Prevention is better than cure. Geoffrey Randall and Susan Brown

Transcription

1 Prevention is better than cure Geoffrey Randall and Susan Brown

2 Published by Crisis, Crisis 64 Commercial Street London E1 6LT Telephone: Fax: Website: Further Crisis publications are available to download at Crisis UK (trading as Crisis) Charity number Company no ISBN I

3 Contents Explanatory notes iv Foreword v Summary vi 1. Introduction 1 2. Causes, risk factors and crisis points 3 3. Preventing homelessness: the work of projects Conclusions: a programme for preventing rough sleeping 33 Appendix 1 Tables 38 Appendix 2 Research methods 42 References 43 Acknowledgements 44

4 Explanatory notes Interview quotations. These are reported verbatim from client interviews. After each quotation, the respondent s gender and age are given, followed by the type of project where they were interviewed. Case studies. Section 3 includes case studies that are illustrative of a range of projects. These case studies are distinguished by a shaded background. Note to tables. The percentages in tables have been rounded, so totals may not exactly equal 100 per cent. Where more than one answer was permitted, this is indicated by * at the foot of the percentage column. Base numbers are given in brackets. Unless otherwise stated, non responses have been excluded and the base numbers reduced accordingly. The research. The research was commissioned by Crisis and carried out by Geoffrey Randall and Susan Brown, who are partners in Research and Information Services. iv

5 Foreword The complex needs of homeless people have changed radically over the last thirty years. Crisis has been working with vulnerable, single homeless people since We have picked up the pieces of lives broken by rough sleeping alongside people s mental health problems, drugs and alcohol misuse, unemployment and family breakdown some of the triggers and consequences of life on the streets. From our well-known Christmas support through to year-round hostels and outreach services, we work with each person to tackle their own set of problems. Promisingly, the numbers of people sleeping rough on our streets has been going down. This is due to the concerted efforts of agencies like Crisis as well as Government programmes such as the Rough Sleepers Initiative and the London Rough Sleeping Unit. It is clear that homelessness is about far more than a roof over someone s head. It is vital to prevent rough sleeping and all types of homelessness from going up. So we will have to work hard to provide a programme of services that are tailored to those who are susceptible to rough sleeping. The first in our series of New Solutions research Prevention is Better than Cure is an important step in identifying where our services should focus in the new millennium. It is possible to prevent people from sleeping rough as long as there is appropriate accommodation with long-term support in place a challenge that faces all statutory and voluntary agencies. Even if we do not see rough sleepers on the streets, this vulnerable group will still need our support. In this research we discover how this can be done. Shaks Ghosh Chief Executive, Crisis v

6 Summary This report examines ways of preventing homelessness and rough sleeping. The research surveyed the experiences of 120 people who sleep rough and interviewed staff from 19 different projects which work to prevent homelessness, as well as reviewing other research on the subject. Risk factors and crisis points The report identifies a number of factors which increase the risk of homelessness in individuals, and crisis points which can trigger rough sleeping. Often, these are compounded many are of course interrelated. The key risk factors are: Disputes with parents and step-parents: 33 per cent of homeless people gave this as one of their reasons for first sleeping rough and 21 per cent as the main reason, rising to 37 per cent of people aged under 26. Experience of physical or sexual abuse: surveys have found up to 40 per cent of homeless young people have suffered violence or abuse. Time in local authority care: surveys find between a quarter and a third of people sleeping rough have been in local authority care at some stage. Lack of qualifications: only 38 per cent of people sleeping rough have any educational qualifications, compared to 66 per cent of the general population. School exclusion: 28 per cent of people surveyed had been excluded from school. Unemployment: 90 per cent or more of homeless people are unemployed. Alcohol and drug misuse: between a third and a half of people sleeping rough have alcohol problems and up to 40 per cent of younger homeless people have drug problems. Mental health problems: research has found that as many as 60 per cent of people sleeping rough may have mental health problems. A combination of mental health, drug and alcohol problems: 36 per cent of people surveyed gave an indication of having multiple problems. Contact with the criminal justice system: around half of people sleeping rough have been in prison or a young offenders institution and many have repeated contact with the police and courts. Previous service in the armed forces: surveys have found that around a quarter of people sleeping rough have served in the armed forces at some time. Marital or relationship breakdown: 13 per cent of the people surveyed gave this as a reason for sleeping rough the first time and 9 per cent gave it as the main reason. Previous experience of homelessness: 85 per cent of the survey had experienced more than one episode of sleeping rough. Lack of a social support network: agencies interviewed identified this as leading to and prolonging homelessness. Failure to furnish or maintain a home: agencies giving tenancy support identified this as a warning sign that the tenancy may be failing. Debts, especially rent or mortgage arrears: 26 per cent of people surveyed gave arrears or money problems as a reason why they first slept rough and 11 per cent as the main reason. vi

7 Causing nuisance to neighbours: agencies identified this is a symptom of other problems, often linked to mental health and alcohol difficulties, as well as being a cause of eviction. The key crisis points which can precipitate rough sleeping are: Leaving the parental home after arguments. Leaving care without adequate support. Leaving prison. Discharge from the armed forces. Marital or relationship breakdown. A financial crisis of mounting debts. Eviction from a rented or owned home. A sharp deterioration in mental health or an increase in alcohol misuse. Preventing homelessness: the work of projects There is a wide range of services which help to prevent homelessness. The key services are: Education in schools on homelessness and leaving home. Advice services for young people. Family mediation services for young people in dispute with their families. Services to help people return to accommodation in their home areas. Extended and improved support for young people leaving care. Support for people in contact with the criminal justice system. Support for existing tenants of social housing with mental health and substance abuse problems, including the development of specialist support for people with multiple problems. Support for people at risk of losing their home because of relationship breakdown, rent arrears or nuisance to neighbours. Multiple services and inter-agency work provided through day centres and advice centres. Befriending and mentoring services to tackle social isolation. Resettlement services for people leaving the armed forces. Specialist support for young people and women. The way forward The report makes detailed recommendations for the further development of services in all these areas. It concludes that the key to preventing homelessness and rough sleeping is access to suitable accommodation, plus adequate practical support. Too often in the past the emphasis has been on the provision of accommodation and the support on offer has been inadequate or non-existent. More detailed assessments of the most effective forms of intervention are needed, through separate evaluations of the different kinds of projects and the funding of pilot projects where there are gaps. It is clear that it is possible to prevent people at high risk of homelessness from sleeping rough. The challenge now is to develop a network of cost-effective services which will have a substantial impact on reducing the number of people who end up on the streets. vii

8 1 Introduction Background to the report There are more intensive efforts today than ever before to tackle the problems of people sleeping rough. Central and local government and voluntary agencies are working together in new ways, first through the Rough Sleepers Initiative (RSI) and this year through the establishment of the Homelessness Action Programme (HAP) and a London Rough Sleepers Unit. Previous programmes have focused mainly on rehousing people who are sleeping rough and they have had a significant impact. However, there is a growing realisation that it is equally important to prevent people from reaching the stage where they sleep on the streets. This need was highlighted in the report on rough sleeping by the Government s Social Exclusion Unit (SEU, 1998). For many years it was thought that the most important cause of rough sleeping was a shortage of affordable housing. While this is an important factor in heightening the risks of homelessness, it has become increasingly clear that many people sleeping rough also have a range of other problems which make it difficult for them to access or sustain permanent housing. Evaluations in different areas of the country have found serious problems of rough sleeping in areas with no shortage of social housing to rent. Crisis is developing a research programme into new solutions to preventing homelessness. They commissioned this report from Research and Information Services to review the evidence on the factors that might lead to rough sleeping, the range of services which help to prevent homelessness and the scope for developing them further. The problems experienced by people sleeping rough and the services to tackle them are complex and varied. The problems can range from a young person leaving home after a family argument, to an older person with a mix of alcohol, drug and mental health problems who is leaving prison. The preventive services range from education in schools, to tenancy support and work in prisons. The report This report presents an overview of problems that might lead to rough sleeping and of the wide range of services which help to prevent homelessness. It identifies many examples of effective work. It is an initial mapping exercise and proposes a way forward for the future development and evaluation of such services. There is no single or simple answer, but the development of such services and identification of the most effective means of preventing homelessness could make a major contribution to wider programmes to end social exclusion. The research for this report consisted of interviews with people with a history of sleeping rough and with agencies providing preventive services, along with a review of existing research on the subject. A total of 120 people who were either currently sleeping rough or had a recent history of doing so, were surveyed to assess the reasons why people started to sleep rough, what, if any, preventive services they had received and what other help might have prevented them from becoming rough sleepers. Staff in 19 agencies specialising in support services aimed at preventing homelessness were interviewed. The work of the agencies covered: Education in schools on homelessness and leaving home. Family mediation services for young people in dispute with parents and step-parents. Extended and improved support for young people leaving care. Support for people in contact with the criminal justice system. Services for existing tenants of social housing with mental health and substance abuse problems, including the development of specialist support for people with multiple problems. Support for people at risk of losing their home because of relationship breakdown, rent arrears or nuisance to neighbours. Multiple services and inter-agency work provided through day centres and advice centres. Services to tackle social isolation. Resettlement services for people leaving the armed forces. Specialist support for young people and women. The focus of the research was on projects which were not primarily concerned with the provision of accommodation for homeless people, but with preventing the need for such provision by intervention before the point of homelessness. There are further details of the research methods in Appendix 2. 1

9 Section 2 of the report examines the range of factors which might lead to homelessness and rough sleeping, drawing on the experiences of homeless people themselves and the agencies working with them, as well as on previous research. It reports on the types of service received by people who have slept rough and what they believe might help to prevent rough sleeping. Section 3 examines a wide range of projects which work to prevent homelessness, examining first the specific problems they tackle and then the methods they use to alleviate these. The final section of conclusions and recommendations identifies current best practice and makes proposals for future developments. 2

10 2 Causes, risk factors and crisis points Causes or risk factors? It would seem logical that in order to prevent homelessness it is first necessary to identify its causes and then to remove them. However, there are major difficulties in such an approach. Housing shortages, poverty, unemployment, personal difficulties such as mental health, drug or alcohol problems are sometimes said to be the causes of rough sleeping. However, there are continuing problems of rough sleeping in areas with no housing shortage. Equally, the great majority of people in poverty or with mental health, or substance abuse problems, do not sleep rough. While millions of people will experience one or more of these problems, there are perhaps 2-3,000 people who sleep rough on any one night in England (Randall, 1998). It follows that housing shortages, poverty, mental health and substance abuse problems cannot be said to cause rough sleeping. What can be shown from previous research is that these and other factors described below are more likely to be found among people sleeping rough and will increase the risk of rough sleeping. This distinction has important implications for policy and service delivery. If the assumption is made that these factors are causes of homelessness which must be removed, then policy must aim to eliminate or reduce mental health problems, alcohol and drug abuse, educational underachievement, poverty, family disputes, and all the other factors discussed below. Rough sleeping will only be reduced by long-term programmes affecting millions of people. If, however, a combination of these factors is seen as increasing the risk of rough sleeping, there is the possibility of identifying the much smaller number of individuals who are at risk and targeting support services to prevent them sleeping rough. It is also central to this approach that services cannot attempt to resolve all the problems experienced by their clients, but should instead focus on very specific problems, such as family disputes, rent arrears or nuisance to neighbours that can trigger homelessness. Preventive services can then set and achieve realistic objectives. Previous research has identified a range of factors associated with people sleeping rough and which might increase the risk of homelessness. For this research, these factors were explored further in structured interviews with people who had recent experience of sleeping rough and with agencies which have developed prevention services. This section presents the main findings from the interview survey, followed by an examination of each risk factor, drawing on evidence from the agencies and further detail from the interviews with rough sleepers. The experiences of people sleeping rough The survey A survey of 120 people who had recent experience of sleeping rough was carried out in day centres, hostels and winter shelters in central London which were known to have high proportions of rough sleepers among their users. Tables giving detailed findings from the survey are in Appendix 1. The great majority were men (83 per cent) and white (90 per cent). Over a quarter (28 per cent) were aged 25 or under, and a third (31 per cent) were aged between 36 and 49. The survey profile is broadly comparable to the demographic profile of all rough sleepers in central London (HSA, 1998). Current accommodation and recent experience of sleeping rough The majority were currently staying in temporary or insecure accommodation. Over a third (36 per cent) were staying in winter shelters, a further third (33 per cent) were staying in hostels or night shelters. Only a small proportion (7 per cent) were currently in secure accommodation in either a local authority or housing association tenancy. (See Table A2.) One fifth (20 per cent) had slept rough the night before they were interviewed and half of these had not had any accommodation at all for three months or more. Forty per cent of all those currently in some form of accommodation had slept rough immediately before moving in. The great majority (85 per cent) had more than one episode of sleeping rough and many had been longterm rough sleepers. Nearly half (46 per cent) had slept rough in total for two years or more, and a quarter (27 per cent) had done so for five years or more (Table A3). Over half (54 per cent) had first started sleeping rough more than five years previously and as many as 38 per cent had done so at least ten years previously. One in six (17 per cent) were aged 17 or younger when they first started sleeping rough and nine per cent were aged 15 or younger (Table A5). 3

