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.

Ending homelessness? Fund domestic abuse services

In May, the Government announced proposals for a new legal duty to help secure the future of domestic abuse refuges. With partners from across the housing, homelessness and women’s sectors, St Mungo’s is calling for support for survivors facing homelessness.

Photo fo Cat Glew, Women's Strategy Manager for St Mungo's St Mungo’s helps thousands of women and men find a home away from the dangers of the street. But home isn’t always a safe place.

Many St Mungo’s clients are survivors of domestic abuse. St Mungo’s data from 2016 shows that at least 54% of our female residents with a history of rough sleeping had experienced violence or abuse from a partner or family member. A 2015 study found that as many as 92% of homeless women had experienced violence or abuse during their lifetime.

Creating safety for people facing harm from those they love and trust is a serious challenge. St Mungo’s works with specialist domestic abuse organisations who support our clients, so we welcome proposals to try to provide a more certain future for domestic abuse services.

Working with housing, domestic abuse and homelessness partners, we have responded to the Government’s consultation on future support for survivors of domestic abuse.

We need a strong, specialist domestic abuse sector who can work with survivors facing homelessness. Only then can Government hope to achieve its aims to end rough sleeping and support all survivors of domestic abuse.

But why would improving domestic abuse support help end homelessness?

1. Domestic abuse puts survivors at risk of homelessness – and vice versa

A third of female St Mungo’s clients say that domestic abuse contributed to their homelessness. Escaping domestic abuse can force survivors to make an impossible choice – live with abuse, or face homelessness.

Trying to keep safe while homeless can also be risky. A study by the University of York for St Mungo’s found that women are often hidden homeless: staying with friends, family, or strangers who expect sex in return for shelter.

Women who do sleep rough can form intimate relationships on the street in order to survive – but relying on a partner for protection can expose survivors to escalating abuse and control.

2. Lack of funding and support is forcing survivors to sleep rough

Funding for refuges and other life-saving domestic abuse services has suffered severe cuts. English local authorities cut spending on refuges by nearly a quarter between 2010 and 2017.

In 2016-17, Women’s Aid found that 60% of referrals to refuges could not be accepted. One in 10 women supported by their No Woman Turned Away project were forced to sleep rough whilst waiting for a refuge space.

3. Support for survivors facing multiple disadvantage is in short supply

Survivors with mental health, drug or alcohol problems are less likely to be able to access specialist domestic abuse services, who are rarely resourced to support them safely.

Women’s Aid research found that 31% of women with mental health problems and 65% of women with substance use problems were refused an available refuge space because of their needs.

SafeLives found that survivors facing multiple disadvantage may be unable to work with local domestic abuse services if they do not have a phone or cannot attend regular appointments.

Survivors with no access to public funds because of their immigration status are excluded from most domestic abuse accommodation because they are not eligible for housing benefit to cover the rent.

4. Survivors without a safe home are left in danger

Under the current legislation, survivors of domestic abuse approaching their local council for help are not automatically considered to be in priority need for housing. Instead, people are required to prove they are additionally vulnerable in order to be owed the ‘main homelessness duty’ – and access to settled accommodation.

Evidence shows that survivors found not to be owed the duty are more likely to return to a dangerous situation. Some end up rough sleeping, sofa-surfing or living in unsuitable temporary accommodation where they are at further risk of abuse and are removed from services that could support them.

Calling for change

The Government has proposed a new duty on local authorities to assess local need and commission domestic abuse accommodation.

It’s a good start, but Government must also confirm ring fenced funding to support those services. The proposed definition must be made clearer to make sure that specialist refuges are rebuilt and protected.

Every survivor deserves support, and we think Government should also provide separate future funding for specialist domestic abuse outreach services to work with survivors facing homelessness.

A new programme of investment in homelessness services is also badly needed. As part of this, we need women-only homelessness accommodation in every part of the country as a safe route away from the streets.

