to 145 in year three.
Official data from the Department of Housing shows that the Peter McVerry Trust has yet to deliver the minimum contractual annual threshold in Dublin in any year since securing the contract. Instead, the number of new Housing First tenancies in the capital region fell sharply after the organisation ended its partnership with Focus Ireland mid-2019 to start its standalone contract. https://datawrapper.dwcdn.net/v1rpC/1/
While there are no public figures matching the exact contract dates, the most favourable three-year bracket in the period saw 271 new tenancies in Dublin out of the 405 required. Despite the end of the last Covid-19 restrictions in early 2022, the Dublin region still benefited from fewer than 125 new Housing First tenancies in the latest reported 12-month period from October 2022 to September 2023.
This is in contrast to nationwide figures, where the Department of Housing reported that the target set in September 2018 for 663 new Housing First tenancies over the following three years was exceeded with 722 recorded by October 2021.
Since 2019, the Peter McVerry Trust has held the contracts to roll out Housing First in half of Ireland’s eight regions. The Dublin contract alone accounted for just under half of national targets until 2021, and over half under the current 2022-2026 plan.
Instead of leading the increase in tenancies in the past two years, however, the capital’s share has continued to decline in the last two years, according to official statistics.
All this boils down to the DRHE’s acceptance in 2019 of a promise by the Peter McVerry Trust that it would privately raise nearly two-thirds of the funds required to roll out the State’s flagship policy to tackle homelessness in the capital. The public authority got what it paid for, with Dublin falling behind the rest of the country in delivering housing first.
The Peter McVerry Trust declined to answer questions from The Currency.
“A typo” and a legal letter
The contract attracted criticism, most acutely from the Peter McVerry Trust’s former Housing First partner, Focus Ireland.
The Currency has obtained partially redacted correspondence between Focus Ireland and the DRHE through a freedom of information request. After the DRHE’s then director Eileen Gleeson wrote to the charity to explain why it had not been selected, Focus’s CEO Pat Dennigan pointed out that the Peter McVerry Trust had scored below the elimination threshold on “proposals to manage and lead effectively,” one of the mandatory quality criteria for selection.
The DRHE redacted details of the scores in documents released to The Currency. However, it replied to Focus at the time that the Peter McVerry Trust’s low governance score resulted from “a typo”. Once that was corrected, the two former partner organisations were left to compete on price and Dublin City Council’s law department confirmed Peter McVerry Trusts’ low-cost bid as the winner.
This was despite Focus later highlighting the DRHE’s “assessment of the qualitative and delivery aspects… in which we demonstrated a clear leadership over the preferred bidder”.
Focus followed up with a legal letter from its solicitors Sherwin O’Riordan maintaining that the DRHE had failed in its obligation to explain the contract award. “Our client has concerns that the marks awarded to the successful tenderer in respect of the qualitative award criteria for which no reasons have been offered were simply not justified and is concerned that lower marks than those awarded ought to have been awarded to the successful tenderer,” the lawyers wrote on March 8, 2019.
“The service cannot possibly be provided at this price.”Focus Ireland’s solicitors
But they also questioned the validity of the price bid by the Peter McVerry Trust. “In our client’s view and based on our client’s obvious and extensive experience of the service, the service cannot possibly be provided at this price in accordance with your requirements. It is wholly unsustainable and will inevitably give rise to difficulties in service delivery.”
Solicitors for Focus demanded a “full explanation” from the DRHE and alleged “violations of the procurement rules,” seeking a freeze on the start of the contract to “avoid having to bring this matter before the courts”.
Four days later, Dennigan backtracked to protect Focus’s position as “a leading candidate to provide those services” in the future.
“We are very clear about how we prioritise our time and our expenditure,” he wrote to Gleeson while instructing Sherwin O’Riordan not to launch court proceedings. “We believe that formal legal action will be a distraction from our core mission.
“However, that does not mean that we are satisfied with the outcome of the tender process. More importantly, this also does not mean that we have confidence in future similar processes with DCC [Dublin City Council] and the DRHE.”
Seeking a meeting on the future of procurement of services, Dennigan concluded: “We need to have confidence that we clearly understand the objectives and processes which are likely to be involved in future tender projects and that we can have confidence that procurement processes are conducted in a fair and transparent way with the goal of providing sustainable, high-quality services.”
New tenders early in 2024
The CEO of Focus had put his finger on the core issue. The 2019 Dublin contract was a low point for the procurement of homeless services, and the past four years have seen change that will only become fully apparent when all Housing First regions tender out new contracts early in 2024. The 2019 contracts were extended past the initial three years and are now coming to an end.
In an interview with The Currency, Focus Ireland’s advocacy director Mike Allen picked up where the 2019 documents ended. He said his organisation then took some time to reflect on what had happened.
“A proportion of our board are coming from senior positions in private enterprise,” Allen said. “They took some explaining to understand how you could win a contract to provide a major service, and then have to restate your accounts to take into the fact that winning this contract meant that you had to reduce the the surplus or increase the deficit you were going to have at the end of the year – being worse off for winning a contract.”
