Blog: Homelessness and complex needs – insights from across the UK

In her guest blog for Shelter Scotland, Anna Evans (of Anna Evans Housing Consultancy), offers some insights into homelessness and complex needs from around the UK.

A comprehensive study on homelessness in Glasgow led by Anna Evans Housing Consultancy has provided valuable insights from local authorities across the UK on how to meet the needs of homeless people with complex needs. But what do we mean by homelessness and complex needs? Also termed as multiple exclusion homelessness, it’s the extreme end of homelessness – often associated with chaotic lifestyles, repeat homelessness, experience of drug or alcohol dependency, mental health issues, criminality/ASB issues, and rough sleeping. The majority are male, single and aged 25-59 years old. While homeless applications are on a downward trend in Scotland, homelessness is increasing amongst single males, some of whom will have complex needs.

A large body of evidence has been building over the last decade on the causes of, and ways of addressing, homelessness and complex needs. Going back to 2007, the Mental Welfare commission for Scotland published “Not my Problem”, a shocking story of how Mr G died prematurely due to health, social work and housing passing the buck between services. There will be many other unreported stories like Mr G across Scotland. The report showed that complex and multiple needs are often seen as too risky for community based services and the alternative is a vicious cycle of homelessness, prison, hospitals and longer term care.

Later the JRF Multiple Exclusion Homelessness Research Programme (2011) discussed the inextricable link between housing, health and social issues; that homeless people with complex needs do not fit neatly into existing service compartments, with homelessness and housing agencies often left to take the lead, but are left isolated and find themselves out of their depth.

In response to the clear evidence on ineffective, and inefficient responses to people with complex needs, many local authorities have been undertaking fundamental reviews of their approach. Key findings from the comparative research undertaken as part of the Glasgow study showed:

Systemic and transformational change is needed to change culture around responses to “deserving and undeserving” clients, to break down organisational boundaries and silos between departments and the lack of responsibility and ownership for complex / multiple needs cases.

Effectiveness and efficiency are key drivers in making transformational service change, as homeless people with complex and multiple needs are commonly said to make up around 20 per cent of the homeless population but take up 80 per cent of service resources.

Commissioning of services has to be truly integrated. Traditionally, commissioning strategies have limited the ability of organisations to effectively tackle complex needs. Internal competition within commissioning along the lines of different client / care groups means that services are unable to deliver a truly integrated service.

Keeping hold of clients or ‘stickability’. This means using assertive outreach and sticking with clients – finding ways to build trusting relationships, including the use of peer mentors and flexible support options that may be needed for a long time.

There needs to be a range of different housing and support options, some of which may not be permanent, but will be long term temporary options. Many local authorities are now operating, or are moving towards accommodation pathway models, to provide structure, clarity and accountability.

Housing First models have been used with great success in a number of the comparator cities. The most successful element of these projects is the attention to intense wrap around and flexible support. Turning Point’s evaluation can be read here.

Using specialist, highly skilled staff, and Psychologically Informed Environment (PIE) approaches where the focus was on improving service users’ experience of services, making them feel valued and empowering them to make long lasting changes in their lives. A Good Practice Guide to Psychologically Informed Services for Homeless People provides a useful guide and case studies.

Supply crisis means the aggressive use of PRS - All of the local authorities experienced similar housing supply pressures and all used the private rented sector extensively to increase supply. There was considerable emphasis on dedicated move-on or move-through teams who played a central role in procuring a supply of private rented accommodation to help prevent “silting up” of temporary accommodation.

Read the full detailed research report on Homelessness and Complex Needs in Glasgow, 2014 (Anna Evans Housing Consultancy in association with Emma Davidson, Mandy Littlewood, Susan Solomon).

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