And of course, automatic priority need should be extended to all survivors, so that anyone fleeing domestic abuse in England is guaranteed a safe home.

New homelessness boards

Administrative tinkering or an opportunity to end rough sleeping for good?

Photo of Rory Weal, Senior Policy and Public Affairs Officer — Rory Weal, Senior Policy and Public Affairs Officer

Last week the Government finished its first stage of consultation on a shake up to local authority structures for tackling homelessness. Changes to statutory structures may not be something that gets the heart racing, but when it comes to delivering the changes and funding needed to end rough sleeping for good, they could have a key role to play, writes Rory Weal, Senior Policy and Public Affairs Officer for St Mungo’s.

Rough sleeping – the most dangerous form of homelessness – has risen by 165% since 2010. This is the result of spiralling housing costs, increasing insecurity for private renters and cuts to services that prevent homelessness – all problems that require national Government to act.

And yet, it is actually local authorities who are charged with the primary day-to-day responsibility for tackling homelessness. Since the Homelessness Reduction Act (HRA) came into force last year, this responsibility has expanded to include providing advice and support to anyone at risk of, or experiencing, homelessness.

What are Homelessness Reduction Boards?

The latest government proposal – to create Homelessness Reduction Boards in local authorities – builds on the positive momentum achieved by the HRA, and the Rough Sleeping Strategy, to get a grip on the growing homelessness crisis in England. The proposal is an attempt to ensure all relevant public services and agencies step up as members of these new boards, and they are held to account for their part in preventing and reducing homelessness and rough sleeping.

So far so good. But as many of us know, central Government hasn’t made this job easy for local authorities of late.

A challenging backdrop

Recent research from St Mungo’s and Homeless Link, published last month, shows that local authority spending on services for single homeless people fell by 53% between 2008-09 to 2017-18. This drop is the result of cuts in funding from central government, particularly impacting ‘Supporting People’ services, which focus on helping people to avoid and escape homelessness. Add to this the wider issues of a lack of social rented housing, unaffordability and instability in the private rented sector, and welfare reforms, and we see a dangerous combination of factors which have increased individuals’ vulnerability to homelessness.

So with such a challenging backdrop, how can an administrative change really be expected to deliver the impact required to end rough sleeping? The short answer is that on its own, it can’t.

But there are a couple of reasons why this is a more than worthwhile exercise:

Firstly, because at the local level there is a huge variation in the way any strategic response to homelessness is developed, implemented and monitored. Sometimes this means that elements of the ‘system’, such as health services, are failing to play their part.
Secondly, because we believe these new structures could be the vehicles for central Government to deliver the resources councils need to tackle the problem.

Investing the funding that’s needed

We believe Homelessness Reduction Boards – or a similar set-up where good oversight and accountability is assured – should provide Government with the confidence to invest the extra £1 billion in homelessness services that we know is needed. Having mandatory structures closely scrutinising what services deliver, key partners such as the NHS, prisons and children’s services working to prevent homelessness, and collecting data to demonstrate and respond to this, should satisfy Government that each pound will be spent effectively.

The jury is still out on the impact this could have. As always the devil will be in the detail. The principles of these new Boards, however, seem sound and provide an opportunity to secure the funding desperately needed for homelessness services.

This shouldn’t avert our focus from the other vital changes required – including building more social homes and improving private renting. Only when these solutions come together will we see everyone have a home for good, and a country in which no one faces the injustice of sleeping rough.

Read our full response to the consultation.

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

Helping people sleeping rough from Europe and beyond

Petra Salva is St Mungo’s Director of Rough Sleepers, Migrants and Criminal Justice Services. She has been working directly with people sleeping rough in London for over 20 years and heads up St Mungo’s rough sleeper and outreach teams across London boroughs and south east England. Petra also represents St Mungo’s on a pan European network which shares best practice and ideas across Europe to help reduce street homelessness. In a blog first published on the Huffington Post, she explains how we work to help destitute non-UK rough sleepers to move away from the streets for good, with the right support in place to rebuild their lives.