From then on, the board insisted on approving the price Focus would bid in any public tender. “The guidance they gave is that our pricing should be on the basis of full recovery of immediate costs at least,” Allen said, with only some shared overheads funded out of the charity’s own resources.
“We lost a number of contracts as a result of that over the succeeding years,” Allen said. “But more recently, we’ve seen a pattern in which local authorities are responding to that, and we’ve won contracts since.”
Yet this is still some way from fully recovering the cost of delivering services on behalf of the State, he cautioned. He mentioned frontline staff’s pensions, which for example are covered by the State for public servants but not for those in similar positions at voluntary organisations, or the employment of organisation-wide health and safety or data protection officers.
Focus Ireland’s advocacy director Mike Allen.
“That’s something where there are discussions going on with the Department of Housing and representatives of local authorities, to try and shift that so it would be full cost recovery,” Allen said. As for private charitable donations, “the fundraising should go to do the additional things that the State hasn’t yet thought of: innovative things, filling gaps that the State isn’t filling, or additional services that would really make a difference to people that aren’t currently within the State’s planning.”
According to Allen, annual public expenditure on alleviating homelessness (so-called Section 10 funding) now stands around €400 million, up from €50 million ten years ago, with the vast majority going towards providing shelter by renting accommodation from private landlords.
A minority of funding goes towards tenancy supports delivered by specialist workers at voluntary organisations. Focus Ireland provides these services only. Other charities also provide their own accommodation. Housing First aims to tackle all problems facing a homeless person through one holistic service.
“If you’re funding a Housing First service, you’re funding staff with skills and qualifications whose job it is and who are successful at moving people out of homelessness and ending their homelessness,” Allen said.
Staff “would be doing everything from making sure they’re on the housing list, advocating with the local authority that they should have priority in relation to certain things, supporting the household to look for other housing options in the private rented sector and so on, but also helping them link in with mental health services or health services or employment services, or any other mainstream public services they wouldn’t be aware of, and they would find difficulty linking in with while they’re in emergency accommodation.”
“It’s like, ‘We get a cheaper car because we get one with only three wheels’. It doesn’t work.”Mike Allen
According to Allen, this is the type of work where cutting costs is counterproductive: “You end up not providing the support for people to effectively move,” he said. “You spend a lot of money to move them out of homelessness, and they fall back into homelessness again.”
His experience of dealing with the authorities in the past is that they were constantly seeking to cut spending here and there, arguing it was in the public interest; but he said it is not. “It’s like, ‘We get a cheaper car because we get one with only three wheels’. It doesn’t work.”
The table above, however, shows a reversal since the bidding war for the 2019 Dublin Housing First contract. Public tenders for homeless services in the past two years have seen voluntary organisations including the Peter McVerry Trust submit winning bids close to or above the cost estimated by the authorities.
There has also been a “sympathetic ear” from the Department of Housing under Minister Darragh O’Brien and the DRHE’s current director, Mary Hayes, after an initial period following the 2019 row when criticism from Focus was seen as “sour grapes”.
“Yes, we were upset that we had lost the contract for something we were very committed to delivering. But we were also pointing out that if they continued in that direction, they were hollowing out the whole homeless sector,” Allen said. “For a period, I think that fell on deaf ears and they just sort of said, ‘Great, this organisation will do it cheaper and we don’t care that somebody is saying we need to pay more’.
“I think even before certain issues that have come to light in the Peter McVerry Trust, there was a growing recognition that the model wasn’t working. That’s partly just people listening. And it’s partly, right across the sector – not just the homeless sector, it obviously is other care sectors – the recruitment problems we were having.”
Allen’s view is that the State’s past policy was to subcontract services to charities under the same professional standards, but expecting to pay around 10 per cent less than through public service agencies. This has driven workers away from those employers because of poorer pay and conditions.
Amid gaps in services, increased trade union activity culminated in mid-October’s threatened strike in the voluntary sector. It was cancelled at the last minute after the Government backed a pay agreement at the Workplace Relations Commission.
A new procurement process
Back at the Housing Agency, Rob Lowth agreed with Allen’s assessment. “From a staffing perspective, we all want the best quality and sometimes you have to pay slightly more for your staffing as a result. I know there’s been a lot of, I suppose, unrest in the sector – agreements and strikes and so on,” the national director of Housing First says. “To be at the frontline of homeless services, they deserve increases. They deserve to be getting remunerated for the quality of the work they’re delivering, because it really is a difficult environment to work in.”
To secure both adequate capacity and price in the next round of Housing First contracts, Lowth says his office has been working on a new procurement design since its establishment last year: “We’re feeding in all what we’ve learned over the last 18 months or so, in terms of the good, the bad and the indifferent.”
He says consultations with local authorities, the HSE and homeless NGOs have revealed aspects as unexpected as the inclusion of dental health, after lack of access to a dentist emerged as a significant challenge to some homeless people’s nutrition and ability to stabilise their life in a new home. As a result, when calls for Housing First tenders go out in the coming weeks, they will follow an entirely new two-step process.