11 Accommodation before first sleeping rough Four out of ten (38 per cent) had been living with parents or foster parents immediately before their first episode of sleeping rough. A fifth (22 per cent) had been in insecure accommodation either hostels, B&B or with friends or relatives and a further fifth had left a private rented or owner occupied place before sleeping rough the first time (Table A4). Two thirds of young people currently aged under 26 had been living with parents or foster parents immediately before sleeping rough, compared with 40 per cent of those aged between 26 and 39 and a fifth of those aged over 40. Reasons for first sleeping rough The survey asked people an open question about how they had come to sleep rough the first time. Usually they described a combination of factors. Most frequently mentioned was being asked to leave or evicted (36 per cent), followed by disputes with parents or foster parents (33 per cent), money problems or rent arrears (26 per cent). One in eight (13 per cent) had first slept rough following marriage or longterm relationship breakdown, although a much higher proportion (45 per cent) had experienced a relationship breakdown at some stage in their lives (Table A6). When asked to identify one main reason for resorting to the streets the first time, around a fifth (21 per cent) said disputes with parents. Again there were age differences, with the younger age groups more likely to have left because of parental disputes (37 per cent of those under 26 and 28 per cent of those between 26 and 39, but only 4 per cent of those over 40). Around 19 per cent of all ages had been asked to leave or evicted, but younger people were more likely to have done so because of difficulties with parents, whereas older people were more likely to have had difficulties in a tenancy. Around one in five (18 per cent) mentioned drinking as one of the factors which led to their first episode of sleeping rough and one in eight (13 per cent) mentioned drug use. The figure for drinking doubled to 36 per cent, when people were asked separately whether it had been a factor the first time they had slept rough and a similar proportion (33 per cent) said it was a factor subsequently (Table A7). Asked a similar question about drug use, 15 per cent said it had been a factor on the first occasion of sleeping rough, rising to 23 per cent who said it was a factor subsequently (Table A8). Around a quarter (28 per cent) had been in regular contact with people on the streets before they had first slept rough and ten per cent of all those interviewed cited this as a factor leading to them sleeping rough: It was the easiest way out. At least you re not going into a strange environment. I knew where to go the first thing you find out is where to kip and score. Friends made it all easy for me. (male, 47, staying at hostel) Alternative accommodation The survey explored whether people had any alternatives to sleeping rough the first time. Only a quarter (26 per cent) thought there had been. Hostels or B&Bs were the most commonly mentioned (by 13 people), eight people said friends or relatives had been possible alternatives and six thought parents might have taken them back. A wide range of reasons was given as to why they had not taken the accommodation available, often related to the reasons why they had left their existing accommodation, but there was no clear relationship between types of accommodation and the reasons for not taking it. The great majority (79 per cent) had not had any help at that stage with finding alternative places to stay. Yet nearly the same proportion (75 per cent) thought that they might have been helped to avoid the first episode of sleeping rough. A third said advice about accommodation and a quarter that actually finding accommodation would have helped (Table A9). One in six mentioned help with rent arrears or other money problems, one in ten thought reconciliation with parents and a similar proportion said counselling or someone to talk to, might have helped: If I could have talked to someone immediately when the problem was happening. (male, 53, staying at hostel) Accommodation after first sleeping rough Two thirds (64 per cent) of people interviewed had spent a month or more on the streets on the first occasion, although those aged under 26 were more likely to have spent a shorter period, with half having slept rough the first time for less than a month and a quarter less than a week. Two thirds (65 per cent) had moved into temporary or insecure accommodation 4

12 after their first time on the streets, mostly into hostels or winter shelters (45 per cent). Others had moved into B&Bs, friends or relatives homes, or a squat. A fifth (18 per cent) had returned to parents, foster parents or care and 40 per cent of those aged under 26 had done so. Few people moved directly from sleeping rough into a secure home. Only four people had been resettled into a council or housing association tenancy after their first episode of sleeping rough. Three quarters (73 per cent) did not think of the place they had moved into as a permanent place to live. The most common reason for leaving (17 per cent) was that it had been a time limited stay, although a similar proportion (19 per cent) gave a range of reasons reflecting a dislike of hostel accommodation, such as other residents behaviour, access hours, rules, and use of drink or drugs. Last home Asked about the last place they had thought of as home, a quarter (26 per cent) said it had been their parents or step-parents home, nearly a quarter (23 per cent) had a council or housing association tenancy or had owned their last home, whereas 15 per cent mentioned some form of temporary accommodation, or sleeping rough, as their last home. Nearly four out of ten (38 per cent) had thought of the place they left to sleep rough the first time as their last home, suggesting they had never felt settled since. Over a third (37 per cent) had held a council or housing association tenancy at some stage, a quarter of whom considered it their last home. Eight people were currently council or housing association tenants, and two of these had previously had tenancies since first sleeping rough, which had failed. Over half the tenancies were known to have failed for a variety of reasons, the most commonly mentioned being drink or drugs problems, difficulties with money or managing the tenancy, or problems with neighbours. A further one in six left because of relationship breakdown, including escaping from violent or abusive behaviour by their partner. Factors affecting continued rough sleeping The survey asked people whether particular factors, such as the availability of free food, not having rent or bills to pay, freedom to drink or use drugs whenever they wanted, or lack of commitments generally, had made it more likely they would sleep rough, or whether they made no difference. The majority (59 per cent) said such factors had made no difference and a slightly lower proportion (54 per cent) said there was nothing they had ever liked about sleeping rough. Among the significant minority who did think particular factors made a difference, the most common mentioned were having friends or people they knew on the streets (26 per cent), lack of commitments (23 per cent), not having rent to pay (16 per cent) and being able to drink when they wanted (15 per cent). (See Table A10.) As one respondent summed them up: Lack of responsibility, freedom to take drugs and drink, no rent, no bills, no hassles. It s OK when you know how to do it. (male, 47, staying at hostel) These factors were reiterated when people were asked what, if anything, they had liked about sleeping rough. Not having commitments (27 per cent) and having friends (23 per cent) were the most common (Table A11). A sense of belonging to a community seemed to be important while not having to be committed to it, perhaps reflecting a loss of established relationships: Every time you go back on the streets, it s like having a little family. You look after each other and look out for each other. You ve got no one to answer to, so you don t have to be anywhere at any particular time. It s complete freedom. (female, 25, staying at hostel) I was made to feel welcome when I first slept on the streets. Everybody was friendly and I had no commitments to anyone and the freedom to do what I wanted when I nted. (male, 25, day centre) Risk factors and crisis points The survey findings point to a range of factors which appear to have increased the risk of homelessness and precipitated rough sleeping. A study of elderly homeless people suggested that a number of factors, such as mental health problems, could create pathways into homelessness. These were described as relevant states. Other factors, described as triggers actually lead to homelessness (Crane, 1997). This is a useful model which can be built on, drawing on other research and the findings from this study. This report uses the terms risk factors and crisis points and the following sections examine the evidence for the impact of different factors. 5

13 Risk factors Family disputes and breakdown Research consistently finds a high proportion of people sleeping rough have a history of family disputes and breakdown. A survey in London found that the most common reason, given by 38 per cent of homeless people, for the first episode of sleeping rough was family or relationship breakdown, followed by disputes with parents or parental violence (22 per cent) (Randall and Brown, 1996). Research in Manchester found that the most common cause of homelessness was disputes with parents or partners, totalling a half (49 per cent) of all reasons (Carlisle, 1993). A study of young people found that most had left home when they were 16 or 17. Two fifths reported either long-term abuse, or violence in their families (Smith et al, 1998). The problems often start before the age of 16, two fifths of the clients of Centrepoint had run away from home when they were under 16 (Barter, 1996). There are particular problems with step-parents. A survey in Scotland found that a quarter of homeless young people in Scotland had a stepparent, compared to four per cent of all Scottish young people. Another study found that young people with step-parents by the time they were 16 had a three times greater risk of leaving home before they were 18 due to disagreements and ill feeling (cited in Evans, 1996). Such problems are not confined to young people. A survey of elderly homeless people found that over half (58 per cent) had experienced broken or disturbed homes during childhood. This lack of settled family life continued in later years: only nine per cent of homeless older men had ever been married, compared to 76 per cent of all men aged over 55. Of those who had children, over half (56 per cent) had no contact with them for over five years (Crane, 1997). The agencies interviewed for this study emphasised family breakdown as a contributory factor to homelessness. Over half (59 per cent) of the clients of the Alone in London Service cited it as a major factor in their homelessness and 56 per cent wanted to repair relations with their family (see Section 3 for more information on the work of the projects interviewed for this report). Research for the Safe in the City initiative cites national survey data which show that 33 per cent of young people with step-parents have left home by the age of 21, compared to 14 per cent of all young people (Bruegel and Smith, 1999). The same research casts more light on the particular problems which appear to heighten the risk of homelessness for young people, including: Only one in six homeless young people said their childhood was happy or good, compared to three quarters of the other local young people surveyed. It was family violence, rather than just arguments, which was associated with later homelessness: while six out of ten and nearly half of the other young people reported continuous or frequent arguments, nearly a quarter (23 per cent) of young people who became homeless said arguments frequently involved hitting, compared to only seven per cent of the other young people. The parents of homeless young people were more likely to have mental health and substance abuse problems. Agencies emphasised that it is very important to identify children at risk of homelessness at an early age, certainly by 13 or 14. A third of young people in the Safe in the City research had left home before the age of 16 and a further third at 16. Other agencies pointed out that they would probably have exhibited risk factors at school or when in contact with other agencies. Although some surveys show that a high proportion of homeless young people report that they were told to leave home, rather than left voluntarily, some agencies pointed out the need to interpret these answers carefully. Staff providing family mediation services found that the difference between a family argument and being told to leave was often difficult to untangle. Young people who prefer to move into a hostel or other temporary accommodation may have an incentive to say that they could not return home. There are worrying levels of abuse of young people and no agencies would encourage them to return to such circumstances. However, some services might inadvertently encourage young people to leave home before they are ready for independent living and increase the risk of longer-term homelessness. For example, suggesting accommodation alternatives and choices, including access to hostels, rather than encouraging a return home may increase the risk of later homelessness. Some agencies believe that greater emphasis should be given to family mediation and keeping young people with parent and foster parents, unless this is clearly detrimental to them. The survey for this research found 38 per cent had been living with parents or step-parents immediately before their first episode of sleeping rough. The great majority of them, 33 per cent of people in the survey, mentioned disputes with parents as a factor which 6

14 had prompted them to leave and 21 per cent said it had been the main factor. A third of these who said it had been one factor reported they had been told to leave, and a quarter mentioned violent or abusive behaviour by a parent or step-parent: I was kicked out of the house. I didn t get on with my stepfather, he used to beat us. I used to back-chat him. He used to assault me, my sister and mother. I used to notice he was violent when he was drunk, but ignored us when he was sober. I was ten years old at the time. (male, 25, staying at hostel) A sixth mentioned drug use as a factor in the disputes they had with parents: Through drugs, cocaine, robbed my mum and dad. Took five-and-a-half-grand from them. I got kicked out. I was 12. But they said the door s always open, but because I ve done wrong I always felt bad. Even after I cleaned up. (male, 30, staying at hostel) The survey asked a separate question about whether people had ever been asked to leave their parents or foster parents home: 39 per cent said that they had, and 31 per cent had experienced serious disputes with a step-parent or parent s partner (Table A14). Asked if anything at all might have helped them avoid sleeping rough the first time, a third of those who had left because of family disputes mentioned that reconciliation with parents might have been possible. Some admitted they had chosen not to attempt it: I could ve made the peace with my stepdad for my mum s sake but I hated the bastard so it was easier all round if I just left. I preferred to go off on my own. (male, 26, staying at hostel) Others believed it would not be reciprocated: Communication with my family, trust from them. I didn t earn their trust, because I wasn t shown that trust Father was a man not to show emotions, you were supposed to be perfect and not have problems. I fell to pieces when he got married again, no love or trust with stepmother, on both sides. (male, 32, staying at hostel) Or, there was no possibility of returning to live, even though they were still in contact: Once before, mum took me back but this time she wouldn t and she wasn t going to change her mind. I visit her now but she won t let me back. (male, 25, staying at hostel) A third of those who had first slept rough after leaving their parents home thought that nothing at all would have helped avoid having to do so, reflecting a sense of having had no choice. A further third, however, thought that advice about or finding suitable accommodation might have helped avoid sleeping rough. Asked about what the impact of being asked to leave their parents home had been, some described vividly their sense of rejection: It made me feel isolated, worthless, no one to turn to. Teenagers still need parents. (male, 24, day centre) [I felt] sad and lonely. Felt like an outlaw. I couldn t look after myself. (male, 26, day centre) Others clearly felt it had affected the whole course of their lives: That s where everything stemmed from, my whole fucked up life. (male, 32, staying at hostel) This is why I m where I am today. I m a hard bloke to settle now. (male, 55, staying at hostel) Some could now see they had played a part in the breakdown: Now, I can see they were saying, we can t be running after you all your life. It ruined it at the time, because I had nowhere to go. (male, 29, day centre) Leaving local authority care Surveys of people sleeping rough have found that between a quarter and a third have spent time as children in local authority care (Anderson, Kemp and Quilgars, 1993; Randall and Brown, 1996). This compares to only one per cent of all children and young people under the age of 18 who have been in care. Around two thirds of young people in care have left by the age of 18, while the average age of leaving home for all young people is 22 (Evans, 1996). This means that care leavers have to attempt the transition to independence at a much younger age than other people. These problems are made worse because care leavers tend to have lower levels of educational participation and attainment, higher unemployment, unstable career patterns and higher levels of mental health problems (Stein, 1997). 7

15 In the survey of rough sleepers for this research, a third (32 per cent) had been in care at some point in their childhood and eight per cent (eight people) had run away from a children s home or foster parents to sleep rough for the first time. Some mentioned repeated episodes of running away from care: Just running away from children s homes. I had a stepfather who was no good. [They] put me in a halfway house but that only lasted a few weeks. Had to stay in one place and be a good boy. I was a good boy but I couldn t stay inside all day. No one could take my freedom away from me. (male, 34, day centre) Out of these, two thought reconciliation or mediation to return to their family home might have helped them avoid having to sleep rough: Bother in the [children s] home. They kicked me out. Mum said she d take me back home, but she never. The choice was a boarding school or sleeping rough so I preferred sleeping rough. (male, 21, staying at hostel) I slept in a scrapyard and I were only 11 years old. I didn t want to be away from my family. I didn t want to be away but the police talked me round and said you need a care order. They took me away from my family, my brothers and sisters. (male, 39, day centre) One said that accommodation advice might have helped, but five felt there was nothing at all that would have helped to prevent sleeping rough on the first occasion. The problem of young people leaving care too early has been getting worse in recent years. A 1999 Department of Health Circular states that the proportion of care leavers, aged between 16 and 18, who leave at the age of 16 increased from 33 per cent in 1993 to 40 per cent in It goes on to say: The discharge from care of 3, year olds in 1997 does not appear to accord with the parenting responsibilities of local authorities, no matter how well supported some might be by after care schemes. Many of these young people are extremely vulnerable and it is questionable whether they are ready for the degree of independence occasioned by their discharge from care. The Government anticipates, therefore, that local authorities will retain a number of 16 and 17 year olds in care longer (DoH, 1999) Agencies working with homeless young people who have left care supported this approach. Some pointed out that the main need of most such young people is adequate support, rather than independent accommodation. They point to the very variable level of services currently provided by local authorities. While some services are very comprehensive and effective, others are leaving children and young people with inadequate support and at high risk of homelessness. One project reported that up to 50 per cent of care leavers subsequently lose their tenancies. One study found that over half of young people made two or more moves and a sixth made five or more moves in the first two years after leaving care. Most of these young people needed continuing support to sustain their tenancies. Over a fifth became homeless at some stage (Stein, 1997). Agencies also made the point that most young people have continuing, if diminishing, support from parents until well into their twenties. Such help is much less often available to young people who have left care. If the risk of homelessness is to be reduced, they will need some support until they are settled into secure housing and managing to sustain a tenancy independently. Relationship breakdown Almost half (45 per cent) of the survey of people who had slept rough reported having experienced marriage or long-term partnership breakdown (Table A 14). A quarter of these had first slept rough immediately after a relationship broke down. Three of the 20 women interviewed first slept rough to escape violent or abusive behaviour by their partners. Some people described vividly their experience of the emotional trauma. For example, those who had slept rough for the first time following a relationship breakdown, described the impact: [I was] devastated, completely hopeless. No one to turn to, no one to talk to. Terrible. (male, 39, day centre) Devastating, shattered completely. All things seemed to just collapse around me, nowhere to turn. (male, 45, day centre) For another who had slept rough previously, it had resulted in returning to the streets: I went to pieces. Straight back on the street, drugs and alcohol use escalated astronomically. (male, 32, staying at hostel) 8