Every week I hear stories and get updates about people who St Mungo’s outreach teams are trying to help off the streets. I also try as much as possible to meet people myself so I can see first-hand how things are working and understand more about the issues that homeless people face, and the challenges for our outreach colleagues.

Peter’s journey

Recently I heard about Peter*, a 45 year old man from Poland. Peter had lived and worked in Poland and then the Netherlands with his partner for many years before moving to London with hopes of work and a better life here in the UK. However, once in London things didn’t work out as he hoped. After working in construction as a machine operative, his life was turned upside down when the relationship with his partner broke down and she returned to the Netherlands.

Peter dealt with his sudden loneliness by drinking and then moved on to using cocaine. Eventually he lost his job and soon after his accommodation. He, like many others in a similar situation, ended up sleeping rough on the streets of London.

Our outreach team met him on the streets and offered support. Initially Peter refused to engage with us. We didn’t give in though and kept visiting him on a regular basis. Eventually as winter and freezing temperatures set in he became more willing to talk and think about what to do.

Peter began to talk about returning to Poland and getting help with his alcohol and drug use. He realised he could not “get clean” without support and that he couldn’t access treatment in the UK. He hadn’t considered that he might be able to get the treatment he needed in Poland. Through our supported reconnection service, we worked with Peter to make this option a reality.

Getting the right help

My colleagues told me that Peter completed his treatment in Warsaw and is now in full time skilled employment assembling electrical components. Just days before my outreach colleagues met up with him again in Poland he had finally been helped into his own flat. Peter was proud to tell us about his work and show us pictures of his flat where he enjoys having his friends and sister visit him. As they chatted, he reflected on the moment he arrived at the treatment agency in Warsaw and was met by his sister who had gone there to welcome him back.

You might wonder why we couldn’t help Peter to get the help he needed in the UK? The simple answer is he, like many others, had become stuck on the streets. Government policy meant he wasn’t eligible for housing or publically funded support services in the UK. This situation has led many people to become destitute and eventually very unwell on our streets. We know of some who have died.

In London about 57% of people sleeping rough are non-UK nationals. That means their options are legally limited when it comes to accessing housing, treatment services and any other welfare assistance that is possible for UK citizens. Our Routes Home service, funded by the Mayor of London, works with vulnerable people like Peter. Last year, the team helped over 60 people who had really complex and high support needs to voluntarily return to their home country into accommodation and treatment with the support and assistance they needed.

Why couldn’t Peter get help in the UK?

When we met Peter he didn’t have many choices. We didn’t want him to die on the streets of London. We wanted him to have a second chance. That meant persevering with him, and working with many different agencies and being realistic about the legal and practical limitations he faced.

When our outreach teams meet people who are sleeping rough but have no support needs and are able to work, our focus is on helping them to find a job as the only way to stay in the UK and resolve their homelessness. Where people have physical or mental health needs or have issues around substance use, we work with partners in the UK and in people’s home countries to ensure they can receive appropriate housing and support, often through our Routes Home service.

When they have complex immigration issues, we also support people to get legal advice through Street Legal, our partnership with migrant charity Praxis and Refugee Action UK.

Working with migrants who are sleeping rough is challenging and complex work. We often get asked about the approach we take and the partners we work with, in particular what our relationship is with the Home Office in such cases.

Supporting and advocating for our clients

In terms of our approach, our first response to non-UK nationals sleeping rough is always to offer help and support, ensuring people understand their rights and entitlements and, where possible, are provided with assistance to take up options in the UK including work and housing. Where this is not possible, and people are not eligible, St Mungo’s will offer services to provide treatment and housing options in home countries through supported reconnection like Routes Home.

In areas where local authorities have decided to engage the Home Office to take action against individuals or groups of rough sleepers, St Mungo’s outreach teams work alongside the Home Office teams to provide support and advocate on behalf of vulnerable individuals. This decision to be present on the street during such operations means we can ensure that the best solution for vulnerable people is sought and that any work being done with individuals to resolve their homelessness is not jeopardised by Home Office interventions.

