Spotlight on: Mental Health Support and Homelessness

At St Martin-in-the-Fields Charity we recently undertook a call for insights, asking people with personal and professional experience to tell us about challenges and good practice around access to mental health support for people experiencing homelessness. In this blog, we round up what we have learnt so far.

Background

Through our Annual Frontline Worker Survey we have consistently heard that there is a need to improve access to mental health support for people experiencing homelessness, in order to help people secure and keep a safe place to live. In 2022, 75% of frontline staff described accessing mental health support for people they worked with as ‘difficult’ or ‘very difficult’.

As a result, at St Martin’s Charity we have committed to learning more about this topic and offering a grant round making funding available to scale up work in this area. Details of the funding opportunity are currently live on our website here, and interested parties can apply before 5pm on Friday 17th February.

Thank you to everyone who took the time to share their knowledge and experience in response to our recent call for insights. Below you can find a summary of what we have heard and a list of resources we have found useful. We look forward to sharing further learning as we develop our work in this area. 

What we’ve learnt about accessing mental health support so far

1. What are the gaps in service provision for people experiencing homelessness accessing mental health support?

Key areas for improvement raised were:

• More outreach to connect with people.
• More preventative work and early intervention, to act before crisis.
• Addressing potential exclusion of people from mental health support due to co-existing struggles with addiction.
• Overcoming practical barriers to accessing support services (e.g. digital exclusion, lack of flexibility with attending appointments, language barriers, difficulty navigating the system, challenges due to lack of documentation).
• Improving capacity in services – currently insufficient resources and staffing contribute to long waiting lists and affect available support.
• Supporting staff with training – to learn about relevant topics (e.g. different mental health conditions, the types of support available, neurodivergence) as well as particular approaches (e.g. Psychologically Informed Environments, Trauma Informed Care).
• Need for greater partnership working to help achieve the above and avoid unnecessary delays and repetition. 

“I've referred many clients for early intervention help and their cases aren't seen as 'bad enough' therefore don't meet the threshold.”

 “There are exceptions where the service is accessible, responsive and engaged. Sadly these are generally exceptions.”

 “In our experience a lot of time and energy is required in building a trusting relationship prior to any 'treatment' and this is not possible in mainstream services.”

2. Are there particular access points / times when mental health support is most needed?

Points highlighted when mental health support was most needed included:

• Early intervention.
• Transition points - moving-in / moving-on from particular support or accommodation (e.g. leaving hospital, prison, local authority care, moving from child to adult services, or moving from homelessness to mainstream health services).
• Outside of healthcare settings (e.g. linking in with supported accommodation or the wider community).
• Flexible timings and out of hours (e.g. drop ins, evenings and weekends).
• All the time – timing will vary for different individuals but consistent and holistic support can help.

“Transition points are key - from the street to a hostel or assessment centre, to supported housing, to more permanent accommodation. It is often at these transitions when difficulties arise, and it is often here where services are withdrawn.”

“Often people are asked to move services and this requires people to build new relationships and retell their story. We often find people slip through the cracks here and return to services that they trust but from whom they may no longer be access a service.”

3. Who do services struggle to engage and support and why?

People it was suggested services may struggle to engage and support included: people without a correct diagnosis, people experiencing multiple disadvantage, people with comorbidities, people with substance misuse issues, people with personality disorders, people with schizophrenia, people with neurodiversity, people with learning disabilities, people with a brain injury, and people with NRPF status.

Possible reasons why services struggled to engage and support these people included a lack of capacity, exclusionary criteria, lack of flexibility in approach and lack of awareness or specialist knowledge and skills.

“We have noticed that people who experience multiple forms of disadvantage are especially poorly served. This is most noticeable in co-occurring mental health and substance use […] We find that people with these co-occurring conditions are often poorly served as there is little agreement on what support falls under mental health and what requires a response from another sector. People’s lives don’t work like that.”