16 It ruined me. I had a home, two cars. When I got divorced I moved to London, started drinking. I felt isolated it spiralled out of control. (male, 43, day centre) Mental health A survey which administered standard psychiatric tests to people sleeping rough found as many as 60 per cent may have mental health problems (Gill, Meltzer and Hinds, 1996). Research using standard diagnostic techniques with homeless young people found that, on a conservative estimate, half suffered from treatable psychiatric disorders, but only 15 per cent of these had ever received psychiatric help. (Craig, Hodson and Woodward, 1993). A study of older homeless people found that two thirds either reported, or were observed to have, affective or psychiatric problems (Crane, 1997). However, despite the commonly held view that the closure of long-term psychiatric hospitals has resulted in former patients sleeping rough, this does not appear to be a significant problem. A number of studies have found that very few rough sleepers who are seriously mentally ill have ever been in long stay hospitals and of those who are released from such institutions, only one or two per cent at most go on to sleep rough (Craig and others, 1995; Crisis, 1997; House of Commons Health Committee, 1994). Understandably, people with mental health problems are less likely to see themselves as contributing towards their homelessness. Nearly half (47 per cent) of the people in the survey of recent rough sleepers had seen a mental health professional at some point in their lives and 16 per cent had spent time in a psychiatric unit. However, only three people specifically referred to mental health problems as the main reason they had first slept rough. I became depressed and after so many weeks you lose your job and then your house. When you re in a depressed state you don t realise what s happening to you and you drift on to the street. (male, 45, day centre) A further 19 per cent reported that mental health problems had made it difficult for them to find or keep a place to live. One Interviewee who had recently been rehoused after sleeping rough on and off for years and had lost tenancies previously, was clearly worried about sustaining the new tenancy: I didn t want to live alone, I can t stand being isolated. If the Council flat doesn t work the health worker doesn t think I should be alone in a Council flat I ve been there five weeks. I come here [the day centre] to see old mates. (male, 24, day centre) Agencies interviewed for this study confirmed the importance of mental health problems and pointed out that they went beyond treatable mental illness. Many of their clients exhibited chaotic behaviour and personality disorders which are considered untreatable by mainstream services and which mean they receive little support from them. These problems can lead directly to homelessness through inability to manage money, rent arrears, nuisance to neighbours, a tendency to damage their flats and to move on if any problems arise. These problems are made worse by the unwillingness of some people to engage with services. Their mental health problems also often leads to social isolation and lack of support networks, which heighten the risk of homelessness. Alcohol and drug misuse As with mental health, alcohol misuse tends to be under reported in all surveys. Nevertheless, surveys have found that around a third of homeless people report heavy drinking or alcohol related problems (Anderson, Kemp and Quilgars, 1993). A survey which used diagnostic tests found a half of people sleeping rough were alcohol dependent (Gill, Meltzer and Hinds, 1996). Street outreach workers in London have assessed up to 20 per cent of people sleeping rough may have a drug problem, varying from 39 per cent of those aged under 26 to two per cent of those aged over 40. A survey by Hungerford Drug Project found that 35 per cent of street homeless young people aged 16 to 25 were heroin users, 18 times higher than those with homes. A half (49 per cent) were injecting some form of drug (Flemen, 1997). A third of the rough sleepers in the interview survey said that alcohol use, either by themselves or someone else, had been a contributory factor to their first episode of sleeping rough. A further third said that it had been a factor on subsequent occasions. A fifth reported it was a factor both initially and subsequently (Table A7). In most cases, it was the respondent s drinking, but one in ten mentioned their parents drinking, or growing up in an environment where drink was prevalent: We all had lager when we were kids and [I] first got into cannabis in the care home. Parents drinking set me off, them drinking in front of me and I tried to do it. (male, 34, day centre) 9

17 I was nine years old, taking drink and drugs. My parents couldn t afford my drink because of paying for their own, so they slung me out. (male, 21, staying at hostel) Among those aged under 26, it was more likely to have been drinking by another household member than their own drinking that had led to the first episode of sleeping rough, whereas among the older age groups it was their own drinking that had led to problems. For some, drinking and sleeping rough had started as a free and easy lifestyle, made possible by the availability of casual work: I was bricklaying, I got paid by the day. I slept rough some times and not others if the weather was good, it wouldn t bother me to sleep on the Heath, because I was pissed most of the time. We had no fringe benefits in that job, so you got your pay each day, then pissed it away. I didn t want to [take accommodation] sleeping rough on Hampstead Heath didn t bother me. I was younger then, the weather was better! Sleeping out meant I had all my money for drink. (male, 47, day centre) Others gave drinking as the main reason for leaving temporary accommodation or not taking up offers of accommodation: It d be alright for a couple of weeks then I d want to drink and they aidn t let you in the hostel. Then all my money would be gone and I couldn t pay for the room, so it was easier to leave and drink on the street. (male, 48, day centre) Or, not being able to sustain a tenancy: I get drunk I cause a nuisance and get thrown out. I drink my rent. I wouldn t have to sleep rough if it wasn t for alcohol. Sleeping rough leads to more drinking, feeling more comfortable, it helps you sleep. You need another drink to get yourself together when you wake up and then you just go on and on. In the end you lose the will to find a place to live. (male, 55, staying at hostel) One in six said that being able to drink whenever they wanted made it more likely they would sleep rough rather than find accommodation. Fifteen per cent said that use of drugs had been a factor leading to their homelessness the first time. This proportion increased to 23 per cent for later episodes of sleeping rough (Table A8). The increase is attributable to those aged between 26 and 39, who appear to have become more vulnerable to drug use after their first episode of sleeping rough, with 43 per cent of them reporting it as a factor on subsequent occasions, compared with 16 per cent, the first time. People were not inclined to think counselling about drinking or drug taking would have made any difference to whether they slept rough at any stage. Around a third of those who said that drinking or taking drugs had been a contributory factor thought that help or counselling might have made a difference to the first episode of rough sleeping. Slightly higher proportions thought such services might have helped on subsequent occasions. Some felt counselling might have been beneficial: I had to drink to beg and stay warm. Counselling opens your mind, instead of being on one track of drinking all the time. When I go on binges, I drink for several days. Counselling could put me on the right lines. (male, 25, staying at hostel) Others were not at all receptive: I don t believe in it [counselling]. It s alien to me, you ve got to do it yourself. I d rather brood, I d rather talk to family and friends. I don t want a stranger in my private life. I don t usually talk to strangers at all. (male, 37, day centre) One respondent emphasised the importance of early intervention with drug use: If you catch a person in the first stages, you ve got a chance of [drug use] not getting a criminal hold. But how do you reach them? It would stop 50 per cent of cases I think if you could stop kids when they first start heavy drugs. Soon it s too late and you get into the underside of life and criminal stuff. (male, 24, day centre) However, there were differing views about what was of practical help. For example, support from a fellow user who had given up: Not at first, [but] after four or five years, like. When my mate, a dealer, came off, he became clean and it helped me because he d been there and done it and he could understand me and where I was at. I wouldn t have trusted anyone who hadn t been there themselves. (male, 30, staying at hostel) 10

18 Or, help to keep accommodation: Knowledge of what my needs were how to take drugs and keep a roof over my head at the same time. I wasn t going to give up taking drugs and being treated like a criminal makes you just walk away. (male, 47, staying at hostel) Access to safe methods of maintaining the habit was mentioned: Information about where to get clean needles and disposables. Medical advice they wouldn t get a doctor, they had a nurse, but she wasn t interested, wouldn t help. Hostels should have sound practical help and advice. (male, 47, staying at hostel) Agencies interviewed for this study confirmed the risks of homelessness to substance misusers. Rent arrears and other debts can arise because of the chaotic lifestyle and the priority given to expenditure on the addiction. The only social network of people in these circumstances may be other drinkers or drug users who are homeless or on the fringes of homelessness. People may join groups of street drinkers for company and become part of a rough sleeping group. Attempts to change their behaviour may bring social isolation by separating them from fellow substance abusers. Multiple problems Agencies which provide support services to tenants or to people in day centres, found that many clients had multiple needs. These multiple needs can mean that people fall between services. Many people sleeping rough suffer from both mental health and substance abuse problems. A survey of winter shelter residents found that over half (54 per cent) had mental health problems and of these 70 per cent were also perceived to be dependent on drugs or alcohol, making a total of 38 per cent with a combined problem (O Leary, 1997). Complex problems of mental health and substance dependency are not easy to identify in a half hour interview survey. The survey of people sleeping rough for this research asked a number of questions which, taken in combination, could be regarded as broad indicators of whether respondents had multiple needs. Interviewees were asked whether drink or drug use was associated at all with their first or subsequent episodes of sleeping rough, and whether or not they had ever been in a drugs or alcohol unit. They were also asked if they had ever been in a psychiatric unit, if they had ever seen a mental health professional in their lives, and whether they had ever had mental health problems which had made it difficult for them to find or keep a place to live. Half the people in the survey (51 per cent) had seen a mental health professional at some point in their lives or reported having had mental health problems. Sixteen per cent reported mental health and alcohol problems, a further 13 per cent reported mental health and drugs problems and yet a further eight per cent reported mental health, drink and drugs problems (Table A13). In all, 36 per cent of people in the survey gave some indication of having multiple problems. The criminal justice system Many rough sleepers have repeated contacts with the criminal justice system. Surveys have found that around half have been in a prison or remand centre at some time (Anderson, Kemp and Quilgars, 1993; Randall and Brown, 1996). This high proportion is linked to both mental health and substance abuse problems. One study estimated that 70 per cent of arrests of people with no fixed abode may be associated with alcohol or drug use. Homeless people who are drunk are more likely to be arrested because they cannot be advised to go home or be taken to a hostel if they are acting disruptively (O Leary, 1997). A study of people appearing at two magistrates courts in central London found that as many as a half (49 per cent) were living on the streets and three quarters (77 per cent) had previously been psychiatric in-patients (Jones, 1992). The problems of mentally vulnerable people in the criminal justice system are now more widely recognised and have been the subject of major official enquiries. However, many people still fail to gain access to care, even after repeated involvement with the system. It has been estimated that a third of the prison population has a significant mental health problem, but do not meet the criteria for transfer to the NHS (Revolving Doors Agency, 1997). These are mainly people on short sentences who do not meet the criteria for hospital admission, but who have significant mental health problems that impairs their ability to lead settled lives. Many rough sleepers come into this category. Offending makes it more likely that someone will become homeless and homelessness makes it more 11

19 likely that they will re-offend. Approximately 90,000 prisoners are released each year and many have lost their homes because they were unable to maintain them while they were in prison. In one study, fewer than half of the ex-prisoners were able to return to their previous home after they had been released (Carlisle, 1996). This problem has been made worse because the period for which prisoners can claim housing benefit on their homes while they are in prison was reduced in 1995 from 12 months to 13 weeks. Many also lose their partners and their jobs, increasing their risk of sleeping rough. Many ex-prisoners are unwilling to accept a place in a hostel as they see it as a return to institutional life and many hostels will not accept those convicted of arson or sex offences. A national survey found that 40 per cent of prisoners expected to be homeless on their release (Carlisle, 1996). If someone loses their tenancy because of a prison sentence they may be classified as intentionally homeless by the local authority and so ineligible for rehousing. Many rough sleepers revolve between the streets, hostels and prisons. Because they are often convicted of relatively minor offences and are in prison for less than 12 months, they do not receive support from the probation services, which since 1991 have been required to target those with longer sentences. The cycle of problems which is created can be seen from the fact that two thirds of ex-prisoners who have no satisfactory accommodation re-offend within 12 months of release, whereas only a quarter of those with good accommodation do so (Carlisle, 1996). A quarter of the interview survey had been in a young offenders institution and all but two of these had also been in prison. Half the people in the survey (49 per cent) had been in one or the other or both (Table A12). Trouble with the police was often mentioned, either directly or indirectly, as associated with their first period of sleeping rough: I d been in nick I got out and jumped bail and came straight to London. I was sleeping rough because I couldn t claim benefit, I was having to be anonymous. (male, 36, day centre) In some cases, this was from an early age, linked to substance use and problems at school: I was sniffing glue I used to bunk off school and get a pot of glue. They sent the police out cos I was missing, so I kept escaping. (male, 28, staying at hostel) A third (30 per cent) of people in the survey reported having slept rough immediately or soon after leaving prison or a young offenders institution. Usually, lack of information about accommodation on or before discharge was given as the reason: Being able to get in contact with hostels, agencies etc before being released. Basically they should ask you if you have somewhere to go on leaving HM prison. (male, 25, day centre) Or, adequate support to help return to a previous area and home: If someone had helped me get accommodation. My probation officer doesn t help. I want to be in Essex, not here. I d like to go home and get my boys back, but I get no help from probation. (female, 39, day centre) One interviewee pointed out the risks of returning to drug habits and re-offending after discharge: In prison they give you 100 and that s it. If you have a drug problem, you spend it on that otherwise, what do you do with 100? you don t know where to go and what to do. There s no organisation they send you to, so you go out with money and buy drugs with it and it all starts again. The drugs rehab didn t stop me taking drugs, I did it on my own. (male, 24, day centre) Another interviewee described a pattern between sleeping rough and spells in prison, after early experience of not being helped into accommodation: I didn t bother going to agencies, I was so used to prison and sleeping on the streets. The first time they offered me parole and I turned it down as I thought the more time I m in here, the more chance I d have of them finding me somewhere. In fact I d have been better off on parole as they find places for you then. (male, 32, staying at hostel) Education and qualifications Agencies interviewed found that people sleeping rough have often had disrupted and poor quality education, leading to low levels of qualifications and to unemployment. Only 38 per cent of people sleeping rough have any educational qualifications, compared to 66 per cent of people aged over 16 in the general population (Anderson, Kemp and Quilgars, 1993). Exclusion from school heightens these problems. A quarter (28 per cent) of people in the survey for this study reported they had been excluded from school 12