I am very clear about our approach, which has been developed over many years and is based on the realities of what we face out on the street every night working with people sleeping rough, often in extremely desperate conditions. Our position is clear: our role is to support and advocate on behalf of people sleeping rough so they can move on with their lives and leave homelessness behind them.

*Peter is a pseudonym but he is happy for us to share his story.

This story was first published on our website in March 2017.

How can we halt the rise in ‘returners’?

Rory Weal, St Mungo’s Senior Policy and Public Affairs Officer, looks at why more people are returning to rough sleeping and why the Government needs to act now to halt a worrying trend

For those of us passionate about ending homelessness there was, for once, some welcome news last week. New figures from the latest annual CHAIN (Combined Homelessness and Information Network) report (PDF) showed that there has been an 8% decrease in the number of people sleeping rough in London.

The 7,484 people who were seen rough sleeping in 2017/18 is the lowest total since 2013/14, although it is still over twice the number seen ten years ago.

London seems to be bucking the national trend, suggesting services are working better together to prevent people sleeping rough in the first place, as well as helping them off the streets quickly if they end up there.

Rising numbers returning to rough sleeping

However, we should be under no illusion that the annual CHAIN statistics paint a rosy picture. Among the positives, the figures also give serious causes for concern – not least on the rising number of people returning to rough sleeping after a period off the streets.

In 2017/18, 1,119 people seen rough sleeping during the year were returners, representing a rise of 8% on the previous year and 27% since 2014/15. While overall numbers have gone down, the total number of returners continues to rise. In addition to the number of people sleeping rough, the CHAIN database also records the outcomes for people seen sleeping rough in London. These figures suggest the root of the problem is an increasing reliance on short term accommodation, with people who have experienced rough sleeping finding longer term sustainable housing harder and harder to access.

Of those who had been sleeping rough and were booked into accommodation last year, 78% moved into short-term accommodation (such as hostels). Just 22% found mid-long term housing (such as the private rented sector or long term supported housing), a fall from the previous year.

At the same time, the proportion of people leaving short-term accommodation to take up a place in longer term housing has halved in three years, from 40% in 2014/15 to 21% in 2017/18. Many of those who fail to find a home are moving back onto the streets, with ‘negative’ reasons for departure from hostels and other short-term options also rising in recent years.

Why do people return to rough sleeping?

To shed more light on the reasons people return to rough sleeping after time off the streets, St Mungo’s has published a new report, On my own two feet. The research, carried out by peer researchers with experience of homelessness and rough sleeping, uncovered many reasons people end up being pushed and pulled back to life on the streets.

The research revealed multiple barriers to accessing long-term housing for people with experience of rough sleeping, including the reluctance of landlords to let to people receiving benefits, a lack of truly affordable rents, money for a deposit or support for individuals to manage their tenancies.

The keys to ending rough sleeping for good

How can we make things better? At St Mungo’s we believe the Government should use its upcoming rough sleeping strategy to increase long term accommodation options for people with a history of sleeping rough and guarantee funding for accompanying support.

One model which should be expanded is the Clearing House in London, which offers ring-fenced social housing for people with a history of rough sleeping and ongoing support to help them cope with living independently and move towards employment. Another good model is Housing First, which provides stable tenancies and intensive support for people who have complex needs.

We know that getting people into suitable, long term housing with appropriate support is key to ending rough sleeping for good. We now need action to achieve this. We cannot allow the rise in returners to become the start of a worrying new trend.

We must not let fatalism set in

Rory Weal, Senior Policy and Public Affairs Officer at St Mungo’s, explains why we’re calling on Government to enact urgent measures to stop the scandal of people dying on the streets

One week ago marked the first anniversary of the Grenfell Tower disaster. It was a time to reflect not only on the lives that were lost on that day, but also on how we all respond when faced with a human disaster on that scale.