4. What works to help people access mental health support?

The following practices were identified as helpful in enabling people to access mental health support:

• Varied and clear entry points to support – e.g. assertive outreach, embedding specialist workers and community-based services with a ‘no wrong door’ policy.
• Adequate capacity within services – enabling early, rapid, flexible and consistent support where needed and removing barriers to access.
• Commitment to relationships – listening, being non-judgemental if appointments are missed, taking time to build trust.
• Peer support – through staff members and volunteers, drawing on the knowledge and skills of people who have experienced homelessness and mental health support themselves, for example to help navigate services and advocate for individuals.
• Lived experience of homelessness and mental health support informing the design of services and training of colleagues.
• Partnership working between stakeholders – interdisciplinary teams sharing expertise and services working together to improve experiences of transitions.
• Particular models, with buy in at a senior level – e.g. Psychologically Informed Environments and Trauma Informed Care, strengths-based and person-centred approaches, an understanding of gender and culturally specific elements.

“Flexibility, time and space to build relationships, opportunity for face to face meetings, consistency of staff and care provision.”

 “We would recommend wherever possible that there should be a single plan created in conjunction with people who are using services that delineates clear responsibilities across sectors and precludes the need for people to retell their stories and allows people to get the help they need as soon no matter who or when they ask for it.”

Lastly, the relationship between mental health and housing was reiterated here. A fundamental way of improving people’s mental health is ensuring that they have safe, suitable and sustainable accommodation and homelessness is prevented wherever possible.

5. If good support was in place, what would markers of success be?

Suggested markers of good support included:

• People accessing support share positive feedback about services.
• More people are able to access meaningful support where needed.
• There are improvements to people’s quality of life (e.g. their personal goals around health, housing, relationships and work).
• Within services, staff are able to respond to individuals’ needs, suitable processes are in place to support this, the workforce is effective and stable, there is an empowering culture in the service and collaboration with other stakeholders.
• At a population level, more mental health issues are prevented from escalating (e.g. reduced contact with emergency services) and homelessness is minimised.

“We feel that if this type of system was implemented and working well then it would result in people being able to access support as and when they needed it without feeling like they are being passed about and at the mercy of meeting particular criteria. There would be no such thing as talking to the wrong person about how you are feeling – talk to who you trust about your feelings.”

“A good marker for success would be not allowing people to get to the point where they are breaking, early intervention can save lives once staff can recognise the signs and work intensively with people.”

Useful resources

Practical tools for frontline staff and people experiencing homelessness:

1. Groundswell’s resource hub. In particular, their collaborative information leaflet created in partnership with Mind which provides tailored mental health information for people experiencing homelessness, and their short film Clarissa created to improve the health of people affected by homelessness, through better understanding of their experiences.
2. Homeless Link’s guidance and resources on building effective relationships between mental health and homelessness professionals and supporting the mental health needs of people experiencing homelessness.
3. Mind’s explanation of how housing and mental health can affect each other. Provides tips for coping and where to find support, and information on your legal rights.

Further insight into this topic:

• Centre for Homelessness Impact (January 2022) What works evidence notes: 06 Mental Health
• Fulfilling Lives LSL Research and Learning Partnership Groundswell, NPC and Sheffield Hallam University (2022) Research and Evaluation for Fulfilling Lives Lambeth, Southwark and Lewisham (LSL) – a project working with people facing multiple disadvantage
• Groundswell (November 2022) #HealthNow peer research report ‘Knowing where to turn’: access to mental health support whilst experiencing homelessness
• Homeless Link (October 2022) The Unhealthy State of Homelessness 2022: Findings from the Homeless Health Needs Audit
• MEAM (February 2019) The MEAM Approach
• MEAM (June 2022) Multiple disadvantage and co-occurring substance use and mental health conditions
• Mind (November 2017) Brick by Brick: A review of mental health and housing
• NICE Guideline (March 2022) Integrated health and social care for people experiencing homelessness
• Opportunity Nottingham (October 2019) Severe and Multiple Disadvantage in Nottingham: A summary document based on the Joint Strategic Needs Assessment for Nottingham City
• Pathway (July 2021) Kerslake Commission - Pathway submission paper
• Simon Community NI and Depaul (January 2023) Mental Health and Homelessness

If you would like to add to this list, please get in touch: frontline@stmartinscharity.org.uk.