Homelessness Contents

6Vulnerable groups and multiple complex needs

68.As discussed in paragraph 38, in order to receive homelessness support, an applicant must be judged as being more vulnerable than ‘an ordinary street homeless person’, which can be an extremely high level. Many homeless people are affected by one or more of poor mental health, substance addiction or experience of abuse. However we have found that while services can be very effective at addressing a single complex need, they may struggle when an individual has multiple needs.

69.When we visited Crisis Skylight in Birmingham, we met several homeless people who told us that services worked in silos without consideration of a person’s wider needs. One young man described visiting a doctor with depression and alcohol abuse and being signed off work without further treatment. He then lost his job and his home and moved into a hostel, where his needs worsened because he did not get the support he needed. He felt that if the doctor had helped him address his issues when he first sought help, he would not have ended up homeless. A Client Needs Survey conducted by St Mungo’s in 2015 found that “41% of St Mungo’s supported housing tenants said relationship breakdown had contributed to their homelessness, 39% said a mental health issue had contributed and 35% said drug use had … All of these problems are known to overlap and reinforce one another”.85 Services tend to focus on a single need, such as mental health or drug addiction, rather than on multiple needs and how the different needs interact with one another. Oliver Hilbery told us “In many situations for people with multiple needs, they simply have so many contacts with the statutory and voluntary sectors that they do not know where to turn”.86

70.Mr Hilbery also told us of the difficulties some services have in dealing with dual diagnoses: “There is a real difficulty in the mental health field about supporting individuals who are drinking or using drugs, for example. Once people have been turned away from that system once, it makes it very hard for them to go back and engage again”.87 Given that significant numbers of homeless people suffer both from poor mental health and substance addiction, this failure to meet multiple needs is troubling.

71.We heard from Ross Symonds about being homeless in Bristol and his difficulties accessing services (see paragraph 64). We also heard that services are not designed with the user’s needs at their centre and that providers can fail to take into account the lives and circumstances of their users:

As a system and a series of services, we expect individuals to act as people would act if they did not have these experiences in their lives. We expect to see them for an appointment at two o’clock next Thursday, for them to meet that appointment and to turn up, and of course that is just not how their lives work. In many cases, they are taking really rational decisions about whether to attend the benefits office to stop their sanction, to go for their mental health care need appointment or to do something else. It becomes very complicated for them.88

72.This makes it much harder for homeless people to access the help and support they need, and makes their homelessness more entrenched. Katharine Sacks-Jones from Agenda told us that “For someone worrying about where they are going to sleep that night that will take priority over addressing their mental health needs. When people do reach the point of trying to seek help, it often is not there or is not accessible to them”.89 The costs of homelessness to the public purse are significant–the annual cost is estimated to be up to £1 billion. Research from Crisis has also shown that tackling single homelessness early could save central Government between £3,000 and £18,000 for every person helped. It is therefore imperative that support services better capture and address all of an individual’s complex needs to help them escape homelessness as soon as possible. They can only do this through a personalised approach, as described by Mr Hilbery:

We have a situation in a lot of the sectors across the multiple needs field, in which services will come out and say to individuals, “We do this; do you want some of it?” Really of course the question should be, “What do you need to do and how might we provide that for you?”90

Mental health

73.Mental health problems are particularly high amongst homeless people. Homeless Link conducted a health audit of over 2,500 homeless people in 2014 called ‘The Unhealthy State of Homelessness’. They found that the proportion of homeless people diagnosed with mental health problems (45 per cent) was nearly double that of the general population (around 25 per cent). 36 per cent of those surveyed suffered from depression (compared to three per cent of the general population) and there were also higher than average instances of bipolar disorder, personality disorder, schizophrenia and post-traumatic stress disorder. Twelve per cent cited a dual diagnosis.91 Witnesses described mental health problems as being “both a cause and a consequence of homelessness”:92 those with pre-existing conditions are at greater risk of homelessness, and the longer someone is homeless the more likely it is that they will develop mental ill health. Research from St Mungo’s has found that four in ten people who sleep rough have a mental health problem, and that these people are over 50 per cent more likely to be stuck sleeping rough for longer than a year.93

74.As discussed earlier in this report, accessing services can be a challenge for homeless people. There is a further difficulty in mental health support services as many people have diagnosed needs, but fall short of the required threshold to qualify for specialist support. Mr Hilbery told us that:

The issue for a lot of people with multiple needs is that their mental health needs fall just below the threshold of access to secondary care. Indeed, a lot of their needs will fall just below the threshold for access to a range of services. They might have a learning disability that is just below threshold and a mental health need that is just below threshold, which pushes them straight back into the primary care field as being their only way forward.94

75.Helen Mathie from Homeless Link also explained that:

They may not reach those thresholds for the referral routes, but also the structure of some mental health services is quite rigid and the lack of flexibility can be a real problem. As we have discussed, we are working with people who may well be very vulnerable. They may have other problems going on with their lives, which makes it challenging to engage in the kind of way that services expect people to engage in, so maintaining treatment pathways and turning up for appointments at set times.95

76.Given the prevalence of mental ill health among homeless people, especially those sleeping rough, it is essential that mental health support services maintain the flexibility needed to deliver effective treatment and that the sum of multiple needs is considered. We recognise that resources for many services are stretched and call on the Department for Communities and Local Government and the Department of Health to review the funding of mental health services for homeless people with a view to maximising their effectiveness at helping people out of homelessness as early as possible. We therefore call on the Government to produce a detailed action plan on how it intends to address the mental health needs of homeless people, including the delivery of outreach support to rough sleepers and assessing the vulnerability of applicants for homeless support. We see this as a priority for the cross-Departmental Ministerial Working Group and will be seeking an update in twelve months’ time.

Vulnerable women and girls

77.There are particular challenges for homeless women, who are at a greater risk of sexual violence, prostitution or engaging in unhealthy relationships in order to access accommodation. The Nia Project argues that women who are homeless or at risk of homelessness will often take almost any measure, including measures that increase their vulnerability to predatory and exploitative individuals, in order to avoid being street homeless.96 Women At The Well, a women-only drop-in centre in Kings Cross, explain that many of their clients report engaging in unwanted sexual liaisons to avoid rough sleeping and to ensure they secure accommodation each night.97 Agenda reported that 28 per cent of homeless women have formed an unwanted sexual partnership to get a roof over their heads, and 20 per cent have engaged in prostitution to raise money for accommodation.98

78.Victims of domestic violence and abuse have an increased risk of becoming homeless. St Mungo’s reports that 44 per cent of their female clients had experienced domestic violence, and 19 per cent had experienced abuse as a child.99 Katharine Sacks-Jones from Agenda told us that:

experiences of domestic abuse can be highly traumatising and lead to women developing mental health problems or to developing problems with drugs and alcohol, which can then make them vulnerable to homelessness. There are obviously some really practical reasons as well. Women often become homeless fleeing a violent relationship so, in trying to escape that relationship, they become homeless. When women are homeless, they are vulnerable to further abuse and violence.100

79.It is clear that homeless women can be subject to particular challenges and risks. However support services do not always cater for the specific needs of vulnerable females, so women may be less likely to engage with services. The Nia Project highlight a survey of homeless women conducted by Crisis which found that that while 60 per cent of the homeless women surveyed had slept rough, only 12 per cent had engaged with any street outreach teams.101 The charity argued that “because homelessness is dominated by an assumption of male service users, it is often the case that services are shaped more with male service users in mind”. Women accessing mixed-gender services “may find they are confronted with former buyers and pimps as they try to access such services”, because the men might be waiting outside even if there are certain times of day dedicated to women.102 Similarly, Women At The Well highlight that many of their clients “report that workers are unskilled and inexperienced in dealing with issues associated with women such as self-harm and eating disorders” and that “Disclosing abuse and violence may be difficult both because of the nature of their experiences and due to additional cultural factors, to a male key worker”.103

80.We heard from Helen Mathie from Homeless Link that only around 11 per cent of homeless accommodation in England offers women-only provision.104 Katharine Sacks-Jones told us that the refuges for women fleeing domestic violence are overstretched and not able to accommodate women with complex needs, such as mental ill health or substance addiction, so such women are turned away. Mainstream, mixed-gender homelessness provision does not offer a safe environment and so “For women with complex needs who are fleeing domestic violence, there is a gap and they can fall between services. Neither on the domestic violence side nor the homelessness side do they cater for their needs”.105 Women who have been victims of domestic violence are particularly at risk of becoming homeless, and there is currently insufficient support to help them escape homelessness. We therefore call on Government to ensure that sufficient resources are available to meet the very real need. We also recommend that the Government review the level of refuges and hostel accommodation for single people and consider providing additional resources for further provision in areas of highest need.