20 (Table A14). Most of them (four out of five) said they had also been asked to leave their parents or foster parents home, and three quarters reported serious disputes either with a step-parent or parent s partner (compared with 39 per cent and 31 per cent respectively of all those in the survey). Asked about the impact school exclusion had on their lives, some thought it had little or none, and appeared to shrug it off with comments such as: Done me a favour really. (male, 40, staying at hostel) Not much I didn t fit in at school anyway I didn t care about being thrown out. (male, 19, staying at hostel) However, others felt the importance of missing out on basic qualifications: [It] left me uneducated and unable to get a job. (male, 31, day centre) A lot, as I never left school with an education. It affected getting work and everything. I went to college in the end, City and Guilds bricklaying. But I ve got no GCSEs and a lot of people do ask for them. (male, 30, staying at hostel) Some linked the experience to difficulties they were having at home: [It was] at the same time my mother threw me out. I never told school about my home life problems and I got destructive there. I had no exams and no one wants to take you on a college course if you re on the streets. (male, 32, staying at hostel) Just kept me on the streets more, I was unruly. I told teachers what was going on [at home] but they were no help. They used to put me in detention which made me despise them as much as my stepfather. They put me in detention because I couldn t do homework. (male, 25, staying at hostel) Another described a sense of worthlessness that exclusion had given him: [It] felt like I was the worst kid in the school. I found out since I have dyslexia. (male, 29, day centre) Unemployment The great majority of clients of the agencies interviewed for this study were unemployed. Surveys consistently find that 90 per cent or more of people sleeping rough are unemployed, including up to one in five who are long-term sick or disabled (Anderson, Kemp and Quilgars, 1993; Randall and Brown, 1993). Many are very long-term unemployed, with around a third having had no job for five years or more (Anderson, Kemp and Quilgars, 1993). Service in the armed forces Repeated surveys have found that around a quarter of people sleeping rough have been in the armed forces at some stage, excluding national service (Anderson, Kemp and Quilgars, 1993; Randall and Brown, 1994; Gunner and Knott, 1997). Two fifths of homeless exservice people surveyed for a Crisis study said they had never settled after being discharged (Randall and Brown, 1994). A number of factors may lie behind the disproportionate number of ex-services people sleeping rough, including their belated entry into the housing market; spending years in institutional life; a lack of experience of independent living, housekeeping and budgeting; a culture of heavy drinking while in the forces and a lack of settled community ties (Randall and Brown, 1994; Gunner and Knott, 1997; Crane, 1997). The survey of rough sleepers for this research found 17 per cent had been either in the armed forces or the merchant navy, a slightly lower proportion than other surveys of rough sleepers have shown. All but two were aged over 26 and two thirds were aged over 40. One described how he had first started to sleep rough after discharge: I had no knowledge of how the system worked, I d never been in that situation. I didn t even know how to sign on. I used to be in the services. In the army everything s done for you, your meals, when to get up, go to bed. You can t think for yourself. Coming out of the forces into Civvy Street is difficult for a lot of people. (male, 62, day centre) Additional risk factors Agencies interviewed suggested a number of additional factors which might lead to an increased risk of homelessness and rough sleeping. These include: Learning difficulties and literacy problems. These can lead to difficulties for people in sustaining tenancies and dealing with bills. Problems with housing benefit and rent arrears are more difficult to 13

21 manage. People who do not understand correspondence may not wish to admit this and find it impossible to deal with bureaucracy. Frustration can lead to angry scenes and a breakdown of relations with officials. This can be followed by eviction or the abandonment of the tenancy. Lack of a social support network. An absence of family or friends can make it very difficult for people to cope with problems in a tenancy, or be motivated to sustain it. Many rough sleepers report problems of social isolation and loneliness as reasons for losing tenancies. For all the hardships, life on the street does offer a social network to some people and once they have become part of it, it can become difficult to leave. Unless they are helped to move off the streets rapidly, people can become institutionalised as rough sleepers. Previous experience of rough sleeping. The great majority (85 per cent) of people in the survey for this study had more than one episode of rough sleeping. Some started with just a few days in an emergency: 14 per cent slept rough for less than a week for the first time and a further 22 per cent for less than a month. Most of these subsequently became long-term rough sleepers. Problems with neighbours. Agencies working to prevent homelessness among people with mental health problems found that causing a nuisance to neighbours was often a sign of such problems and of difficulty in sustaining the tenancy. Severe nuisance could also lead to eviction. Failure to furnish or maintain the home. This often indicates a lack of money or of commitment to the home and a failure to settle in it. Crisis points While a range of factors increase the risk of homelessness, there is generally a specific life event that precipitates rough sleeping. These events involve leaving a previous home, often in a crisis. People often then have limited or no access to alternative accommodation. They may have low priority for social housing and be unable to afford rents in the private sector. Unless they have friends or relatives who are able and willing to put them up, they have no alternative but hostels or rough sleeping. The main factors identified by previous research, and by people sleeping rough and by agencies interviewed for this study are: Leaving the parental home after arguments. These are often the culmination of problems going back to the early teens or even earlier years. These difficulties can be exacerbated by other problems such as mental health or substance abuse by parents, children or both. The presence of step-parents can also increase the risks of breakdown. Although when interviewed young people will often say they were thrown out of home, the reality is often more complex. Agencies find a worrying level of physical and sexual abuse, but in other circumstances reconciliation with the family might be possible. Leaving care. It has been seen above that young people depend on family support often until well into their twenties. The earlier such support is withdrawn, the more vulnerable the young person will be to homelessness, particularly because young people leaving care often also have other risk factors such as low levels of qualifications and higher levels of mental health problems. Eviction from a rented or owned home. Most people sleeping rough have had their own home, usually rented, at some stage. Problems of rent arrears and nuisance to neighbours, often resulting from mental health or substance abuse problems, leads to eviction or abandonment of the home. Single people may not be considered as in priority need for local authority housing. Even where they are, eviction often leads to exclusion from local authority housing on the grounds that the person made themselves intentionally homeless. Relationship breakdown. Surveys consistently find that around 90 per cent of people sleeping rough are men. Some men who start to sleep rough in their twenties and thirties have left the home they were sharing with their partner. They may well have mental health or substance abuse problems that contributed to the breakdown. In these circumstances, they often have no priority for social housing and are often offered little help by other agencies, particularly if they are seen as at fault in the relationship breakdown. Many women who sleep rough have been victims of domestic violence. Leaving prison. It has been seen that a half of people sleeping rough have been in prison or a remand centre and that many lose their homes while they are in custody. It will be seen in Section 3 that there are serious gaps in the housing support services for ex-prisoners. In the absence of rehousing opportunities, there are high risks of homelessness. Discharge from the armed forces. As with leaving care or prison, people discharged from the armed forces are leaving an institution which has provided them with accommodation, but which may not 14

22 have prepared them for independent living or offered access to alternative housing. A deterioration in mental health or an increase in alcohol or drug abuse. Many people do sustain homes while suffering from severe mental health or substance abuse problems. It will be seen in the next section that tenancy support schemes can achieve high success rates in sustaining tenancies. However, sudden and sharp deteriorations in problems can lead to a crisis which leads to someone abandoning their home. Such a deterioration can result from social isolation following rehousing into independent housing. A financial crisis, caused for example by errors in Housing Benefit or other benefits, or by mounting debts, can cause people who have difficulty coping with finances, because for example of mental health problems, literacy or learning difficulties, to abandon a tenancy. Many homeless people who have lived chaotic lives, or spent years in institutions where they have not had to cope with independent living, may give up and turn or return to the comparative simplicity and freedom of life on the streets. The evidence from previous research, from people sleeping rough and from agencies offering preventive services identifies a range of factors which increase the risk of homelessness and of crisis points which can precipitate rough sleeping. The next Section examines what agencies can do to identify people at risk and to intervene to prevent them from rough sleeping. 15

23 3 Preventing homelessness: the work of projects Just as there is a wide variety of risk factors and crisis points that can lead to rough sleeping, so there is a wide range of services which help to prevent homelessness. The services examined for this study were: Education in schools on homelessness and leaving home. Advice services for young people. Family mediation services for young people in dispute with their families. Services to help people return to accommodation in their home areas. Extended and improved support for young people leaving care. Support for people in contact with the criminal justice system. Services for existing tenants of social housing with mental health and substance abuse problems, including the development of specialist support for people with multiple problems. Support for people at risk of losing their home because of relationship breakdown, rent arrears or nuisance to neighbours. Multiple services and inter-agency work provided through day centres and advice centres. Services to tackle social isolation. Resettlement services for people leaving the armed forces. Specialist support for young people and women. With such a wide range of services, the aim was to map models of current provision and identify possible future developments. Individual projects were examined as examples of each type of provision. These case studies are illustrative of the range of current projects: in most cases, there are many other projects which could have been used as examples. Education There are broadly two objectives in providing education on homelessness in schools: to further pupils understanding of homelessness as a social problem and to help them prepare for leaving home in a way that minimises the risks of homelessness. Although the two cannot be entirely separated, it is the second which most clearly fits the preventive model. Research by Centrepoint in two London schools found that one in five pupils expected to leave home within the next two years. The great majority (85 per cent) wanted to stay in their home area, but few knew where to go for help or advice. They expected more help from the council than they were likely to receive (Searle-Mbullu, 1997). Several agencies, including Centrepoint and Shelter, have produced teaching materials for schools and leaving home guides for young people. The survey of rough sleepers carried out for this research asked people what services would help people avoid having to sleep rough. Some specifically mentioned the role schools could play and peer education: Schools should give out information if this happens to you, this is what you should do. People like me could go in schools and talk to them, to give basic points to young people before they start a life of crime. (male, 24, day centre) There should be people going into schools, youth clubs, people who have been homeless themselves, to let them know it ain t nice. More literature left around them places letting them know. Not authoritarian figures, [but] people kids can relate to, not preaching but talking to them. (male, 32, staying at hostel) Schools should also play an important role in identifying children and young people who are at risk of future homelessness, because they have problems in the parental home. They cannot seek to resolve all these problems, but they should try to engage other specialist services. Centrepoint Centrepoint runs a programme for developing school education on leaving home. In they worked with two schools to develop a programme which aimed to: prevent young people from becoming homeless; ensure that young people develop the skills and knowledge to help them make a successful transition to independence; develop a programme of education that would be readily applicable to other schools. Key conclusions from the project were that schools should: provide a range of learning opportunities about leaving home and homelessness, particularly those who might be at risk; 16

24 focus on Years 9 11, when students are likely to be most responsive to the topic; include education about leaving home in the curriculum for personal and social education and in other areas such as art and drama; develop links with external housing agencies. Centrepoint also runs a peer education project which trains homeless young people to present training in schools and youth clubs on homelessness and related topics. A report on its work (Searle-Mbullu, 1998) found that: peer education is more sustainable if the need for it is identified by those who will deliver the programme; the project could provide useful information to other young people; peer educators are likely to be leading transient and chaotic lives which affects the level of commitment they are able to give and the speed at which they develop skills; the aims, objectives and boundaries of the programme must be clearly defined from the outset; training of peer educators needs to be focused, clearly structured and intensive to sustain interest; it is easier to assess the impact of peer education on the educators than on the young people receiving the education. Bristol Cyrenians have developed a similar peer education scheme with private sector funding and support. It uses the skills and experience of young people who have been homeless to provide peer education to young people about the problems of leaving home. Sessions are run in schools, youth centres and children s homes to provide education, information and advice about the experience of homelessness and what practical steps a young person can take to avoid it. In addition, the initiative offers the peer educators the opportunity to develop a range of communication and organisational skills and confidence building. Advice services for young people Although young people are likely to contact agencies because they want their own independent housing, it was pointed out by some agencies that, at least for 16- to 19-year-olds, all options should be explored and not simply alternative housing. One agency suggested that it had become too easy for young people to access accommodation. Advice services should include exploring the possibility of young people returning to their parents or foster parents, options which are often better in the long run than striving for independence at too early an age. Family mediation services are examined below. Advice services also have an important role in discouraging homeless young people from moving to city areas, such as the West End of London, where they will be at risk of becoming involved with the street homelessness culture. Projects play an important role in encouraging and enabling young people to find solutions in their home areas and to return to them if possible. Alone in London Service Alone in London provides a range of services to over 3,000 young people a year. They offer one-toone advice and a crisis counselling service to over a thous and young people every year. The process starts with a 50-minute assessment interview with a caseworker who concentrates on resolving immediate problems such as finding emergency accommodation or claiming benefits. Over a third (39 per cent) of the young people they saw in 1997 and 1998 had experienced physical, mental or sexual abuse. In addition around 2,500 contacted their telephone advice service last year. The assessment interview identifies the services needed by the young person from a broad range on offer through Alone in London. These include: An advocacy service which helps young people to resolve specific problems by their own actions, with support from the service. For example, they give help with making applications for housing or benefits. By involving young people in the process they aim to help build self-confidence and independence. Supported casework, which involves a caseworker and the young person contracting jointly to work on a specific personal problem together. This may involve dealing with difficult problems such as physical, sexual or emotional abuse and 17

