The new NHS plan for mental health services has a clear offer for people sleeping rough

For organisations who have campaigned for many years on homeless health, the NHS Mental Health Implementation Plan is a cause for celebration. Beatrice Orchard, St Mungo’s Head of Policy, Campaigns and Research, explains why the plan must deliver on its ambition to make sure everyone sleeping rough can access the mental health support they need.

When the Government’s Rough Sleeping Strategy was published exactly one year ago by MHCLG, there were some positive signs that other government departments would also be doing their bit to reverse the dramatic rise in the number of people sleeping rough in England.

One of the most solid commitments was in relation to improving mental health support for people who are sleeping on the streets. Last month, the details of this commitment became clearer when the NHS Mental Health Implementation Plan was published.

The plan is clear that by 2023-24, 20 areas with high levels of rough sleeping will have established new specialist mental health provision for people sleeping rough, which will be made possible with £30m of central NHS funding invested for this specific purpose.

This is a fantastic result for St Mungo’s Stop the Scandal campaign and our continued efforts to press the Government for investment in specialist mental health services to ensure people sleeping rough can access the support they need.

Sleeping rough and mental health – the links

It is fairly easy to understand that sleeping rough has a negative impact on a person’s mental health and wellbeing, as well as their physical health.

Evidence shows people sleeping rough are 17 times more likely to be victims of violence compared to the general population. News reports describe horrifying attacks and abuse on people sleeping rough and our clients tell us about their experiences of feeling lonely, frightened and even suicidal.

Furthermore, we mustn’t overlook the fact that some people sleeping rough have already been through many traumatic experiences in their lives, including violence and abuse from a young age.

All of these experiences can cause mental health problems to develop or worsen, but also impact on the type of mental health support people need and how easy they find services to access.

New avenues into support

The new, NHS-funded, specialist services will make sure that people sleeping rough can access to clinical mental health support by integrating with existing homeless outreach, accommodation and physical healthcare services.

They will be required to adopt a trauma-informed approach, known to help improve the psychological and emotional wellbeing of people with complex needs. We also expect the new services to help people who have drug and alcohol problems and are currently excluded from some mainstream mental health services as a result.

This specialist support breaks down all of the barriers people sleeping rough often face when trying to get help to improve their mental health. Really effective specialist teams can also influence mainstream health services in their local area, encouraging them to become more knowledgeable and understanding of the needs of people who are sleeping rough.

So far, so good. But what about people sleeping rough in other areas not in receipt of this new funding?

A welcome step forward

Research shows 4 in 10 people sleeping rough in England have an identified mental health problem. The latest data from the CHAIN reports on rough sleeping in London shows 50% of people sleeping rough in the capital in 2018-19 had a mental health support need.

It is welcome, therefore, that the new plan for mental health requires all areas of the country to complete a mental health needs assessment for people sleeping rough and take action to increase access to mental health services for this group.

This new approach to mental health for people sleeping rough is a real step forward.

Specialist mental health services have been tried in the past. We know they can make a dramatic difference to individuals’ lives, and help to reduce rough sleeping by supporting people to move on from homelessness for good.

Better still, it doesn’t stop with specialist services this time. Instead all NHS services will need to think about how people sleeping rough can access the healthcare they need in order to rebuild their lives.

St Mungo’s will be watching closely and encouraging all areas to ensure the plan delivers.

Creating change for women facing homelessness

St Mungo’s has published a new three year ‘Women’s Strategy’ setting out how we plan to improve our services for women and influence policy on women’s homelessness. Our Women’s Strategy Manager Cat Glew introduces our approach.

Five years ago St Mungo’s published our ground-breaking Rebuilding Shattered Lives research into women’s homelessness. We found that homelessness services are often designed with men in mind, and were often failing to support women effectively.

Sadly, it remains the case that women facing homelessness are still at a disproportionate risk of harm from those they love and trust, alongside the existing dangers of homelessness. Since 2014 a growing body of evidence has highlighted the connections between women’s experiences of violence and abuse, poor physical and mental health, substance use and homelessness.

According to the latest figures, 642 women sleep rough on any one night in England, up from 509 in 2016. Many more women are likely to be experiencing hidden homelessness – seeking shelter with abusive partners, squatting or sofa surfing with friends and family – so may be missing from the statistics.

Women’s homelessness often occurs after prolonged experiences of trauma, including physical, sexual and emotional abuse by those closest to them. Violence and abuse are both a cause and consequence of women’s homelessness, with women experiencing further abuse, exploitation and violence while homeless.

Women-only spaces are a matter of safety for many women. Despite this, just 7% of homelessness services in England offer women-only provision, according to data from Homeless Link.

