Blog: Understanding and a compassionate approach to addressing multiple and complex needs
Today’s bumper edition of Homeless Spotlight sees Streetwork highlight its women’s project alongside a blog from its CEO Kenny Forsyth and an interview with a Streetyouth practitioner.
Too few of us understand that people who are homeless face both a wider and a deeper set of challenges than homelessness itself. The wider set of challenges tends to be the more obvious and includes drug use, alcohol problems, mental health issues and poverty. These are the issues that support services are usually aligned to.
Drug services deal with drug problems, housing services deal with housing problems, state benefits alleviate poverty and so on. These wider issues are multiple, exist concurrently and indicate people with complex needs. For individuals with multiple and complex needs their addictions, mental health problems, poverty or homelessness are however only the presenting issues.
What is misunderstood and often ignored is that the person is also wrestling with the deeper issue of dealing with past trauma and adversity. Trauma that is most often suffered during childhood.
Extensive research indicates that childhood trauma and adversity is most often the root cause of the multiple and complex needs experienced by adults. To put it more simply, appalling childhoods lead to recurring homelessness. People whom have experienced trauma and adversity through childhood are amongst the most vulnerable and disenfranchised in society. They can appear to be stuck in a recurring cycle of failed intervention and life expectancy is low with the average age of death for a homeless person in Edinburgh being 39.
The impact of childhood adversity and trauma, at its core, is that the ability to build and sustain relationships with others (individuals, organisations or communities) is either damaged or was not built in the first place. Without sustainable relationships people become isolated and lonely. For many it is not a question of recovery – that implies that there was something lost that can be recovered, rather it is often a process of discovery – building as adults the components for living that were missed or disrupted in childhood.
The person ends up excluded from society and the specific services that are trying to help. It is often assumed that it is the support organisations that exclude individuals due to chaotic presenting behaviours, and that is sometimes true. It also is true however that it is the individual themselves that can drive the exclusion.
If a service (a GP for example) offers care to an individual and, because of childhood experience, ‘care’ to that individual effectively means ‘pain’, then it is not surprising that the person rejects the care because their perception is of this being painful. Exclusion and loneliness are the outcomes. Loneliness alongside homelessness is a killer. Society – in general - does not realise this.
Resolving homelessness is not therefore just about housing. Any effort to support people must understand the requirement to build, over time, an individual’s ability to make and sustain relationships with others as well as providing them with a home. Likewise, wherever the home is, any effort to integrate people who have severe complex needs must recognise that the surrounding community will struggle to build a relationship with an individual who struggles with relationships. The community will need support also.
Possibly this may seem to the observer to be, although a severe problem for those involved, a very small problem in terms of numbers of people and impact upon society generally. This is not the case. In the first instance the moral case for helping is absolute. The individual’s circumstances developed during , childhood, when all of society should have been ensuring their emotional and physical well-being, but failed to do so. On top of the moral case there is the economic case.
A random sample of Streetwork’s active case files shows that 45 per cent of people who use our services have three or more presenting complex needs. Streetwork supports over 2,200 people per year. This means that there are at least 1,000 multiple and complex needs individuals in Edinburgh and therefore potentially between 10,000 and 15,000 in Scotland.
Some will be on the street rough sleeping, some are in temporary or supported accommodation, some are in their own homes (for a time), some are in prison and some are in hospital. Because of their experiences people churn through these various places (forms of accommodation). The root cause of the churn is the person’s inability to access services (statutory or 3rd sector) which properly helps them with their root relational issues. The churn costs money.
Recent research by academics indicates that the financial cost to treasury of a complex needs individual can be between £22k per year to £50k per year. These numbers lead to a conclusion of between 0.1 per cent to 0.2 per cent of the Scottish population costing society up to half a billion pounds per year. This is a significant percentage of the Scottish budget (up to 2 per cent).
On this basis not only is the moral case for helping clear but the economic case is unambiguous. It costs between £5k and £10k per person per year to provide appropriate on-going support (for as many years as it is needed) in order to save the country £10k to £40k net per person per year. This is an enormous saving.
The most fundamental things that a human being needs are somewhere to feel safe, a home, and secondly the warmth of human relationships around them. Remove either of these and a person begins to fail. To give a person just a home therefore is not enough – we need to work with people in order to help them build the emotional components for living that were not built in the first place. It takes time and effort. If we can do this we will move our country and society forward considerably.
Also from Streetwork…