This week St Mungo’s has been highlighting another human disaster: the rising number of people dying on the streets. It is less visible, more dispersed and slower moving. But it is a disaster nonetheless, when so many people are dying in circumstances that are preventable and shockingly premature.

Data suggests that, in London, someone dies on the streets every fortnight. In the rest of the UK, as many as two people are now dying every week, a rate twice as high as five years ago. The average age of someone who dies sleeping rough is 47 for a man and just 43 for a woman.

What is worse is that these figures are likely to be an underestimate, given that recording deaths is infrequent and not done systematically.

Our new report Dying on the Streets: the case for moving quickly to end rough sleeping looks into these figures in more detail. We found that mental health support needs among people who have died has increased dramatically, from 29% in 2010 to 80% last year.

To find out more about what is going on the ground, we also carried out a national survey of street outreach services earlier this year. The picture that emerged is one in which the number of rough sleepers is growing, at the same time as access to vital service is getting harder. This is creating a perfect storm to which the most vulnerable homeless people are falling victims.

Some of the findings were shocking. 70% of respondents said access to mental health services for people sleeping rough had got harder compared to five years ago, and 64% said this was true for emergency accommodation. The majority of respondents had experienced a death in their area, but only one-quarter of those had any experience of a review being carried out.

In short: there is less help available, people are dying, and these deaths are going ignored.

But statistics don’t capture the most tragic consequence: the sense of acceptance and inevitability which increasingly meets the death of someone sleeping rough. As such tragedies become more commonplace, we come to expect, and sadly, accept them.

We must not let fatalism set in. Dying on the streets should be unthinkable. It is certainly preventable. There are ways to stop this scandal from continuing, but only if the determination and political will is there.

To achieve that end, earlier this week we held a roundtable discussion in Parliament. This was attended by the Minister for Mental Health, MPs, and experts in the field, who all recognised the gravity of the issue and resolved to stop the scandal of deaths on the streets. With the Government’s rough sleeping strategy due for publication next month, now is the time to turn those warm words into firm action.

We are calling for a package of measures to ensure rapid relief from rough sleeping, to get people off the streets and prevent future deaths. This includes access to specialist mental health services, an expansion of emergency accommodation, and full reviews to learn the lessons from every single death that occurs on our streets.

Without such interventions, I fear current trends will worsen, lives will be cut short, and our claims to being a compassionate society will be left in tatters. We hope the Government uses its upcoming rough sleeping strategy to avoid this fate. The price of failure is too high.

Hope from terrible tragedies

Niamh Brophy is St Mungo’s Palliative Care Coordinator. We are the only homeless organisation to have such a person, supporting both clients and staff with ‘end of life’ experiences.

For most of us, I hope Dying Matters Week is an opportunity to talk to our loved ones about death and the things that feel important to us: where we’d like to be cared for (for most of us it would be at ‘home’), and how we’d like to be remembered by our loved ones.

But what if you don’t have a home? And what if you don’t have a family or support network to have these conversations with?

This is the reality for the rising numbers of people experiencing homelessness. For many, their death will go ignored, not given the dignity or respect they are due, and with little planning given to their end of life wishes or preferences.

This year’s Dying Matters Week (14-20 May) comes at a particularly poignant time. Recently, news that the number of deaths of people sleeping rough has more than doubled in the past five years shocked the public.

These are individuals dying in car parks, on street corners and park benches, with no one around to support them as their lives draw to a close. This is desperately sad, and something most of us would think completely unacceptable in our society today.

But from these terrible tragedies has sprung some hope. Campaigns have been launched to address and prevent these deaths from happening in future such as the #makethemcount campaign.

Ed Davey MP has also proposed a new Homelessness End of Life Care Bill that aims to ensure people do not die homeless and alone on the streets, but have access to care and accommodation for the end of their life.