Our greatest challenge and our most important aim is to create an environment of physical and psychological safety for women in homelessness services. We’ll be working hard to make sure that each of our female clients has a safe place to live and has every reason to feel safe in our services.

We know that funding for women-specific work is falling, but we also understand that our female clients cannot wait for the Government to prioritise women’s homelessness.

As a homelessness charity, it is our responsibility to make sure that we are achieving the best possible outcomes with women, as well as men. We have made the decision to make women’s safety and women’s recovery a priority. Our new Women’s Strategy sets out some ambitious aims that will help us improve our practice and influence government policy.

Our ambitions for the next three years include:

Offering women-only services and spaces as an option for all female clients, at every stage of their recovery
Supporting and equipping St Mungo’s staff to better recognise and respond to violence and abuse
Improving rough sleeping services so that they are even safer and more effective for women
Working with specialist agencies to offer individual support to women around domestic and sexual abuse

There’s plenty to do, but I’m really looking forward to working with all our clients, staff and partners to make our ideas a reality. Listening to the ideas and experiences of St Mungo’s women is an amazing privilege and the very best part of my job. I hope that partners, politicians and the public will read our strategy and join us as we create change with women facing homelessness.

Read our brand new women’s strategy here

‘I’ve come a long way’

Mohamed left care at 16, has lived in numerous hostels and is now on an FA Coaching course at Fulham FC. He shares his excitement about the opportunity he’s been given.

I came to the UK as an unaccompanied child refugee. I moved from hostel to hostel. In the place I last lived, when you get to certain age they ask you to move on. I always thought I’d stay there until I was ready to move on. I left care when I was 16 and had to adapt and grow quickly.

I’m 23 next month, so I’ve come a long way. I adapted by avoiding getting in trouble and negative situations. I started to realise that time is valuable. I also learned not to get involved in things that don’t benefit me. If you don’t have a good set of friends, you can get into trouble. When you’re younger, you’re exposed to a lot of things, like going clubbing, or just being out with your friends. I’m really happy that I avoided getting in trouble.

Independence at 17

When I was 17, I had just become independent. A lot has changed – I am more tuned in. I have adapted – no more wasting time, allowing it to go past me. When you get older, things become a little different. You have to fend more for yourself.

The best thing you can have is positive support. I have the best support from Jackie, my St Mungo’s support worker and the manager, Octawia, also David, another support worker, they have advised and all supported me. I’ve been in hostels since 2011 and I’ve come across a lot of support workers in 10 hostels. I can honestly say this is the best support I’ve had from St Mungo’s.

Jackie understands me. She talks and explains things to me like a human being and actually helps me – that is sometimes rare to find in hostels. I think that everyone who lives here would say the same thing. There’s no way I’m not going to take advantage of any opportunities.

I never had any professional relationship with my keyworkers before. When I got inside the hostel, I lived in my room until I got moved out. There was no following up with things. My support worker is always encouraging me to achieve as much as possible and to focus on what I need to achieve.

Opportunities make life better

It’s great having the opportunity to do things – that’s what makes life better. I’ve lived in hostels since 2011 run by different organisations. The opportunities were there before, but they were quite limited because of where I was. They would only help you with the main things like studying or working. There weren’t the extra opportunities.

Now I‘m on a Football Association (FA) Level 1 Coaching Course at Fulham Football Club which comes with qualifications. I was referred to it via another course through Arsenal FC – my support worker, Jackie, was the link.

When I started at Arsenal FC, it gave me great motivation. I eventually got this opportunity which is consistent. The Arsenal FC course was eight weeks, which finished. I get to play a lot of football. Joining this course has helped to strengthen my position on the Homeless World Cup Team. We’re going to Russia next year. The tournament was in Brazil four years ago. Playing Brazil has been one of my dreams.

‘I’m humbled by the opportunity I’ve been given’

I’m also involved with Become, the charity that helps young care leavers. Life is better. I’ve given up smoking – I gave up six months ago. I started smoking when I became independent due to the stress. After six years, I finally gave up. It’s one of my biggest achievements. My social worker has seen a dramatic change in me.

I’ve just started at Fulham FC. I’m humbled by the opportunity I’ve been given. It’s really exciting. I get to be at Craven Cottage. I’m considering becoming either a trainer or a support worker with young people, to inspire them if they want to achieve – anything is possible. I feel like I’m doing something with my life. Being at Arsenal was exciting but Fulham is more exciting because of the added qualification. I get to go and watch matches, something I never had a chance to go do – it’s really nice and I’m grateful.

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