Care leavers

81.Crisis note that 24 per cent of homeless people have been in care,106 which suggests that further support to help the transition from being in care to independence is needed. We heard from three clients of the Children’s Society who were all formerly in care and had experienced homelessness. They told us about a lack of structure to the transition when leaving care. Children in care and in full time education receive support from their local authority until they are 25. However if they are not in education, this support ends at 18. They emphasised to us the “sudden cliff-edge” they encountered when support was withdrawn from them. They also highlighted the fact that very few young people can now afford to leave home at 18 and so continue to receive support from their parents, yet for care leavers the safety net is removed with no option of returning for further support, help or guidance. Care leavers are by definition vulnerable and require additional support (this issue is also considered in the Education Committee’s report on the mental health and well-being of looked-after children).107 Consideration should therefore be given by the Government to review the transition to independence. One of them suggested that care leavers be exempt from council tax until they were 21 to mirror the support other young people would be likely to receive from their family. To help reduce the risk of homelessness for children leaving care, the Government should consider a policy whereby they should not be required to pay council tax until they are 21.

Entrenched homelessness and the Housing First model

82.Originating in the USA and now popular in many European countries, the ‘Housing First’ approach does not require people to address their wider social care and support needs before they are put in long term accommodation, or while they are in it. The approach argues that housing is a basic human right and should be provided immediately and on an open-ended basis. Research conducted by the University of York on the effectiveness of the Housing First model explains that:

People using Housing First services are much more likely to have severe mental illness, poor physical health, long-term limiting illness, physical disabilities and learning difficulties than the general population. They are often highly socially marginalised, stigmatised and lack social supports and community integration. They are likely to be economically inactive and to have histories of contact with the criminal justice system. Rates of problematic drug and alcohol use are also high … Housing and support are also separated, i.e. getting access to housing and remaining in housing is not conditional on accepting support or treatment. Service users are also not expected to stop drinking or using drugs in return for accessing or remaining in housing.108

83.Professor Sarah Johnsen argued that Housing First pilots should be extended in England and told us that:

There is really now consistent compelling evidence internationally from a number of countries that have implemented it using very robust randomised control trial studies and so on to show that it is an extremely effective intervention with people with long-term experiences of homelessness and complex needs, particularly substance misuse issues and/or mental health problems.109

84.The Housing First model appears to have had a positive impact in Finland, where the government delivered two successive Housing First building programmes (PAAVO I 2008–11 and PAAVO II 2012–15). As part of the programmes around 2,500 new dwellings were constructed and 350 new professionals were hired. An international review of the PAAVO programmes explains that “By investing in prevention, and in housing guidance in particular, it has been possible to prevent approximately 200 inhabitants per year from becoming homeless. Most importantly, long-term homelessness has decreased by approximately 1,200 persons from 2008 to 2014, and homelessness continues to decrease”.110 However we are cautious about investing further in Housing First in England because of the severity of England’s homelessness challenge and the scarcity of funding and of social housing. Many people have been on social housing registers for over ten years and are therefore likely to be concerned by what might be seen as a means of jumping the queue. We acknowledge and commend the work delivered through existing Housing First pilots but we believe that resources should be focussed on supporting more mainstream efforts to tackle homelessness and prevent instances of entrenched homelessness.

Ex-offenders and those with No Recourse to Public Funds

85.There is a close relationship between offending and homelessness. Nacro, the crime reduction charity, explain that

One in five individuals being released from custody said they had no accommodation to go to on release, and almost half of homeless people in one survey had been in prison or a young offender’s institution at one point. 15% of newly sentenced prisoners reported being homeless before custody and 12% of prisoners depend on housing benefit to help with their rent before they enter custody. Having suitable accommodation is the cornerstone to effective resettlement, providing stability for the individual to rebuild a positive life.111

86.Despite this close relationship, ex-offenders and those leaving prisons do not always receive the support they need. We heard from Nick Hooper of Bristol City Council about a new initiative to manage resettlement from prison but that “What used to happen to us quite often is, on a Friday afternoon, they would turn up at the housing advice point, having been sent there by the prison”.112 We also note reports following an inspection of HMP Bronzefield, a women’s jail in Surrey, that prisoners had been given tents and sleeping bags on their release in the absence of accommodation. A Ministry of Justice spokeswoman is quoted as saying that “the responsibility for making sure there is housing available ultimately lies with the local authority”.113 This lack of coordination between the Ministry of Justice and the Department for Communities and Local Government is extremely worrying.