At St Mungo’s we contributed to both of these initiatives. But more work is needed to ensure people get access to the care they need. That’s why we’re calling on the Government to ensure a review is carried out every time someone dies on the street, as part of their new rough sleeping strategy. This would ensure deaths no longer go ignored, and that lessons can be learnt to ensure such tragedies are not repeated.

St Mungo’s were also involved in research published last year that explored the unique challenges in providing end of life care to people in hostels. What emerged was a picture of great complexity, but also plenty of opportunity to improve the experience of residents and staff when faced with such difficult situations.

It’s now a decade since St Mungo’s first acknowledged the importance of providing end of life care to people who are homeless by establishing a Palliative Care role.

In response to the increase in need of our residents, and the growing numbers of people dying on the streets, we will be expanding the service in 2018 and recruiting another member of staff to ensure all residents can be supported and cared for in the way that feels right for them.

We continue to work every day to ensure our residents can access healthcare and be supported to approach the end of their life with dignity and respect. This Dying Matters week, we would encourage everyone to start a conversation on how we as a society can prevent the unnecessary deaths of people sleeping rough, as well as how we treat homeless individuals with dignity as they approach the end of their life.

‘Giving people a fresh start in life’

“We help people who are living in their own homes but need support to ensure they are able to keep a roof over their head.” Ola Pedro, Team Leader at St Mungo’s Tenancy Sustainment Team North, tells us about how his team supports people who previously slept rough to live independently in the community.

St Mungo’s Tenancy Sustainment Team (TST) North works with people who formerly slept rough and who are now housed across North London. Our team supports them to maintain their tenancies and to further develop their skills and confidence to move on into independent accommodation – moving away from homelessness for good.

We want to make sure people are socially included. We link them with packages of support, as needed – around mental health, substance misuse, employment, ex-offending, offending – as well as other activities to help them sustain their tenancies and feel part of the wider community.

‘We carry out home visits to make sure that people are living safely’

We work with people who are often tackling three or more health and other issues, for example, substance use, risk of offending, and or physical and mental health problems. The sector jargon would be ‘high needs’ clients and they can need a lot more intense one to one support.

We carry out home visits regularly to check that people are living safely. If there are any issues around their support needs, these can be represented in how they live. For example, if a person is going through severe depression, the state of their property can reveal that. These visits mean we can make sure the person is comfortable in their home, in their area, and to identify any maintenance issues or anything that landlords need to be aware of.

Benefits are a major issue at the moment. The roll out of Universal Credit has caused a lot of stress for our clients. We are finding many people are having to go without money while their applications are being processed, for six to eight weeks. This is something that TST staff have had to pick up. If not, it creates issues which permeate into every other area of people’s lives and means they need even more support. We help people, for example, by offering food vouchers and topping up their electricity and gas, if needed. We have drop-ins every Monday and Friday, so people can also come in and sit down with us for some support if they want.

‘I feel joy when I go home’

I got into St Mungo’s through volunteering at St Mungo’s Islington Mental Health Team. I tried a corporate job but just didn’t find it rewarding. I like the dynamism of this role – it’s extremely active, you’re never in once place for a long time. I’m the team manager but I also work with clients, I support around 55 clients myself. I’ll visit about four or five clients in one day, each needing different kinds of support, so it’s about balancing that with the managing and admin side of the role.

I feel joy when I go home as I know I’m making a difference. I’m improving the quality of people’s lives – taking them from a place where they are not so happy to a place where they can feel confident, and our team are part of that process.

‘Giving people a fresh start in life’

I supported one person, for example, who had his tenancy taken over by a group of drug dealers. They were force feeding him crack cocaine and heroin, just so they could use his accommodation to cook and to sell the drugs.

He didn’t actually tell me this had happened until I got a phone call to say that he’d been admitted into hospital for abscesses on his arms and hands from injecting. He had also been beaten up really badly.

When I went to the hospital, I had a really long discussion with him about why he didn’t want to tell me this. He said there were a lot of feelings of guilt and shame around why he didn’t want to tell me what had happened.