25 help to uncover the reasons behind problematic behaviour in other contexts. It may include examining attitudes to authority, family relationships, self-esteem and anger management. Difficulties in these areas can make it difficult for young people to resolve housing and other problems and can lead to them being excluded from services such as hostels and day centres which are designed to help them. Throughout the process the young person takes responsibility for working through the sessions and chooses the right support services to complement them. An informal befriending service means that young people can return to the agency for help and support at any time, whatever problems they are encountering. It has been seen that many homeless people lack social support networks and voluntary agencies can to an extent help to compensate for this absence. Seven supported housing schemes provide accommodation and practical and emotional support for vulnerable young people. Each young person agrees a Contract of Support which covers the support they will receive on budgeting, independent living and finding work, education or further training. A resettlement service for people moving on to permanent housing. It builds on the contract made while the young person was in supported housing and provides continuing support for up to six months, or longer if necessary. A family mediation service, which is discussed in more detail below. A project to help young people to return to their home areas, which is also discussed below. The Alone in London Service provides a range of flexible services to meet the different needs of individual young people who are at risk of homelessness. For some the best solution is a return home with help to resolve difficulties within the family. Others need emergency accommodation and longer-term help to settle, although not necessarily in inner London if they have come from elsewhere. Many need help with both practical and emotional problems if they are to avoid homelessness in the future. Most initially want practical help with housing, but may then need further support to sustain a home in the longer term. Family mediation It has been seen that family breakdown is a major contributory factor to people becoming homeless and starting to sleep rough. In the immediate aftermath, it is understandable that many young people think the breakdown is irretrievable and they also have a wish for an independent life. Where there has been physical, emotional or sexual abuse a return home is unlikely to be a suitable option. However, some agencies have found that, for other young people who have left home after family arguments, the best solution might be to resolve or reduce these underlying problems. Many of the homeless people interviewed for this study wished family disputes had been resolved rather than running away from them. Indeed, such a response can be the first link in a chain of such events, where a pattern is established of leaving accommodation whenever problems arise. Providing too easy access to accommodation might actually help to entrench family estrangement. The attractions of living away from parents might also lead to some young people presenting problems with their family as more serious than they are. Some agencies argued that, for 16- to 19-year-olds, the provision of accommodation away from their families or from care should be the last, rather than the first, response. The possibility of family mediation should be explored first and should be a requirement, even where emergency accommodation has been provided. In some circumstances, respite accommodation is needed and should be available as part of such a service. Agencies have found that it is important to consider this option at a very early stage of contact with the young person, if possible within the first week of leaving home, before the breakdown with their families becomes irretrievable, or they become involved with the homelessness culture. In the survey of rough sleepers for this study, people were asked what advice they would give to others faced with circumstances similar to their own when they had first slept rough. Among the most common suggestions was that young people should try to return home: Go back home. It ain t no life to lead being on the streets. It s hard to live, you go shoplifting, you go begging, it s no life. There are 15, 16- year-olds, they shouldn t be there, they should be at home with their families. (male, 30, staying at hostel) It all depends on the age. If they re under 20, go back home and sort it out. If it s abuse, seek legal 18

26 help [They] should be taken home again with legal representatives. If they don t want to go home because of violence etc, the authorities should mediate and if they can t reconcile, they should be asked what they want and not put in a hostel with lots of lunatics. (male, 61, day centre) In some cases, respite accommodation might be needed while the problems are considered. One agency found that, even if young people returned home for only six or nine months, during that time they might be able to finish their education and stabilise relationships with their family. Even if the young person does not return home, some reconciliation with the family might be achieved, which would provide the continuing support which is lacking in the lives of many people who start to sleep rough. Alone in London: a family mediation service Over half (59 per cent) of young people in contact with Alone in London cite family breakdown as the major cause of their homelessness and 56 per cent want to repair damaged family relationships. They find that young people and their families can easily slip into a cycle of accusation and recrimination that can result in the young people leaving home. The service helps young people avoid irretrievable family breakdown and the risk of homelessness by working with them and their family to resolve disputes and reach mutually agreed courses of action. They also help young people who are already homeless or in care who want to re-establish positive contact with their families. Two trained volunteer mediators work together with each young person. There are positive advantages in using volunteers because they can be seen as neutral by the young person s parents, whereas Alone in London may be seen as representing the interests of the young people. There are several possible stages to the process, depending on the needs of the young person. First the mediators have one-to-one sessions with the young person to talk about the problems they are experiencing. Together they develop a strategy to try to resolve the problems. Some people may need only one or two meetings with mediators to explore the problems and decide on ways of dealing with them. For other more difficult cases, when the young person is ready, the mediators contact the family to see if they are willing to engage in mediation. The mediators then meet separately with each of the parties. This can be a lengthy process, as the mediators relay messages between the young person and their family. Once the young person and their family feel ready, the mediators arrange a meeting between them. Returning to the home area Some cities attract young people from surrounding areas or, in the case of London, from all over the country. They may have moved to the city after becoming homeless, in part because of the concentration of services there, or become homeless as a result of arriving without anywhere secure to stay. In some areas, particularly central London, there is an established culture of street homelessness among a relatively small group of young people. Agencies working in central London have found that it is important to prevent newly arrived young people from joining this group. There are examples of agencies, including social services and the probation service, exacerbating this problem by referring young people into the West End from outer London to take advantage of services there. Agencies pointed out that statutory services should ensure that adequate support is available in their home areas and never refer young people into the West End of London. One of the homeless young women interviewed for this research, warned specifically against the West End of London, when asked what advice she would give to others in similar circumstances to her own: Go home if you could, or if not, try to get some help. Stay out of the West End. (female, 17, staying at hostel) Several agencies run projects to help young people return to their home areas. Some projects have been unsuccessful, however, because they have offered little more than a free journey back. A review of previous projects and of the needs of newly arrived young people from outside London (Attwood, 1998) found that agencies would need to offer a complete resettlement service, including: an exploration with the young person of all their options; 19

27 a full assessment of their needs by the referring agency; a cooling-off period to ensure that returning home was their best choice; direct contacts between the referral agency and the receiving agencies; arranging in advance temporary and longer-term accommodation, along with any necessary support; access to employment and training opportunities in their home area; monitoring of the individual s progress and of the programme as a whole. These requirements apply where a young person has moved from some distance outside London; they are less likely to be necessary where they have moved from outer London or surrounding areas to the centre. The Magnet Project The Magnet Project is run by a partnership of New to London, Borderline and Alone in London Service. It offers an integrated resettlement and family mediation service to vulnerable young people in London who want to return to their local communities. Family mediation is at the centre of the service, as many young people come to London after disputes with their family and are less likely to resettle successfully unless these are resolved. If the young person decides to return, but not to their family, they are helped to find accommodation in their local area and linked to local organisations that can provide support. Magnet also helps with access to training and employment and with travel costs for those making a permanent return to their home area. Young people who are temporarily housed in a New to London hostel have, as part of their agreement, participation in a session with the Family Mediating Service to consider the option of going home. The project will also be offering training in family mediation to agencies working with young people and parents throughout the country. Leaving care It has been seen that a high proportion of people sleeping rough have been in local authority care at some time. If young people leave care too early and without adequate support, they are at risk of homelessness that could establish a pattern that lasts for many years. The provision of accommodation alone is not enough and many young people lose tenancies to which they moved after leaving care. The right kind of support is critical to reducing the risk of homelessness and rough sleeping for this very vulnerable group. First Key, the National Leaving Care Advisory Group, which conducts audits of local authority services, has found very varying standards of service. The Children Act 1989 placed clearer responsibilities on local authorities to provide support for young people leaving care, but it has been seen that the average age of leaving care has been going down and that the Government is committed to reversing this trend. A number of leaving care projects have been established and the contracting out of these services to more flexible and innovative voluntary groups has been seen as leading to an improvement in services. Nevertheless, the responsibility for ensuring that good quality support services are available lies squarely with local authorities. A recent Government circular states that: Local authorities are: strongly encouraged to prepare after care plans for individual children within the existing legal framework as a matter of priority and to base framework as a matter of priority and to base them on a multiagency assessment of need; and asked to: take steps to ensure that young people only leave care when they are demonstrably ready and willing to do so; use to the full their existing powers and duties under the Children Act 1989 to support care leavers up to the age of 21; ensure that local education authorities, schools, the carers and employment services are fully engaged in the assessment and planning process; ensure that housing providers are involved in the assessment and after care planning process; and that contingency plans are in place in the event of a breakdown of a young person s accommodation arrangements; consider the development of specialist leaving care schemes where these do not already exist; 20

28 consider in every case of a care leaver whether the young person would benefit from the assistance of a mentor or befriender. (DoH, 1999) The Government has stated it will make the provision and periodic review of an aftercare plan a legal duty of local authorities and that it is planning radical new arrangements for 16- to 18-year-old care leavers, along the lines of the action recommended to local authorities in the DoH Circular. The Government also expects local authorities to provide for a graduated transition to independence through semi-supported accommodation. Specialist leaving care teams have been shown to provide more effective aftercare services and the development of them is encouraged by the Government. A review of specialist leaving care schemes (Stein, 1997) found that their work has included the development of: direct individual and group support for young people; a flexible range of services, especially housing and financial support; inter-agency links to ensure integrated support packages; providing advice, information and consultancy services to young people, social workers and carers; drop in schemes to provide social support. In most schemes, the young person is allocated a key worker who will provide intensive support, ranging from practical help to counselling. They have been found to achieve positive outcomes, or progress towards them, for three quarters of young people, as measured by improvements in accommodation, support and self-esteem. A survey of care leavers found that a fifth moved into independent tenancies when they first left care and this rose to three fifths 18 to 24 months later. Most of them needed continuing support to sustain their tenancies. Even for those young people experiencing the greatest instability, continuity of support by schemes often helped to prevent homelessness. This was done not just by providing accommodation, but also by providing support to sustain tenancies, particularly in times of crisis. It was found that young women were twice as likely to be successful at sustaining a tenancy as young men (Stein, 1997). This perhaps indicates a need to target more intensive housing support on young men leaving care. The same review of research found that placement stability, continuity and family links are all essential to achieving positive outcomes. This finding was reinforced by interviews with agencies for this study. They emphasised the importance of young people continuing to stay with foster parents beyond the age of 16 and even 18, just as most young people do with their birth parents. This should take priority over encouraging young people to attempt independence at too early an age. Foster parents can be paid for carrying out this role and there is indeed an overlap between foster care and supported lodgings. Both of these are normally preferable to independent tenancies for 16- to 18-year-olds and indeed for many young people, in to their twenties. Where necessary, foster care can simply be redesignated as supported lodgings. Support during this period of preparation for independence should come principally from the young person s prime carers. Provision of specialist leaving care schemes can result in these links being broken. The emphasis should be on the provision of good parenting rather than the assertion of rights to independent housing. As one agency put it, independence can too easily become neglect. The Kipper Project The Kipper Project provides a range of housing schemes and support services to homeless young people in East London, particularly targeting care leavers, young offenders, drug users and those escaping violence or abuse. The focus is on providing appropriate local housing and support to meet a wide range of needs. There are strong links between young people and their local communities and most do not want to move out of the area. A range of care leavers services has been developed in partnership with the local authority. Three residential schemes offer accommodation and support for care leavers and young offenders who are assessed as unlikely to sustain an independent tenancy, including young people aged over 18 who may already have lost a tenancy. Two hostels provide 18 bedspaces for young people aged 16 to 25, with medium level support and move on accommodation. There is also an eight-bed scheme for 16- to 17-year-olds, who may either be still in school, or on a training placement. Two volunteers live in. Kipper offer floating support to give practical help with independent living skills, such as budgeting, home maintenance and cooking, when 21

29 clients are ready to move into more permanent accommodation, which is provided by the local authority. Help and support for clients to access training and education programmes is also available. In addition, a supported lodgings scheme is being developed in partnership with Providence Row and the local authorities, aiming at young people aged 16 to 18 with higher support needs who have been in care or in contact with social services. The aim is to offer young people their own room in a home with a family, single person or couple, to help with preparation for independent living. Hosts are given training similar to adoption and fostering training, including information and advice about substance use, dealing with violence and eating disorders. The emphasis in all Kipper s work with care leavers, is to offer practical and emotional support so that they can gain confidence, build self-esteem and take responsibility for their lives. Befriending and mentoring Social isolation and a lack of positive role models are important factors in creating homelessness and in making escape more difficult. These can in part be tackled by befriending and mentoring schemes using volunteers. They are a useful addition to professional support rather than a substitute for it. A review of research on mentoring found that it is not effective on its own, but if part of a wider system of support for young people it can fill a significant need of young people for caring and consistent relationships with adults (Stein, 1997). Befriending usually takes the form of relatively informal support for vulnerable people to lessen their social isolation and to help with everyday tasks if necessary. It can work with people of all ages. Mentors more usually work with young people in a more structured although still very personal way, often focused on specific tasks such as finding and keeping employment. It has for example been used to support young offenders (see below, The criminal justice system ). Another example is planned in the London Borough of Hackney as part of the Safe in the City programme, where a project will focus on selected secondary schools, pupil referral and assessment units, youth clubs and other agencies which young people use. It will identify young people at risk of educational failure, offending behaviour and exclusion. Mentoring will seek to raise attainment, aspiration and motivation with a programme of education work which it is hoped will help to prevent future homelessness. Arlington Care Association Arlington Care Association provides a volunteer befriending service for socially isolated people. The scheme is based on a belief that vulnerable and isolated people can benefit from non-judgemental contact with others. The service targets people whose circumstances, use of alcohol or drugs, or mental health problems, will often exclude them from accessing support through most social or professional channels. The type of contact varies according to the needs and wishes of individual clients. In many cases there are informal recreational outings or activities within the community. Others are designed to achieve specific goals, such as accompanying someone to an appointment. The service also includes visits to clients in hospital. The volunteers provide a range of services including: advice and advocacy, helping clients access specialist services; support during resettlement; visiting and escorting during crises and emergencies. The service works with around 40 supervised volunteers and five students, all attached to specific projects, including five hostels, two supported units and one day centre. Volunteers are likely to see clients more regularly than hostel key workers and can gain important information about clients behaviour which might affect their resettlement. Some volunteers work directly with resettlement teams and assist with life skills training. By its nature, befriending is less goal orientated than professional interventions, but aims to reduce the social isolation of homeless and potentially homeless people, a factor which many identify as underlying the failure of previous tenancies. Bristol Cyrenians Bristol Cyrenians also run a mentoring project for homeless young people. Volunteer mentors are 22