“Stage one is a pre-qualification document, which will require elements of financial assurances, general insurances, tax clearance cert – all of the different associations there for a company, but there will be elements of quality as part of that stage one as well,” Lowth says. “Everything what we’re trying to focus on is about the quality. It’s not necessarily about the estimated running costs of the project.”
Although procurement will continue on a regional basis, smaller organisations will have the option to tender for a single county.
Rob Lowth, national director of Housing First at the Housing Agency. Photo: Thomas Hubert
Lowth says that stage two would consist in an evaluation of the organisations pre-qualified within the framework of stage one to rank them by order of capacity. “You’re giving choice to the local authority and the HSE to say, ‘Well, if we give 30 tenancies to number one, we see how those tenancies get on. And we think that organisation is at capacity, we can then move on to offer number two’,” he explained. While dialogue would continue with the best-ranked bidder, “you have the backup, you have the opportunity to talk to the second organisation on the framework and it’s a negotiated procedure from that perspective”.
Only at the point of entering a contract will local authorities and the HSE then negotiate a price with the selected implementing organisation based on the costings it had submitted in its original tender. “I think that’s something we’ve all learned in the last 12 months, the volatility of economics across the board has been huge,” Lowth said.
From being a deciding factor – albeit not the only one – price has been relegated to a post-selection negotiated point. This also means that changes in the costs of labour and inputs will feed into the final price agreed for each contract.
“Homeless services should be cost-neutral to the organisation delivering them.”Rob Lowth
“Homeless services should be cost-neutral to the organisation delivering them and, in fairness to the HSE, the Department of Housing and the Department of Health, we all get that,” Lowth said. “We have to realise that it has to be a cost-neutral service to make it viable.” He added that voluntary organisations, by their nature, would always do more to help individuals with their own charitable money, but State-funded services had to deliver their own outcomes and Housing First was the most closely monitored such programme.
While new Housing First contracts will still be for three years with a possible extension, there will now be provisions for annual reviews and corrective actions if needed. This means that services provided to some tenants may transfer to a new, better-performing operator over time – without the person having to move home, Lowth clarified, as the accommodation tenancy itself is legally separate from the social and health supports delivered under Housing First.
National policy is now to add 1,319 tenancies under Housing First between 2022 and 2026, doubling the figure of around 1,000 delivered so far. Lowth says that an increase in spending is planned to match this. A central benchmark is a ratio of one intensive case manager for 12 tenants, to be maintained as the number of tenants grows.
To be clear, does Lowth expect the cost of Housing First for the taxpayer to rise under the revised procurement process? “Ultimately, yes,” he says. “We’ve accepted that. When we actually go to release the projections for each region as part of the tender, that’s going to be very visible.” He won’t be drawn on the scale of cost increases until those projections are published.
*****
The coming weeks will redefine the procurement of homeless services for years to come. While the Housing Agency has emerged as a central point to co-ordinate the outsourcing of those supports to charities, local authorities remain responsible for running the tendering process and ensuring the transparent reporting of its results. The next round of Housing First contracts is unique in that they all take part in the process at the same time.
“Each local authority makes its own decisions on these things, so we’re not exactly sure how this is going to roll out beyond Housing First into other contexts, but we hope that it will be a sort of domino effect of good practice across local authorities,” said Focus Ireland’s Allen.
“In terms of looking at cross-government projects, there will be indications as to how we’re monitoring this and it’s being watched closely by the Department of Housing,” Lowth added.
Shortly after our interviews, the DRHE issued a call for tenders to provide the capital’s outreach service. The contractor sends teams onto the streets to meet rough sleepers and refer them to shelters and other services as needed. The Dublin Simon Community secured the current contract in 2019 for €1.4 million over three years, against an estimated cost of €3 million, and later received an extension. The new call for tenders estimates the cost for the next three years to be €7.5 million.
Comparing tendering documents five years apart shows there have been changes to address the issues raised by Allen and Lowth, albeit only partially. On the plus side, there is a new provision for the DRHE to seek clarification of “abnormally low tenders” and disqualify a bidder if it fails to explain “commercially unsustainable or otherwise problematic” pricing. The procedure has also evolved from an open contest to the constitution of a single-operator framework followed by a negotiated contract, allowing more headroom to agree a final price for the services effectively contracted.
The selection of this single operator, however, remains “on the basis of the most economically advantageous compliant tender” with ultimate cost still accounting for 30 per cent of the decision – though this is now on a part with adequate resourcing.https://datawrapper.dwcdn.net/jYW5I/2/
The Peter McVerry Trust, until now the largest provider of Housing First alongside other support services as well as sorely needed underlying one-bedroom apartments, is working through its own financial difficulties at the precise time when charities must pledge additional capacity for the next round of contracts. Will it be able to do so and meet the qualification criteria?
“I very much hope so,” Lowth says. “They have done fantastic things for Housing First, across the country, not just in Dublin.”
“They have fantastic tenants who’ve really gone on a journey of recovery. And amazing staff, like across the sector – amazing staff doing a great job.”
