St Mungo’s CEO, Emma Haddad spoke this morning at the Association of Directors of Adult Social Services (ADASS) Spring Seminar on the subject of women’s homelessness.

“I’m the chief executive of St. Mungo’s. It’s a homelessness organisation, many of you probably have come across us. We support around 30,000 people per year who are experiencing homelessness or recovering from homelessness. And of those we accommodate, we have we provide beds for around 3,000 people per night.

And it’s an important day to be talking about homelessness. The latest stats figures for rough sleeping in London were released this morning, just about an hour ago, and show yet again, an increase in the numbers sadly, although not surprisingly. So we’ve just seen a 14% increase in the last quarter of last year of the number of people sleeping rough in comparison with the same time last year.

And when you look at the annual figures, which were released not long ago back in February, they gave a snapshot of a of a night in autumn 2022, and that showed a 26% increase in the number of people sleeping rough in England, England wide on the previous year. Of those people 13% were women.

What do we know about women sleeping rough and women who are homeless? We know actually that we’re not looking at the true figure. Because sleeping rough and being homeless can often exacerbate the risks and the dangers to women. And we know that they are often hidden, hidden from the figures hidden from street counts and therefore hidden from help as well a lot of the time. So whereas you often find men who are homeless are actually bedded down on the street and visible and able to access outreach teams and that kind of thing, women often keep moving or they will hide themselves away, or they will sleep on public transport and that kind of thing. So that 15% figure is not the true figure.

So that just gives you a bit of context of some numbers and women within those numbers. And then in terms of complexities with which women who are homeless present, they are stark – the health inequalities that homeless people in general face are stark. The average age of death, tragically, for people who have experienced homelessness is incredibly low. It is 45 years for men and is 43 years old for women. And women have physical issues, mental health issues. They are often engaged in high risk substance use and alcohol, and trauma underpins most of their experience of homelessness.

Let me just give you a few facts and figures to illustrate some of some of these health needs. So trauma is usually present in almost every client that we work with and support in St. Mungo’s who has experienced homelessness: trauma from childhood from neglect; from family breakdown; from poverty; as well as from what they’ve experienced in adulthood or might still be experiencing in adulthood. And domestic violence is a big part of that sadly for women. And in 2018, research from the University of York said experience of domestic violence and abuse is near universal amongst women who become homeless.

That trauma as I said, can be due to lots of lots of things. That domestic violence can be continuing even when they’re seeking refuge and support and have become homeless. We also know sadly, there are lots of people who can’t leave the perpetrator. This is often people who have limited status in the UK and it’s very hard for them to find alternative places to sleep because they don’t have access to benefits or services. And so they can kind of find themselves trapped. That trauma can also come from experiences of parenthood, and almost half of the female clients that we work with and support in St Mungo’s are parents and the level of contact with their children varies. Some do have contact some particularly through social media or that kind of thing, but a good half have had their children taken into care or adopted and many have separated permanently and have no contact and that is a another thing that adds to the trauma quite clearly and adds to the mental health implications and often the substance use as well.

And then in terms of physical health, in 2021, I’ll give you figures just from about a year ago, but 57% of the women we were supporting in any of our accommodation services had a physical health need, 81% had a had a known and assessed mental health need, 32% had alcohol related health support needs, and 49% had drug support needs. So the health implications of women who’ve experienced homelessness are acute and high. And it’s often all of those things all together. Women can present as homeless, with substance misuse, with alcohol misuse, with trauma, with domestic violence going on. And we’ve got physical and mental ill health so recovery is extremely, extremely hard.

What we found is probably stating the obvious a bit, but women only support services are key to that recovery. And can make a massive, massive difference although sadly, they are in short supply. We have around four women only services across St Mungo’s. We know that asking women to come in for support in hostile environments or temporary accommodation where it’s mixed, that mixed environment will probably be predominantly men. We often try and separate people out and have women only corridors or floors of buildings but they often don’t even feel safe coming into that kind of environment and will prefer to go back home where it’s not safe or stay on the streets moving around where it’s where it’s also not safe. So very, very hard to help women recover in those mixed environments and make them feel safe.