30 given initial training and thereafter regular supervision, both one-to-one and in group sessions. Matching of mentors and users is carried out on the basis of needs, age, gender, ethnicity and interests. Mentors may help with improving users job readiness, for example though finding voluntary work, enrolling for training, developing CVs and job application skills, or developing social skills, such as confidence building, motivation, or managing time which is alcohol or drug free. There is continuing review and feedback from both mentor partners to the project developer. Mentors report a two-way learning process through the mentoring relationship; developing skills such as listening, patience and diplomacy as well as a greater understanding of homelessness and the benefits system. A further development has been one-off mentoring, where people are matched to a mentor from the pool, for support with a single practical task, such as enquiring about benefits, or completing a job application form. This can prove an introduction to mentoring, or a source of support for people not ready to cope with a longer-term mentoring relationship. The project has found mentoring a valuable process for some young clients. However, to be successful, it requires a certain level of commitment and motivation from users which is difficult for some, particularly if their lifestyle is chaotic. The project s experience suggests that mentoring is more likely to be successful for people who are newly housed rather than those who are still homeless and that the continuing mentor relationships are those where the user is either in supported housing, or in their own accommodation (Randall and Brown, 1999). The criminal justice system There are strong links between rough sleeping and involvement with the criminal justice system. There is a need for intervention at each stage of the process, including police custody, courts, prisons and the probation service. As many as half of the rough sleepers surveyed for this research had been in prison or a young offenders institution, or both. Many rough sleepers pass through police stations and some are held there because their homelessness means they have nowhere else to go. Many also have mental health problems. There is scope to intervene at this point to help prevent homelessness, or to start the resettlement process (see below, Revolving Doors Agency ). There is a particular need for support services for those who are not diagnosed as having severe and enduring mental illness as the mainstream psychiatric services do not give priority to them, while many people sleeping rough have lesser mental health problems, including chaotic lifestyles and personality disorders that contribute to their continuing homelessness. Court diversion schemes help to steer those with mental health problems, many of whom are homeless or at serious risk of homelessness, towards treatment or support. A survey of prisoners found that 33 per cent wanted help with finding accommodation on release. A lack of social support is a crucial factor leading to a loss of their home by prisoners. There needs to be specific housing help provided in all prisons with specialist staff time allocated to this task. There is a need to find out from all prisoners about their previous accommodation, so that action can be taken to maintain it, or to negotiate that new accommodation will be offered on their release. Probation services need to be funded to provide housing help to all ex-prisoners, including those who serve sentences of less than 12 months (Carlisle, 1996). There is also a role for voluntary agencies, for example by providing specialist services such as mentoring for young offenders (see below, the Depaul Trust One-to-One Project ) and support for women prisoners and ex-offenders at risk of homelessness (see below Women s Link ). Revolving Doors Agency The Revolving Doors Agency has set up three experimental, community based, multidisciplinary teams working in High Wycombe, Bethnal Green and Islington. Their aim is to help less serious offenders with mental health problems gain access to the health, housing and social care they need by intervening at the point of arrest. Many clients also have drug and alcohol problems. Preventing tenancy breakdown and homelessness is a major part of their work. Where higher support is needed, an orderly transfer to more supported housing is preferable to waiting until the tenancy breaks down. Working in pairs in the local police stations, they provide support and practical help at the time of arrest. They work closely with the police and 23

31 provide training for them on what the services can provide. They carry caseloads of up to 20 between the two staff, with two to three new clients a week. The casework falls into three categories: one-off help in the police station; short-term work which involves two or three contacts, assessment and referral on to other services; long-term casework. A major task for such projects is persuading excluded people to engage with services. The services are not forced on anyone, but persistence does pay off and they work assertively with people in their own homes, in cafés or on the streets. Many clients say they are glad that the link workers persisted in trying to make initial contact with them. The workers act as advocates and make links to help clients access local services. They continue to provide support and advice for up to two years. An integral part of the projects is an independent evaluation of their work and the development of a framework for auditing services for people with mental health problems who are in contact with the criminal justice system. St Giles Trust: mental health and ex-offenders service St Giles Trust is a day centre in South London which helps 3,500 people each year who are either homeless or in need of support to avoid homelessness. They operate a specialist intervention service for prisoners and ex-offenders, focusing on people with sentences of under 12 months. A pilot scheme ran from 1994 to 1997 and was reviewed at the end of the period (Currie and others, 1997). They contact clients through a pre-release scheme for prisoners and through the probation service and the day centre itself. They have identified a high proportion of people in their client group with undefined mental health problems, personality disorders and learning difficulties. The service includes: assessment of the client s needs, covering mental health, housing, finances, support networks, offending history, and drug and alcohol abuse; preparation of a care plan to meet these needs; help with resettlement and maintaining the tenancy; counselling and support; help to access psychiatric services; referral to other support and therapeutic services both within and beyond St Giles; telephone support to manage crises arising from mental health problems. Three quarters (77 per cent) of their clients had no fixed abode, with the remainder insecurely housed. The problems of clients closely resemble those commonly experienced by people sleeping rough including: lack of social support or family networks; poor educational history; lack of employment opportunities; repeated contact with the criminal justice system; lack of assessments because of resistance to statutory services. Over half had alcohor or drug related problems. The pilot scheme in the prison found that links between the prison and housing and support services in the local area were limited. Where prisoners had previous links with local services, these had generally been lost and low priority was given within the prison to maintaining these links. Lack of accommodation was the most pressing problem on release, because without it exoffenders found it almost impossible to access the other support services they needed. Most clients of the service were self referrals and were in contact for the first time shortly before release. This meant that referral to a hostel was usually the only short-term option. However, most did not want to go to hostels. As a result, they often returned to sleeping rough or insecure accommodation with friends. From the experience of clients who were referred through the probation service, there appeared to be a need to improve links between probation and housing and mental health services. Those not already homeless were in insecure accommodation, typically because they were in 24

32 rent arrears and were often also in danger of being evicted due to behavioural problems, frequently caused by mental health problems combined with substance abuse. The pilot project was able to achieve significant successes: all of the clients who were housed on initial contact with the project remained housed and 62 per cent of the homeless group were found accommodation; 37 per cent went into permanent housing and 25 per cent into temporary accommodation. Outcomes for the remainder were unknown. Only eight per cent of clients were known to have re-offended, all offences were related to substance abuse. Although the project did not have fixed criteria for evaluating successful outcomes, a number of features were present in all cases which were felt to have been successfully concluded. These clients were: rehoused in suitable accommodation; managing mental health and any addiction problems such that they were not a threat to remaining housed; provided with a secure income; avoiding re-offending. Nearly one in five (19 per cent) of clients met these four criteria by the end of the pilot. The key conclusion of the pilot was that: The project demonstrated the overriding issue for this client group is the difficulty of coordinating the range of services they need. Without a project of this kind, most mentally disordered offenders are unable to hold together an appropriate package of services. The success of the project has been its ability to coordinate the input of a wide range of agencies. This role is not any one agency s statutory responsibility, but without it, none of the agencies concerned are able to discharge their several responsibilities effectively. (Currie and others, 1997) Women s Link prisoners and ex-offenders service Women s Link provides a wide range of advisory services to women with housing problems, by telephone, appointment and postal enquiries. In addition, it offers weekly advice surgeries in two women s prisons, working in partnership with the Inner London Probation Service. Dealing with around 120 clients a year on a casework basis, the service has produced a self-help booklet for wider distribution to prisoners and staff. As well as problems with mental health, drugs and alcohol, many women prisoners and exoffenders have suffered abuse and harassment from partners and family members, as well as separation from their children. As many as 80 per cent of women prisoners seen by Women s Link are users of class A drugs, mainly heroin, and it is difficult to find supported projects that will accept those who are not reducing their habit or willing to stop. The main work is to advocate on behalf of women prisoners and ex-offenders with statutory organisations to secure access into social housing. They also refer into specialist ex-offender projects. Most women leaving prison are reluctant to move into hostel accommodation which they see as a continuation of institutional life. In , 63 per cent of clients were helped to find suitable accommodation. The service includes advice on: dealing with rent arrears clients may not have notified their landlords of their imprisonment; sorting out Housing Benefit; advocacy to negotiate retaining a tenancy where the loss of a woman s home is threatened. The Depaul Trust One-to-One Project The Depaul Trust are piloting a mentoring programme which recruits volunteers to befriend young people before they leave a young offenders institution and to continue to support them after their release. They also offer access to hostel accommodation for those who would otherwise be in danger of homelessness. The project offers a structured support programme covering a range of needs including: education and training opportunities; employment; welfare benefits; alcohol and drug use; 25

33 criminal activity; family and peer relationships. The project aims to engage young people whose previous relationships have either been with professionals associated with the criminal justice system and who therefore may be seen as authority figures, or with their families and peers in an environment that may have originally led them into offending. The project recruits volunteers who come from the communities that young people will be returning to on their release, and who can represent positive role models, offering practical advice and support. Contacts start up to six months before release, involving fortnightly visits which are then followed through for up to 18 months. The key measure of the project s success will be whether mentoring has an impact on rates of re-offending. Leaving the armed forces Over recent years the ex-services welfare organisations have become increasingly aware of the problem of homelessness among people who have been in the forces and they have developed a range of initiatives to tackle it. These have included: a hostel for ex-service personnel; a specialist resettlement officer; supported housing; volunteer advice workers from the welfare organisations running sessions in London day centres; a telephone advice helpline. An Ex-service Action Group on Homelessness (ESAG) has been set up with representatives from some of the main ex-service welfare organisations. They are examining existing provision and identifying gaps in services, in collaboration with a Crisis research project. Supporting tenants at risk Most people sleeping rough have had their own home, usually a tenancy, at some stage and have lost it. Where this happened because of relationship breakdown, rent arrears, nuisance to neighbours, damage to the property, or abandonment, there are often associated problems of mental ill health and substance abuse. There are many projects which work with ex-rough sleepers or tenants at risk of losing their tenancy. Some have high rates of success in preventing homelessness, especially bearing in mind that all their clients are at risk of losing their homes. This is normally achieved by practical work to maintain their current tenancy, although on a few occasions it might be by a managed move to housing with higher support. Examples are given below of projects which specialise in supporting tenants with mental health problems, those with alcohol and drug problems and those with general difficulties in sustaining a tenancy. These successful projects have a number of features in common. They are commissioned by social landlords to provide support services, but it is important to clients that they are independent of the landlord. Many clients are resistant to engaging with any agencies, particularly statutory services. People are also understandably reluctant to admit they have not been able to cope with the ordinary demands of adult life. It is important that the support agencies are not seen as being part of the system and they have to be very assertive and persistent with some clients to get them to engage and to stay engaged. Simply to offer services, which is the usual statutory pattern, is not sufficient. Some clients only engage after receiving an eviction order from their landlord. They deal with people with multiple problems and do not exclude clients because for example, they have both mental health and substance abuse problems. They have realistic objectives and focus on practical ways of maintaining the tenancy, such as reducing arrears, money management and reducing nuisance to neighbours, rather than seeking to solve all the client s complex personal problems. Clients themselves want practical help. Offering counselling, for example, can give mixed messages on the purpose of the service and could add to pressure on people to leave their tenancy. Counselling and other therapy are best offered, where they are wanted by the client, through access to another service. They provide floating support which offers a flexible service, not tied to particular properties or fixed amounts of input from staff. This can be intensive at times of crisis, when the tenant may be at risk of abandoning their home. They provide multidisciplinary services without rigid professional boundaries between team members. 26

34 Many clients have been through many different services and become disillusioned with them. As with services to mentally ill people in contact with the criminal justice system, the critical factor is for one agency to coordinate an integrated service. They provide relatively short-term interventions, of between approximately three months and two years, averaging around six months. However, tenants have the option of returning to the service if further problems arise. Where tenants are in need of long-term supported housing, for example because they have learning difficulties, this is arranged as a direct transfer, before they lose their tenancy. Housing and Personal Support Service The H&PSS provides a service to tenants with mental health problems, some of whom are people who have been rehoused through the Homeless Mentally Ill Initiative. Others are local authority tenants at risk of losing their home. The staff consist of Senior Support Workers who are qualified occupational therapists, nurses or social workers and Support Workers who are not professionally qualified. They have two black workers to provide a specialist service to black service users, where this is appropriate. Staff ratios are one staff member to clients. They provide a 24 hour, seven day a week service, with the core service delivered between 9 a.m. and 9 p.m. and telephone cover and an emergency call out service overnight. All users are allocated two workers to ensure continuity of service and mutual support with a difficult and demanding client group. H&PSS considers it imperative that all the workers know all the users well, so that immediate action can be taken when an emergency arises or a user calls for help out of hours. Workers have identified some key factors which they believe encourage previously excluded people to engage with support services. They allow users to work at their own pace, without fear of being discharged from the service. This allows time for a trusting relationship to be formed with people who fear they will be judged as failing by professional services. They encourage users, who have often lost all sense of independence and autonomy, to take responsibility for identifying problems and seeking help for them, rather than the staff defining all problems and solutions. If a user makes contact, the worker on duty will attempt to resolve any problems, rather than send them away until their usual worker is available. This is possible because all the team know all the clients. The problems are often very practical and if the user experiences the service as reliable and readily available, they are likely to return for further help. They also organise a range of social activities to help tackle the social isolation of users and to build relationships between users and the staff team. A key factor in the service is flexibility with intensive support in times of crisis. This can involve the staff taking on detailed organisation of practical matters for a period and then gradually weaning clients off support. In the past three years they have supported former rough sleepers in 40 flats and tenants of 28 other flats. Of these, none have abandoned their tenancies and only two have been moved from their flats with the agreement of H&PSS, following fires. The Alcohol Recovery Project: floating support The Alcohol Recovery Project s floating support operates in four London boroughs. Project workers help both local authority and housing association tenants who have alcohol problems to sustain their tenancies and manage their drinking behaviour. Nearly two thirds of their clients have been homeless, a third have been in prison and around a third will have slept rough at some point. Many have mental health problems and younger clients often also have drug problems. Some come from families where drinking is entrenched and have started drinking as young as 10 or 12 years of age. Tenancies are often at risk because of rent arrears and nuisance to neighbours. The workers aim for harm minimisation and to stabilise the tenancy, rather than enforced abstinence. The service includes: practical support on rent arrears, neighbour disputes and other housing problems; 27

