Working with Homeless People and

Homeless Services

Andrew Casey

Health Strategy Manager, St Mungo’s

Kate Tebbet

Regional Head for Camden Services, St Mungo’s

About St Mungo’s

Homelessness charity and housing association

working to end homelessness and rebuild

lives.

Our services across the south of England include:

Outreach for people sleeping rough

Hostels and supported housing

Advice services

Specialist physical & mental health services

Skills and work services2

Topics

Homeless health and trauma

Common issues in providing primary care to

homeless people

What can help to make the difference

How to signpost patients

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Stark inequalities

The average age of people who die while

homeless is 47; for women it is only 43.

People who are homeless often have

multiple and complex health needs:

• 44% of St Mungo’s residents have a

significant physical health condition

• 73% have a mental health problem

• 55% have substance use needs.

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Impact on health service use

People who are homeless:

Attend A&E 5 times as often

as the general population

Are admitted 3 times as often

Stay 3 times as long

Overall cost 8 times as much

DH ‘Healthcare for single homeless people’ (2010)

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Complex Trauma

Providing a roof is only a start

People who are homeless for years experience

a range of interacting problems

Research has shown that people often

experienced abuse or neglect in childhood

The resulting interpersonal trauma can have a

lifelong impact and can affect the individual’s

ability to form trusting relationships.

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Challenge for Primary Care

Being inclusive and sensitive to the needs of

homeless people within the constraints faced by

Practices

Common Issues

Registration

Complex Needs

Trust and attitudes

Communication

High risk for certain health problems

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1. Registration

Requirement to provide an address and ID

when registering can be a barrier but not

required. See guidance: https://www.myhealth.london.nhs.uk/healthy-

london/programmes/homeless/161214healthcarecards

Poor literacy common – 33% lack the skills to

complete a form, 16 per cent can’t read a letter.

Language issues

Exclusion from mental health and substance

use problems because of dual diagnosis

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2. Complex Needs

Health may not be the homeless person’s

priority – sleep site, food, substances

Distrust – people who have been shunned can

be sensitive to rejection and expect to be

looked down upon

Chaotic lifestyle and unreliable attendance

Long waits can be difficult so manage

expectations

Some homeless people underestimate health

issues and do not proactively raise them

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What Works 1

A welcoming, non-judgemental approach

Offer help with forms (literacy, eyesight)

Flexible approach to appointments and DNAs

Continuity of care with the same professional

facilitates trust (and a named worker)

Willingness to review more than one problem

per appointment

Agree how to communicate

Person to accompany the homeless person

e.g. Peer Support, Homeless service staff

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What Works 2

For those most difficult to work with:

Seek to develop a trusting relationship

Do what you say you are going to do

Be consistent

Avoid comments that might be interpreted as

blame

Negotiate and set boundaries

Explore ambivalence / agree goals

Ensure patient knows what to do in a crisis

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What Works 3

Walk-in services

Take time e.g. double appointments

Multi-disciplinary case reviews

Primary care in-reach services

to hostels and daycentres

Housing surgery in the Practice

Links to homeless services

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Camden Homeless Services

Street Outreach teams

Daycentres

Hostels and supported living services

Advice services

Homeless Link National Homeless Services Directory

(also information for homeless people)

http://www.homeless.org.uk/facts/homeless-england

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Signposting

If someone is either rough sleeping or vulnerably

housed and likely to become homeless then

recommend to the patient they:

a) Go to the local authority’s Housing Options

Service

b) The patient can obtain advice from Shelter’s

Housing Advice line

c) If the patient is rough sleeping, you can contact

Camden Safer Streets Outreach Team

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First Steps

Camden Housing Options Service

5 Pancras Square London N1C 4AG

Phone: 020 7974 4444

Mon-Fri 9am-5pm

https://www.camden.gov.uk/ccm/content/housing/homelessness-and-

sheltered-housing/homelessness/homelessness.en

Shelter’s Housing Advice Line

Tel: 0808 800 4444 (free)

365 days of the year 8am – 8pm on weekdays and 8am –

5pm on weekends

http://england.shelter.org.uk/get_advice/how_we_can_help/housing_ad

vice_helpline

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Camden Safer Streets

Street outreach team provided by CGL

Work creatively with clients to establish

individually tailored plans to enable people to

get away from their street based lifestyle.

Can report people seen rough sleeping via

020 7833 7970 / 0808 8000005 or Email

streetsafe@cgl.org.uk

http://www.camdensst.com/

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Street Legal

Street Legal is a pan-London service delivering

frontline immigration advice and

accommodation to non-EEA migrants found

rough sleeping on the streets of the capital.

A partnership between St Mungo’s, Refugee

Action and PRAXIS Community Projects

Homeless people can refer themselves,

or be referred via StreetLink through their website

or by calling on 0300 500 0914

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Routes Home

Routes Home is a new service to support non-

UK nationals that sleep rough in London.

7 day service providing assessment, advice and

supported reconnection to help non-UK

nationals to find a way off of the street.

Provided by St Mungo’s and commissioned by

the GLA

Outreach and NSNO teams can refer via

0203 092 7455 or referrals@routeshome.org.uk

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No Second Night Out

Supports Outreach team (not GP referral)

Provides a rapid response to new rough

sleeping from 24-hour assessment hubs

Links those who migrate to services back to

where their local connection means they are

most likely to sustain life away from the streets

Provides a single offer based on an assessment

of individual's needs & liaises with services

London wide service provided by St. Mungo’s

Ref: http://www.nosecondnightout.org.uk/

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StreetLink

A homeless person who is sleeping rough can get

help via the StreetLink service:

http://www.streetlink.org.uk/

Anyone can seek help for someone sleeping rough

via StreetLink but better to shortcut

by contacting the Camden Outreach

Team directly.

National service via St Mungo’s

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Further resources

Supporting GP receptionists to help people who

are homeless https://www.myhealth.london.nhs.uk/healthy-london/latest/news/supporting-GP-

receptionists-to-help-people-who-are-homeless

Commissioning guideshttps://www.myhealth.london.nhs.uk/healthy-

london/programmes/homeless/commissioningguidance/commissioningguide and

http://www.rcgp.org.uk/common-elements/rss/~/media/Files/Policy/A-Z-

policy/RCGP-Social-Inclusion-Commissioning-Guide.ashx

Service Standards and Reportshttp://www.pathway.org.uk/publications/faculty/ and

http://www.mungos.org/homelessness/publications/latest_publications_and_resea

rch

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Contact details

Andrew Casey

Health Strategy Manager

St Mungo’s

andrew.casey@mungos.org

Kate Tebbet

Regional Head (Camden Services)

St Mungo’s

kate.tebbet@mungos.org