In 2018, again a slightly out of date figure, but I don’t think it’s changed dramatically: only 11% of the homelessness accommodation services in England were women only and that had come down from 13% a few years previously. And due to that, some of the refuge accommodation for women particularly who have been experiencing domestic abuse or violence is not appropriate for our client group, they won’t necessarily take clients women with drug or alcohol addiction and often don’t have the specialists support and staff on site for those with severe mental health needs. And so, we found that women only support services or women only accommodation environments are absolutely key and have such a positive effect on the recovery, and the building of trust, and the working with women to help them recover and move forward in their lives.

One of the other things that we’ve been running and trialling is what we’ve called the safe space psychotherapy service. And this has been running in North London across the Camden homelessness pathway. And what it’s there for is a trauma informed therapeutic service. It’s there for women who’ve experienced trauma or homelessness, multiple disadvantage complexity and who might otherwise struggle to access traditional therapeutic services.What do I mean by that? Often they’re put off from approaching surfaces because of the trauma or a historic trauma because of their previous interactions with services and that kind of thing. And building trust is really, really hard. It’s also hard for people with slightly chaotic lifestyles, to keep their appointments, even things like that. So what we’ve had is a therapist who comes into our services at known times each week, moves across the different services. It’s an open door policy people can drop in no appointment, no referral, no assessment, no judgement. Women can pop in when they want to. They can stop coming if they want to. But that doesn’t mean that their case is closed. They can come back when they feel they want to as well.

And we’ve found that you know even just dropping in for a chat or going for a walk or having a cup of tea without a formal plan as such necessarily, can be massively positive. We’re just taking that through an evaluation at the moment and seeing what we’ve learned from that and whether it’s a good model to roll out, but we’ve certainly seen some benefits for women in our services in terms of social care more generally.

A year ago we published what we call the Life Changing Care report about the care needs of those who are homeless. 5% of our clients are believed to have dementia, 12% experienced self neglect, and 29% have deteriorating health. 24% we found were not receiving the care that currently meets their needs. As I said earlier, we know that homelessness and rough sleeping in particular can cause all sorts of health, physical and mental health issues. People experiencing homelessness have premature ageing frailty, life changing and life limiting health conditions and in the extreme a very, very early death. So there are extraordinary care needs.

Sadly, there are very, very few residential care services that cater for people with those needs. We actually run a couple of care homes specifically for men who have been homeless and who generally still have a high alcohol addiction and but they wouldn’t have been able to access mainstream care homes. It’s not necessarily that care homes exclude people who have experienced homelessness but often due to the complexity of their needs, they’re in effect excluded because they can’t be cared for appropriately.

But there are other issues around the care system. There are issues with long delays in waiting for assessments, accessing assessments, and as I said earlier, a system that isn’t designed to cater for the very specific needs often have clients who, and women in particular who’ve experienced or are experiencing homelessness. So barriers in terms of their addictions, barriers in terms of people who may struggle to keep appointments and interact with practitioners.

Without those support services to meet their needs, interventions aren’t either available to meet the needs or they’re not meeting all the needs and that means that women in particular, but people who’ve experienced homelessness in general can get stuck. They often get stuck in a hostel environment, and it’s very, very hard to help people move on to independent living. If that care structure isn’t going to be there. They’re often very far from being able to look after themselves in the private rented sector, for example, without that kind of support, and can also get caught in that cycle of their health, mental health and physical health not improving, and sadly also ending up back in homelessness at the extreme.

So what can what can ADASS directors do here? What can you help us with in the sector, is a real understanding of the specific needs not just of women but of women who have been or are experiencing homelessness. And what that means in terms of the complexities of what they are experiencing, and how much tailored care and support is really needed for them. It needs to be this very person centred, very trauma informed, very flexible and have that empathy of what women have been through. There’s a huge element of how you build trust with women who’ve experienced homelessness and all of the trauma that that has caused, or the trauma that led to it, and how you build that trust, particularly as well for women who have had their children taken into care to interact again with social services or social care. It’s very, very difficult for many of them.

And I would also suggest that we need much better data. So there is a problem, as I said at the beginning in general about women who are homeless because they’re often hidden from the counts and hidden from their support services. But data in general around the specific care needs of women experiencing these multiple complexities and what kind of service they’re getting and whether that’s meeting their needs. And finally, just a plea for us to work together across the system as we do. There’s more that we can do, because it has such a multifaceted effect on women, and the causes of homelessness are so multifaceted, that it has to be a multi agency, cross system approach to ensuring women get the care to prevent them from falling into homelessness in the first place, ideally. But if they do, making it as brief as possible and helping them recover in a sustainable way so they don’t fall back into homelessness.”