35 support with budgeting and money management; help with furniture and household goods; help with alcohol problems; advice on drug problems; information on local services and how to use them; liaison with social services; referral to day care services and detox centres. The team working in north London has a maximum caseload of 44 clients between three workers. After an initial referral they make two or three visits a week. The team work closely with the local authority tenancy support team, housing officers, the tenancy mediation service and often with estate caretakers, who have detailed day-to-day knowledge of tenants activities. While the majority of cases are open for around six months, some clients have been supported for up to two years. The team will usually stay in contact if a client has no network of support. A negligible number of tenants refuse the services. None of the clients they have helped has been evicted and only one has abandoned a tenancy. Phoenix House Floating Support Scheme Phoenix House provides a specialist support service to tenants of five housing associations who have difficulty in managing their tenancies, because of drug and alcohol problems. Tenants are referred by their landlords, social services or are self referrals. Many have had a history of rough sleeping. Another indicator of a tenancy at risk is that in a quarter or more of cases they find that the homes are kept in very poor condition. A key underlying factor is relationship breakdown, especially for men. They often lose their family, children and friends at the same time as losing their home. They usually have no priority for social housing. There is a need to intervene at that stage with accommodation and support. The objective of the project is to help tenants manage their drinking or substance use and stabilise their tenancies to prevent abandonment. Staff focus on practical problems of paying rent and not causing a nuisance to neighbours. They aim to help clients to develop skills to manage future problems on their own. Staff have caseloads of 17 to 18 clients each. A detailed multi-needs assessment is carried out for each client, identifying up to 20 different support needs. They are considering ways of identifying tenants at risk at an earlier stage, before rent arrears or nuisance to neighbours are threatening the tenancy. One possibility would be for a detailed assessment of tenants to be made at the time of the letting. They have managed to save the tenancies of all the 34 clients with whom they have worked. They point out that where tenancies do fail there is a need for some route back into housing to avoid the person having to resort to sleeping rough. Thames Reach Westminster Support Scheme Thames Reach have been commissioned by Westminster City Council to provide a support service to tenants who are at risk of eviction because they are causing a nuisance to neighbours or are otherwise vulnerable. The reasons for such problems closely mirror those found by other agencies working with tenants at risk and people sleeping rough. In many cases, they find that clients have resisted social services intervention, or may not fit the criteria for statutory assistance. There are two housing support workers and one team coordinator working with around 55 tenants at any one time. Thames reach provides a range of support by: ensuring the work is highly structured with clear, achievable action plans; regular visits from a Housing Support Worker who monitors tenants progress and provides continuing support for an agreed period of time; being highly mobile and responsive: workers often respond to urgent tenant cries; maintaining close working relationships with local housing officers; liaising with other services such as social services, GPs and advice agencies; 28

36 representing tenants at community care assessments and advocating for services and resources, such as funding for a detox; helping tenants to apply for benefits such as Disability Living Allowance and Community Care Grants; applying for funds from charities for those tenants not entitled to Social Fund Benefits; arranging for the supply of low cost carpets and furniture; referral to a befriending service for the many tenants who suffer from social isolation and who would benefit from the scheme. There is also a duty advice service on weekday mornings. Tenants who are vulnerable or causing a nuisance are referred to the scheme by local housing officers if already housed, or by a local mental health support team if they are new tenants. If possible, an action plan of agreed goals is drawn up with the tenant and the housing officer. Resettlement support is given to new tenants. The scheme worker visits the tenant on a regular basis and persists with visits to tenants not keeping regular contact. On average, 90 home visits are made to tenants each month, with a further 27 attempted visits. Cases are kept open until the local authority is satisfied they can be closed. Some tenants need long-term support and Thames Reach does everything possible to arrange this. Since the scheme started in 1997, there has been only one eviction to date and Thames Reach is still working with this client to find alternative accommodation. Day centres There are over 200 day centres throughout the UK and around 10,000 people visit them each day, of whom one in five have been estimated to be sleeping rough (Llewellin and Murdoch, 1996). Many of the other users are vulnerable and at risk of homelessness. Traditionally, day centres have offered refuge and basic services such as shelter, food and clothing. However, they also offer the opportunity of targeting services on large numbers of people at risk of rough sleeping. Some centres have developed comprehensive services to achieve this, including: outreach and resettlement work with people sleeping rough; support for vulnerable tenants; health services; support for people with mental health, alcohol and drug related problems; benefits advice; employment and training services. Traditional day centres providing only basic services have sometimes been criticised for possibly reinforcing street lifestyles. Innovations in day centre practice mean that, while still providing a refuge for street homeless people, they are actively intervening to end rough sleeping and to prevent homelessness. They are ideally placed to do this because they are in contact with high numbers of vulnerable people who are at risk of homelessness. Use of day centres was a suggestion frequently made by people in the survey for this research, when asked what advice they would give to others in circumstances similar to their own: Go to day centres and see what they can do. They ve got lots to offer, including a key worker who can put you on the right track, put you in touch. (male, 29, day centre) There s day centres. This is your link to mediate if you re about to get evicted. Plenty of people who get a problem exacerbate it themselves because they re frightened to talk to somebody. (male, 51, day centre) My advice would be to get in touch with one of the day centres like this and actively seek help from them. [This day centre] put me on the right road. They were helpful because they knew who to ring up. If you approach a [council] office cold you get no joy or understanding. They pointed me in the right direction and helped me to fight. (male, 45, day centre) Asked about what services would help people sleeping rough, people often wanted day centres open for longer hours and in the evenings particularly, to keep off the streets. A day centre open in the evening up till 10 p.m. advice, tea, coffee, biscuits, showers. If it s wet and miserable there s one place up Pentonville Road for under 21s, but nothing for older people. So you end up on the drink all night, just to stay warm and not too depressed. (male, 36, day centre) 29

37 More day centres open for longer than a few hours, evening times open, with counselling for people trying to stay off the drink. If they re having a relapse they could phone in. (female, 52, day centre) Day centres help a lot, but people need somewhere to go to in the evenings. (male, 46, day centre) Examples are given here of comprehensive services provided by two centres, one providing for young people and one for a predominantly older age group. The London Connection The London Connection runs a seven day a week day centre for homeless and other vulnerable young people in the West End of London. It is used by up to 200 people a day. In addition to the normal day centre services, it undertakes street outreach work and provides a wide range of support including: an advice service that undertakes detailed casework with clients; specialist support for mental health and substance abuse problems; a resettlement service; employment and training schemes; group work to develop independent living skills; a volunteer befriending service. An important element of their work is identifying newly homeless young people among their users who are at risk of sleeping rough. Among the factors used to prioritise the most vulnerable are: people with a history of care; those who have no support network or a dysfunctional family background; school exclusion; substance misuse; a history of verbal, physical or sexual abuse, and refugees or asylum seekers. Those most at risk are targeted for intensive casework, drawing on a wide range of skills within the team. An action plan is developed and agreed with each young person. The main emphasis wherever possible, is to divert young people away from the street culture in the West End of London and to find alternative routes into suitable housing. A detailed resource pack covering services available within each London borough provides reference material for identifying services to which young people can be referred. Casework includes personal support, advocacy, referrals to mediation services, escorts, fares to return to the area they came from and help to access local services. Services aim to highlight the particular difficulties and risks of homelessness in central London. Group work includes looking at ways in which challenging behaviour can result in hostel exclusions. Drugs education focuses on the consequences that substance misuse can have on people s housing prospects. Young people are encouraged to engage positively with agencies providing support, without promoting dependency. The London Connection report a worrying tendency of some statutory services to refer young people to them, because of the wide range of specialist services and expertise they offer and, in doing so, exposing them to a street culture it would be better to avoid. They would prefer to be seen as an agency of last resort rather than the first point of contact for newly homeless or young people at risk. St Giles Trust St Giles Trust is a day centre in south London which was established as a traditional centre in 1962, offering basic facilities in a church crypt. In the past ten years it has developed as a professional service provider to around 3,500 people a year. While around a quarter of users are homeless, four out of five have experienced homelessness in the past and many must be regarded as at risk in the future. Around half of clients had been in prison at some stage. Similar proportions suffer from anxiety or depression, have problems with alcohol or drugs and have had no contact with any family members over the previous year. Many people have a high level of complex problems, but each individual problem may be below the level to trigger statutory services. The centre has moved to high quality premises. This in itself has created a more positive atmosphere in which to do preventive work with clients. Actual or planned services at St Giles include: An open access service in the middle of the day, with a free lunch. It provides the basic services such as food and washing facilities, an initial point of contact as a route into the others services and emergency advice, with crisis intervention. 30

38 There are specific open times for women only and people from ethnic minorities to enhance their access to the service. A specialised youth service is planned. A resettlement programme covering housing advice, arranging accommodation and postresettlement support. An early intervention service for older people to enable them to remain housed. Support for prisoners and ex-offenders with mental health problems. A prison outreach service to prevent offenders becoming homeless on discharge. A benefits advice service. An advocacy service to help people obtain community care entitlements. Health services including an access worker, alcohol, mental health and nutrition services, dentistry, chiropody, eye tests, nursing and complementary therapies. A mental health service. A rent deposit scheme St Giles is also investigating the possibilities of providing: a drugs service; a programme to help people into employment or volunteering; other preventive services targeted, for example, on care leavers or people being discharged from the armed forces. The open access sessions, in which all staff participate, offer an opportunity to observe users over a period and to identify when people might be at risk of homelessness, for example if they are drinking more, losing weight or looking unwashed. They intervene when people s tenancies appear to be failing. They do not aim to provide all services themselves and are an important channel into other, including statutory, services. They also recognise that with such a wide range of services there is a danger of creating dependency: they need to get people into the centre, but also to get them out again and linked into the mainstream community. Other advice services There are many housing and other generalist advice services throughout the country and prevention of homelessness is an important part of their role. Their services range from one-off telephone advice to detailed casework over several months. Their work includes advice and assistance on: tenants legal rights to prevent eviction; rent arrears and other financial problems; claiming benefits; access to rehousing including legal rights and access to housing association, local authority and private sector housing. They do not in general provide detailed support services to people with complex needs and therefore are less likely to have as clients people sleeping rough or those with high support needs. They do, however, act as an invaluable channel into statutory services and can act as advocates for clients right to these services, for example for rehousing by the local authority under the homelessness legislation. Local authorities are obliged by law to provide advice and assistance to single homeless people who are not eligible for accommodation under the homelessness legislation, but the extent of such help varies widely between authorities. A further development of this model is to bring together voluntary advice and statutory services in the same offices. This model was pioneered by The Hub in Bristol. The Hub The Hub provides a single point of access to a number of organisations which offer help and advice in a housing crisis. They provide a one stop shop with the aim of delivering an integrated and speedier service to homeless people and those at risk of homelessness. Nearly 60 per cent of callers have no stable address and eight per cent are sleeping rough. When someone is in housing crisis, speed of service can make the difference between losing and saving their home and between access to alternative accommodation and sleeping rough. A wide range of agencies provide different services: Bristol Cyrenians operate the access team and provide advice on housing, homelessness and 31

39 welfare benefits. They help people secure temporary, private rented, supported and housing association accommodation. They also make referrals into the other agencies in The Hub. Shelter provide a specialist advice and advocacy service for any problems relating to housing or welfare benefits. They offer advice on mortgage or rent problems, applications for benefits and problems with landlords. They also help with appeals and challenging decisions made by statutory agencies, for example on homelessness applications to the local authority. Bristol City Council Housing Services have caseworkers who assess eligibility for housing under the homelessness legislation. They can also give advice and assistance with finding temporary and private rented accommodation. The Housing Service operates a Deposit Bond Scheme to help with access to private rented housing. Housing Benefit officers provide help in applying for benefit and provide a fast track service for the Deposit Bond Scheme. Bristol City Council Social Services provide shortterm support and refer people with longer-term needs to a local social services team. The Benefits Agency provides advice and information on social security benefits and helps where necessary with the completion of claim forms. Advice workers are linked to the Agency s computer system, with access to benefit records. They can speed up the process of claiming benefits, including working with Housing Benefit staff on the premises to speed up payments. Avon Health Authority provide link workers who enable people to access a range of health care services. Individual assessments can be made and health advice given. They have also worked with the local hospital to improve discharge arrangements, referring patients on to housing and other support services where necessary. The Employment Service has details of job vacancies and gives general employment advice. They can help with job searching, including application forms and CVs. They also provide information on training opportunities and on benefits for unemployed and working people. Learning Partnership West provides vocational guidance, information on training and employment and on work placement programmes. An independent evaluation of multi-agency work on homelessness in Bristol, including The Hub s activities, found that: Multi-agency projects can deliver a more effective service to single homeless people. Users themselves have commented on this and staff find that they can more easily achieve satisfactory outcomes, especially for people with complex or multiple problems. Multi-agency working [has] encouraged agencies from both voluntary and statutory sectors to overcome professional boundaries [It has] enabled services both to reach street homeless people (through outreach work) and to play a preventative role, tackling street homelessness at the beginning of the cycle (Pannell and Parry, 1998) This section has given examples of a wide range of services. There are many other projects which could have been included. Many of the agencies have proved successful in preventing homelessness and rough sleeping, and provide examples of proven good practice. Others are innovative and require further evaluation and development. The next section considers what conclusions can be drawn from the experiences of people who have slept rough and agencies working to prevent homelessness. 32

