Homelessness is not a single issue say REACH team members Dr Stephen Donaldson, Ben Sweeting, Richard Croall, Emily Crowe, Hanna Powers, Sandra Rees, Luke Jarvis and Claire Robinson.
Read it here in DDN magazine
When COVID-19 hit it was clear that we had vastly underestimated the number of people who were homeless, and at its peak several measures were put in place to ensure that those experiencing homelessness were temporarily housed.
It has been well established that homelessness is not a single issue, with many people experiencing a variety of complex needs – including mental health, substance misuse, physical health, adverse childhood experiences, neurological difficulties and self-harm, all of which impact on a person’s stability, health and wellbeing. It has been well established that these complex needs, if not addressed, have the overall impact of reducing life expectancy, which is lower among the homeless population compared to other clinical populations. One of the reasons for this is that those with complex needs often sit within the gaps of statutory services, which leads to limited engagement and treatment access. The result is a person left feeling unable to be helped, living day by day, and feeling that they are constantly at the ‘wrong door’.
Substance misuse and mental health issues are prevalent within the homeless community, and have been shown to both increase the risk of – as well as maintain the cycle of – homelessness. While the issue of causality is complex, the reality is that those experiencing complex mental health and substance misuse issues can be harder to house, can find it hard to maintain their tenancy, are more open to abuse and exploitation and ¬– from our experience locally – are more likely to continue a cycle of fluctuating between a tenancy and the streets.
To address the needs of those experiencing homelessness locally in Scarborough and Whitby, Scarborough Borough Council, alongside partners in health and social care, took an innovative approach in early 2021 and decided to develop a multi-agency partnership team where the identification, assessment, housing and care needs of people who were experiencing homelessness could be addressed. The team is informed by a Housing First approach to support stability and help people move out of homelessness and into recovery.
Housing First is an evidence-based approach that aims to provide housing stability to those who have complex and repeat experiences of homelessness. For many of those experiencing homelessness, a psychologically safe place where they can address these needs can feel unrealistic and extremely challenging. The result, sadly, is that people often share with us that they experience a vicious circle which is hard to thrive and survive in. The aim of a Housing First approach is therefore to support people to access housing and have the help they need to maintain their tenancy, while also offering an intense and personalised care approach alongside their accommodation needs. The hope is to ensure that homelessness is addressed alongside the wider health and social care needs people are facing.
REACH stands for reducing exclusion for adults with complex housing needs, and the team consists of housing, mental health and substance misuse practitioners. By having a multi-agency, multi-professional approach the hope is that stability can be achieved – both physical stability in terms of housing, as well as psychosocial stability through consistent tenancy support, social engagement, substance misuse and mental health interventions. As the person’s needs are being assessed, formulated, and addressed by a multi-agency team, therapeutic attachment with the team supports a therapeutically consistent, collective and psychologically safe approach to the person’s care.
As a team we hope to help as many people as we can to transition from homelessness into housing and recovery. This is not without its challenges, but by holding a collective partnership approach with the person, as a team and within a wider multi-agency approach, we are more likely to make this possible. In essence, togetherness offers the hope that while the road of change can be bumpy, stability, safety and recovery can be a possibility.
Dr Stephen Donaldson is consultant psychologist, Ben Sweeting is advance nurse practitioner and Richard Croall is dual diagnosis nurse at Tees, Esk and Wear Valleys NHS Foundation Trust
Emily Crowe is rough sleeping co-ordinator, Hanna Powers is housing support officer and Sandra Rees is community safety and safeguarding manager at Scarborough Borough Council
Luke Jarvis is holistic support advisor at Beyond Housing
Claire Robinson is health improvement manager at North Yorkshire County Council