Today, St Mungo’s put forward a written submission to the Independent Review on Drugs by Dame Carol Black. Here Emma Cookson, Senior Policy and Public Affairs Officer at St Mungo’s explains what this review means and the primary calls St Mungo’s is making towards it.

This is the second part of the review which is examining drug prevention, treatment and recovery (the findings of the first part were published in February this year).This is a huge opportunity to reflect the needs of St Mungo’s clients, and the many other hundreds of thousands who are homeless and face multiple layers of disadvantage.

Sadly, as we are all too aware, there is a significant relationship between homelessness and drug and alcohol problems, which becomes even more pronounced amongst people sleeping rough. Data from the Combined Homelessness and Information Network (CHAIN), a multi-agency database recording information about people sleeping rough in London, shows that 62% of people sleeping rough had a recorded drug or alcohol need in 2018-19.

And it’s not just that people who are sleeping rough have a higher likelihood of drug use – they are also more likely to die from it. The Office for National Statistics (ONS) data shows that in 2018, 726 people died while rough sleeping, with a staggering 40% of all those deaths related to drug poisoning. And it’s getting worse. The St Mungo’s Knocked Back report earlier this year showed that the number of deaths caused by drug poisoning increased by 135% between 2013 and 2018 and by 55% in just one year in 2018. This is an alarming increase.

For many of our clients, drug use, alcohol use, poor mental health and homelessness are interlocking and mutually reinforcing problems. CHAIN data shows that over half of all people with a recorded drug and alcohol problem have a co-occurring mental health problem. These problems create a vicious cycle from which it is hard to escape. If you just address one of these without tackling the other, you are unlikely to be successful. But this is all too often what the current system does.

A St Mungo’s Manager set out the disjoint between systems:

Someone goes into prison and whilst they’re in prison they’re detoxed. But then they’re released and told to go to housing department who say they’re not priority need. They’re then picked up by an outreach team and the only place available is a hostel where there are lots of drug users. This isn’t going to help them in their recovery.

The vicious circle continues. 

Health, homelessness, and drugs and alcohol services are all designed and funded as if people fit into one box, rather than the reality that people’s problems are complex and interwoven. They cannot be addressed one-by-one but need to be approached holistically.

This is why in our written submission to the Black Review we’re calling for the following:

• Integrated, person centred and holistic services.

To best support people we need integrated support and housing pathways, with a treatment package arranged for them in a way which works for them in that particular point in their recovery journey. One of the best ways to do this is through increasing joint commissioning and explore longer contracts. This would help health, homelessness and drug and alcohol services to work better together and encourage them to treat clients holistically rather than providing insular support related only to one need, whilst clients are caught in the gaps in between services. Longer contracts provide the time to build practice and culture change.

• Access to affordable and appropriate housing.

Access to affordable and appropriate housing can act as both prevention and cure for drug misuse. Therefore we want the Government to improve access to truly affordable housing by increasing investment to build 90,000 homes for social rent every year for 15 years, and improving security for tenants in the private rented sector by, for instance, re-aligning Local Housing Allowance Rates to cover the 50th percentile of local rents. There also needs to be an expansion in Housing First services (backed by sufficient funding) and an increase in supported housing provision. This would help prevent individuals from becoming homeless, and rapidly relieve their homelessness if they are forced to sleep rough.

• Further funding for drug support services.

There needs to be more funding for services which are interlinked with drug misuse, such as homelessness support services, to support an integrated approach which looks at the whole system and situations which both cause and exacerbate drug misuse. Previous research from St Mungo’s has shown that £1 billion less is being spent on housing related support services per year (which help many people with complex needs, such as drug misuse, gain and retain accommodation) than a decade ago. We are therefore recommending that the Government invest an extra £1 billion a year in services that prevent homelessness and end rough sleeping. This money should be ring-fenced so it can’t be spent on anything else. This echoes our calls in our Home for Good campaign. 

This review is timely. In the midst of this global pandemic, the health inequalities suffered by those who are homeless have become even starker. This is a chance to put forward bold solutions, which recognise the need to see drug prevention and recovery as interwoven with other systems and services. People aren’t boxes — they have messy, complex lives. We need a whole systems approach which recognises this, so that we can effectively help people.