We worked together very closely over the next three months and he’s now been rehoused away from that area. He got a chance to start a fresh life and went to rehab. He’s completely clean of the drugs that were forcibly put in his system.

When I go home and think about that story, that’s what drives me and makes me want to do this job always.

Towards a new rough sleeping strategy

Beatrice Orchard, St Mungo’s Head of Policy, Campaigns and Research, writes about our priorities as the Homelessness Reduction Act and other measures seek to end homelessness

The Homelessness Reduction Act comes into force today. This is a landmark piece of legislation with the potential to have a hugely positive impact on the lives of many more people who are homeless, or at risk of homelessness, compared to the previous system. It places new duties on local authorities to help prevent and relieve homelessness for people regardless of ‘priority need’ criteria.

This follows news last week of a new initiative to reduce rough sleeping and a decision to reinstate entitlement to housing benefit for all 18-21 year olds. These are very welcome steps towards ending the misery of sleeping rough, an aim that surely unites us all.

In 2016, we at St Mungo’s launched our Stop the Scandal campaign calling for a new national strategy to end rough sleeping and this is what we want to see next.

The government has committed to halve rough sleeping by 2022 and to eliminate it altogether by 2027. To meet this pledge, a ministerial taskforce has been established to produce a new rough sleeping strategy. A Rough Sleeping Advisory Panel made up of homeless sector representatives, including St Mungo’s, is providing guidance to this ministerial taskforce.

Rough sleeping has increased by 169% since 2010. On any given night, 4,751 people sleep rough in England.

Behind these stark figures are people who are living each day at risk of violence, abuse and serious ill health. We have evidence of this from the people themselves, from our outreach teams and our research with people who have experienced rough sleeping. Put simply, it is a scandal.

That’s why it is good to see a sense of urgency from the government.

We agree immediate action is needed to move people off the streets and out of danger. Effective outreach services are part of this. So is emergency accommodation and access to mental health and substance use treatment and support. This must also be aligned with measures to prevent people sleeping rough in the first place and long term support to ensure people don’t return to the street.

The new strategy must protect and expand existing services, which support people off the streets. That includes supported housing, which is the primary route out of rough sleeping for people who need both a safe place to stay and support to recover from homelessness and associated problems, including poor health and experience of violence and abuse.

However, the government’s current proposals to change the way homeless hostels and other short term supported housing is funded puts the future of these life-saving services at risk.

As rough sleeping continues to rise nationally, available places in supported housing have fallen due to major cuts in local authority funding. Research by Homeless Link found there was an 18% reduction in bed spaces in homelessness accommodation between 2010 and 2016.

Despite this, the government now wants local authorities to become responsible for funding the housing costs in hostels, in addition to the support services which councils are already struggling to fund.

Instead, we think the government should adjust its plans in line with calls from the supported housing sector and continue to provide funding for housing costs via the welfare system.

Beyond this, ministers will need to consider the role for innovative approaches, such as Housing First, which has proven successful for ending rough sleeping among those with the most complex problems. Government investment in three Housing First pilots is, again, welcome, but ministers will need to establish long term funding arrangements to make this approach work.

An integrated rough sleeping strategy will also need to be underpinned by a legal framework to help ensure services benefit from sustainable funding and can respond to fluctuations in demand. The Homelessness Reduction Act is a good start, using new legal duties to shift the focus of councils in England towards providing help to prevent homelessness in the first place.

But if the Act is to be a success, councils must be able to help those in danger of sleeping rough find the right housing and support. Sadly, the reality is the unacceptable shortage of affordable housing options for too many people, and this is another long term challenge for the ministerial taskforce.

St Mungo’s has always supported people to move off the streets into accommodation and to access the services that can help them rebuild their lives. This can take days, weeks, sometimes years.

We don’t think it is an easy challenge the government has accepted, but we share their ambition of ending rough sleeping and welcome the opportunity to help get on with it.

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