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It’s complicated: How we could do better for people with complex needs

For many people ‘homelessness’ is just that – for a short period of time they do not have their own home. Circumstances have conspired to mean that the rent couldn’t be paid, a relationship breakdown has led to options running out or a dodgy landlord has left someone without funds. We are proud in Scotland to have a strong statutory safety net, ensuring that anyone who is unintentionally homeless has a right to settled accommodation.

For others, however, the story is a lot more complicated. Homelessness is not a one off event but has happened several times, including sleeping on the street. This type of homelessness is often coupled with many other areas of need: mental ill health, addiction issues, physical health problems, a lack of social support… There is increasing evidence to show that in many cases people who find themselves with these challenges have suffered trauma or abuse as a child. Many have faced the most extreme forms of exclusion. The people that Shelter Scotland engage with told us that the general systems set up to help people who are homeless weren’t working so well for these people with more complicated lives.

To find out more we interviewed 35 voluntary and public sector service providers and 10 people who had experience of this type of homelessness.  The research covered five local authority areas – in other areas there may be better approaches – but the fundamental messages will be shared across Scotland.

People told us that to really help people with complex needs, support and accommodation should be available that nurtures positive, long-term relationships.  The thing that can really make the difference is a single support worker who can co-ordinate the different agencies that offer specialist areas of help, who can be trusted and is in for the long haul.  Flexibility, tolerance and empathy are important characteristics in building these relationships with people who are used to relationships failing and have not been able to engage with the mainstream services.

Unfortunately we found that, in most of the five local authority areas we looked at, these services do not exist in this way. People with complex needs are required to fit in with the same processes and support offered to those who solely have a housing issue.  There aren’t dedicated or co-ordinated services or plans in place for responding to their particular circumstances. Vulnerable people fall through the gaps where often only single-issue services are available (mental health teams, substance misuse services etc.) that do not account for the integrated reality of complicated lives. As Shelter Scotland have said before, there needs to be a shift so that the focus is on People, not Process.

Through the interviews we heard that most professionals do understand what needs to change, but feel frustrated by constraints that are currently put on services.  Commissioners, who hold the purse strings, largely define the way that services are set up.  Funding mechanisms, service criteria and outcome measures do not always allow for interventions to be as effective as they could be for people with complex needs. Too often a numerical list of discrete issues and hard outcomes prevents a more holistic response to the interrelated and deeply rooted nature of challenges faced by individuals.

Scotland may be a world-leader in terms of our legislation and the processes that are in place for people in housing crisis.  We still have a long way to go, however, until we can be proud of our response to the most vulnerable homeless people. Lessons from this research, and others like it, make clear what needs to happen. Now we need leadership, resources and systems change to allow person-centred services to meet the complicated challenge of working with complex needs. A new National Homelessness Strategy would demonstrate a commitment from the Scottish Government to tackle this important issue as a key element of their ambition to tackle poverty and inequality in Scotland.

If you wish to read more about Shelter Scotland’s research into homelessness and complex needs, you can download the full report from our Policy Library.