87.We are also concerned by the effects of some Home Office policies. Non-EEA nationals may have a right to reside in the UK, but not be entitled to receive any public funds or support. With no recourse to public funds, they are at high risk of becoming homeless or destitute without access to welfare benefits or statutory housing services. Henry St Clair Miller from the No Recourse to Public Funds Network told us that the numbers of homeless people who have no recourse to public funds is not recorded. However the NRPF Connect database records data from 36 local authorities and as of 1 April 2016 “2,305 households were being supported with an additional 4,234 dependants. This is a huge cost. It is a cost to those 36 local authorities of £712,000 per week in accommodation and subsistence expenditure, so about £37 million per year”.114 By restricting individuals’ access to public funds, the Home Office is increasing both levels of homeless and spending by local authorities.

88.Homelessness among EU citizens is also an issue. St Mungo’s highlight data from the CHAIN reporting of homelessness in London where rough sleepers from Central and Eastern Europe have increased 77 per cent from 1,526 to 2,695 between 2011/12 and 2014/15. The charity explains that:

EU migrants now have very limited access to housing benefit and so if they are not working it can be extremely difficult for them to pay any rent. This also makes it very hard for them to access hostel or supported housing services which depend on income from housing benefit to cover housing costs … Consequently, homelessness services must find different ways of working in order to effectively support different groups off the street. This takes time and resources which are not always available.115

89.The Regional Asylum Activism project explains that asylum seekers awaiting a decision on their refugee status are effectively not allowed to work. They receive £36.95 a week (£5.28 a day), from the Home Office to pay for their food, clothing, toiletries, transport and other essential items. This support, known as Section 95 support, is equivalent to 52 per cent of Income Support. At the end of July 2015, more than 3,500 people had been waiting more than six months for an initial decision on their application. Regional Asylum Activism argue that many people whose applications are successful, nonetheless become destitute because they are given 28 days to leave their Home Office accommodation, and that this is too short a time to secure a new home and work.116 We support the restriction of access to the welfare system to those who have a right to reside in this country and efforts to return people who have no such right to their country of origin. However we must also acknowledge that the policies behind the Home Office’s actions affect councils’ spending and levels of homelessness. As Mr St Clair Miller explained, “if the game plan around driving up more voluntary return does not work, it is not actually the Home Office that carries that financial risk or that risk to society. That is a risk for local authorities, the voluntary sector and the homelessness sector. There has to be some pushback and some balance in this area of work”.117

85 St Mungo’s (HOL99) para 2.3

86 Q132 [Oliver Hilbery]

87 Q132 [Oliver Hilbery]

88 Q132 [Oliver Hilbery]

89 Q132 [Katharine Sacks-Jones]

90 Q139 [Oliver Hilbery]

92 Q130 [Katharine Sacks-Jones]

94 Q130 [Oliver Hilbery]

95 Q131 [Helen Mathie]

96 Nia Project (HOL19)

97 Women At The Well (HOL35)

98 Agenda (HOL133) para 1.4

99 Agenda (HOL133) para 1.3

100 Q145

101 The Nia Project (HOL019) para 1.1

102 The Nia Project (HOL019), para 4

103 Women At The Well (HOL35)

104 Q146 [Helen Mathie]

105 Q146 [Katharine Sacks-Jones]

106 Crisis (HOL74), para 6.3

107 Education Committee, Fourth Report of Session 2015–16, Mental health and well-being of looked-after children, HC481

108 University of York, Housing First in England: Research Executive Summary, February 2015

109 Q226

110 Ministry of the Environment, The Finnish Homelessness Strategy: An International Review, March 2015, page 3

111 Nacro (HOL143) para 1

112 Q107 [Nick Hooper]

114 Q154

115 St Mungo’s (HOL99) paras 3.16-3.17

116 Regional Asylum Activism North West (HOL75)

117 Q158

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3 August 2016