40 4 Conclusions: a programme for preventing rough sleeping This report has identified a range of factors which increase the risk of homelessness and of crisis points which are likely to trigger rough sleeping. Key risk factors disputes with parents and step-parents experience of physical or sexual abuse time in local authority care learning difficulties and literacy problems exclusion from school lack of qualifications unemployment alcohol and drug abuse mental health problems, including mental illness and personality disorder a combination of mental health, drug and alcohol problems contact with the criminal justice system previous service in the armed forces marital or relationship breakdown previous experience of homelessness lack of a social support network failure to furnish or maintain a home debts, especially rent or mortgage arrears causing nuisance to neighbours. Key crisis points leaving the parental home after arguments leaving care without adequate support leaving prison discharge from the armed forces marital or relationship breakdown domestic violence a financial crisis of mounting debts eviction from a rented or owned home a sharp deterioration in mental health or an increase in alcohol abuse. The wide variety of problems which lead to rough sleeping means that an equally wide range of different types of intervention is necessary to prevent homelessness. These services will require the involvement of many statutory and voluntary bodies including: The Department of the Environment, Transport and the Regions The Department of Health The Home Office The Department for Education and Employment The Ministry of Defence The Police The Courts The Prison Service The Probation Service Local Authority housing departments Social services Health Authorities Local Education Authorities and schools A wide range of voluntary agencies which provide services and funding. Service delivery agencies which are most effective are those which identify and target the people at highest risk and which intervene in practical ways to sustain people in their accommodation, or to secure other suitable housing. In most cases, this support is for a limited period and a central part of it is helping people to develop their own independent resources. Effective services do not attempt to resolve all the problems of their clients, but refer them into other mainstream services, which they are better able to access when they are in settled accommodation. Education It is difficult to assess the effectiveness of education in schools on homelessness. However, education on the practical problems of leaving home is more likely to have an impact than more general lessons on homelessness, desirable as the latter might be as part of social studies courses. Many young people who become homeless have left their parental home, or local authority care, too early. The main emphasis in education should be on sustaining young people in their homes, rather than encouraging too early independence. Lessons are best targeted on Years 9 to 11, when the problems are likely to be more real for students. 33

41 There is also scope for further pilot peer education projects. More detailed evaluation is needed of the most effective means of influencing the attitudes of young people and increasing their knowledge of the responsibilities of independent living. Advice services for young people There is a need for specialist advice services for young people. Their main requirement may be for help and support, rather than simply advice or access to accommodation. Advice work needs to provide access to detailed casework, advocacy, befriending, mentoring, employment and training, resettlement and family mediation (see below). Family mediation Two thirds of young people in the survey for this research had slept rough for the first time immediately after leaving their parents or foster parents home. In many cases homelessness results from a breakdown in family relationships. Agencies providing accommodation for young people may too readily assume the breakdown is irretrievable or that, as housing agencies, it is not their responsibility to intervene in family matters. However, many young people subsequently wish they had resolved problems with their families. Providing them with accommodation before they are ready for independent living, without any exploration of the prospects for reconciliation, may increase the risks of long-term homelessness. Family mediation for homeless young people is a relatively new development and offers promising prospects of preventing homelessness in its earliest stages. Family mediation projects should be developed further and evaluated. Agencies working with homeless young people should consider family mediation as the first option for all their clients. Some young people will need emergency or respite accommodation. Where this is provided, projects should interview young people to assess the prospects for returning to their families. This will require training for hostel and advice staff in interview and assessment techniques in this sensitive area. Returning to home areas It is rarely in the interest of people at risk of sleeping rough to leave their home areas. Many do move to cities, particularly central London. By doing so, they may lose existing social and family ties and replace these with entry into a street homelessness culture. Statutory agencies such as social services and the probation service should not refer clients, especially young people, into agencies in central London. They should instead ensure that homeless people are adequately provided for in their home areas. There is a need for the further development of projects which help people to return to their home areas and to ensure they have access to adequate accommodation and support there. Leaving care The Government is taking steps to reduce the risks to young people on leaving care and local authorities should implement their recommendations as soon as possible. The emphasis should be on young people staying with their primary carers, certainly until the age of 18 and often until well into their twenties. If necessary, this can be achieved by expanding supported lodgings schemes. When young people do move into independent tenancies, there is a need for floating support until they are securely established in stable homes which are not at risk. Specialist leaving care schemes have an important role to play in supporting young people and their primary carers, but should not normally take over the role of primary care themselves. Voluntary agencies should follow the same principles in their services for recent care leavers and should work in close cooperation with primary carers wherever possible. Befriending and mentoring Many people sleeping rough, or at risk of doing so, suffer from social isolation and an absence of positive role models. Where their social networks are limited to other rough sleepers, this can reinforce a street lifestyle. While professional services can help to counteract these, there is also a role for befriending and mentoring by volunteers who can establish a different relationship from those of professional and client. Voluntary organisations are best placed to establish such schemes, working closely with professional support services. Volunteers need to be expertly trained and supervised for this work. The criminal justice system Over half of people sleeping rough have had contact with the criminal justice system and many of these also have problems with mental health and substance 34

42 abuse. Removing people from their homes to prison increases their risk of homelessness on discharge and homelessness increases the risk of re-offending. This is a vicious circle and there are currently far too few services dedicated to breaking it. More support services at critical points could potentially have a significant impact on homelessness, mental health and re-offending. There is a need to build on the schemes such as those being piloted by the Revolving Doors Agency to provide support to homeless people with mental health problems held in police cells. Such help should be extended to other homeless people, who could be offered interviews with outreach workers to help them find accommodation. There is also a need for detoxification centres, or other safe accommodation, for homeless people who are held on drunk and disorderly charges, to avoid them being held unnecessarily in police cells. Mentally ill homeless people can be diverted away from the criminal justice systems by schemes based at courts. Consideration should also be given to giving courts powers to make Resettlement Orders. These could be an alternative for people whose appearance in court was linked to homelessness and would involve voluntary participation in a housing resettlement programme as an alternative to other sentences. These would operate in a similar manner to drug testing and treatment orders. They could be supervised by the probation service, but delivered by voluntary agencies experienced in the resettlement of people sleeping rough. Failure to participate fully in the programme could result in a return to court. Prisons can be a significant cause of homelessness and therefore of re-offending. Six out of ten rough sleepers who have been in prison or a young offenders institution sleep rough soon or immediately after discharge. Although many prisoners lose their previous tenancy, there appears to be little attempt in many prisons to help them keep their homes and often little effective work to resettle them after discharge. This problem is particularly acute for those on short-term sentences of under 12 months, a category which covers many homeless and potentially homeless people in prisons. A radical overhaul of housing support services for prisoners is needed. A new service should include: an assessment of prisoners housing needs at the start of their sentences and action to persuade landlords to hold tenancies open, or to offer new tenancies to released prisoners; resettlement programmes for prisoners who have no accommodation to return to, beginning at the latest six months before their release and continuing for as long as needed afterwards; ensuring that ex-prisoners are not treated as intentionally homeless by local authorities; close working links between homelessness services, prisons and probation, with training in the problems of homeless people and the support available for them; further piloting of befriending and mentoring schemes for offenders. Such a resettlement service could be commissioned from, or developed in conjunction with, voluntary agencies experienced in this type of work. Tenancies at risk Thirty-seven per cent of the rough sleepers surveyed had held council or housing association tenancies at some stage and lost them. Even after being rehoused, many rough sleepers are at risk of further homelessness. The survey found 28 per cent of people had gained a tenancy and lost it since their first episode of sleeping rough. Supporting vulnerable people in their tenancies should be an essential part of the programme to prevent homelessness. There are many examples of highly successful projects which are helping even the highest risk tenants who have mental health, alcohol and drug problems to sustain their tenancies. There is a need to extend such services to all high risk tenants. In most cases, support can be relatively short term and is withdrawn after a period, which might typically range from six months to two years, although flexibility is vital to such floating support schemes. Currently, tenants are often referred to support schemes when their tenancies are already under threat because of rent arrears or nuisance to neighbours. However, in some schemes, tenants are given support because they are known to have serious mental health difficulties, or they have been rehoused as a result of sleeping rough. It would be worth exploring whether other tenants could be identified as being at high risk before their tenancies have run into trouble and whether any earlier interventions might avert such problems. One clear gap is in provision for people (usually men) who have to leave tenancies they are sharing with partners. Homelessness can result from such people leaving a tenancy after a relationship breakup. They may well have contributed to the breakdown and have mental health, alcohol or drug problems. They are 35

43 likely to be offered little help at that stage from the landlord. This can often be the beginning of a downward spiral which ends in rough sleeping. There seem to be few if any safety nets for this group and there is a need to consider programmes which would prevent them from becoming rough sleepers. A programme would include an offer of separate accommodation from social landlords, particularly in areas where there is no shortage of accommodation and support services of the kind offered through resettlement programmes to rough sleepers and other high risk tenants. All social landlords should operate floating support services for tenants at risk of losing their homes and subsidy regimes should reflect the need for such services. There are significant benefits in tenancy support services being provided by agencies which are independent of the landlord. They are often able to engage with tenants who may be alienated from statutory services and who have refused contact with them. Landlords can commission such services and can specify clear outcomes in terms of tenancies saved. This focuses the work on practical outcomes. Agencies interviewed achieved very high rates of success as a result of such a focus. They did not attempt to resolve all the tenant s problems, but instead concentrated on stabilising the tenancy. Agencies found that ensuring the security of clients homes helped them to make progress in other aspects of their lives and to make better use of other specialist services for mental health and substance abuse problems. While all the projects examined were very successful in saving tenancies once they had made contact with the tenant, there were variations in the rate of successful initial contacts. The most effective agencies found that persistence paid off and made repeated attempts to contact tenants, until they were successful. Landlords commissioning services should measure success rates against all referrals and not just those where contact has been made. Many tenants at risk of homelessness have multiple problems. Support teams need to have the expertise to deal with both mental health problems and substance abuse. They should also help with access to employment and training schemes, including literacy training. Further evaluations of the most effective work methods should examine the costs and benefits of 24-hour services and of joint work by staff. People leaving the armed forces Crisis will be examining in more detail the need for further services to reduce the risk of homelessness for people who have left the armed forces. There is scope for developing more detailed housing resettlement services targeted on those at highest risk, who are likely to be single men who have no settled home to which to return and who have any of the other risk factors identified in this report. Such a service could be commissioned from, or developed in conjunction with, one or more of the voluntary agencies which specialise in housing resettlement work. Day centres While continuing to provide basic services of shelter and food, day centres should move away from sustaining street life and towards an active resettlement and preventive role. Their contact with large numbers of homeless people and those at risk of homelessness puts them in a unique position to develop preventive services by identifying people at risk and ensuring support programmes are in place. They could act as a base for many of the other services proposed here. They will of course need additional funding to carry out such a role. Advice services Advice alone is unlikely to prevent many people from sleeping rough, since homeless people often need more detailed support. However, it can help to steer people towards the services they need and there is scope for developing integrated one stop models which could ensure speedier and more effective access to services for people at risk of homelessness. The way forward The key to preventing homelessness and rough sleeping is access to suitable accommodation, plus adequate practical support. Too often in the past, the emphasis has been on the provision of accommodation and the support on offer has been inadequate or non-existent. This research has identified broadly the types of support needed to prevent rough sleeping and examples of agencies which are providing such support effectively. More detailed assessments of the most effective forms of intervention are needed, through separate evaluations of the different kinds of projects and the funding of pilot projects where there are gaps. Additional resources will be needed to provide the scale of support needed to save a much larger number of people 36

44 from the threat of rough sleeping. However, there are already substantial costs incurred as a result of people sleeping rough, particularly in the criminal justice system and the cost of failed tenancies. Further work should include a cost benefit analysis of programmes to prevent rough sleeping, to give a true idea of the net costs of such programmes. It is already clear that it is possible to prevent people at high risk of homelessness from sleeping rough. The challenge now is to develop a network of cost-effective services which will have a substantial impact on reducing the number of people who end up on the streets. 37

45 Appendix I Tables A1 A2 A3 A4 A5 A6 A7 A8 A9 A10 A11 A12 A13 A14 Type of project where interviewed by age range Current accommodation Total length of time spent sleeping rough Accommodation immediately before first slept rough Estimated age first slept rough Reasons for sleeping rough first time Whether drink a factor in sleeping rough first and subsequent times Whether drugs a factor in sleeping rough first and subsequent times Help which might have avoided sleeping rough first time Factors more likely to sleep rough than find accommodation Anything at all liked about sleeping rough Experience of institutions Multiple problems Whether ever experienced any risk factor/crisis point 38

46 Table A1 Type of project where interviewed by age range Table A4 Accommodation immediately before first slept rough up to All % % % % Day centre Hostel Winter Shelter Total (Base) (33) (37) (50) (120) Table A2 Current accommodation % Parents /foster parents home 38 Private rented 14 Hostel/B&B 13 Council/Housing Association tenancy 10 Friends/relatives/squat 9 Children s Home 6 Owner occupied 4 Tied accommodation 4 Prison 1 Total 100 % Winter Shelter 36 Hostel/Night shelter 33 Sleeping rough 20 Council/Housing Association tenancy 7 Friends/relatives/B&B 4 Other 1 Total 100 (Base) (120) Table A3 Total length of time spent sleeping rough Less than 3 months 17 3 months less than a year 26 1 year less than 2 years 12 2 years less than 5 years 19 5 years or more 27 Total 100 (Base) (120) % Table A5 Estimated age first slept rough (See Note) 15 or under Total 100 (Base) (118) Note: Figures are estimated, based on respondents current age and when they said they had first slept rough, which was pre-coded into time ranges on the questionnaire. The mid-point of each range was selected and deducted from the respondents current age. For those who had first slept rough 10 years ago or more, 10 was deducted from their current age. The figures will therefore be overestimates for the longer-term rough sleepers, that is, they represent the oldest age people could have been when they first started sleeping rough. % 39

47 Table A6 Reasons for sleeping rough first time All reasons Main reason % % Asked to leave/evicted Disputes with parents/ foster parents Money problems/arrears Lost job 19 2 Drink problems 18 2 Escape violence/abuse Relationship breakdown 13 9 Drugs problems 13 5 Left institution 8 2 Hostel conditions (various) 7 3 Ran away (Children s 7 Home/school) Death of partner/close 6 4 relative Own accord 6 Look for work 5 Mental health problems 4 4 Preferred to sleep rough 3 3 Other 12 7 Total * 100 (Base) (120) (111) Table A7 Whether drink a factor in sleeping rough first and subsequent times Table A8 Whether drugs a factor in sleeping rough first and subsequent times First time Other times % % Whether a factor at all Respondent Partner 3 1 Counselling might 6 10 have helped Total * * (Base) (120) (120) Table A9 Help which might have avoided sleeping rough first time Advice about accommodation 32 Finding accommodation 24 Help with rent arrears/other money problems 14 Counselling/Someone to talk to 11 Reconciliation with parents 11 Help with drink/drugs problems 10 Finding a job 8 Reconciliation with partner 3 Other 10 Nothing at all would have helped 24 Total * (Base) (119) % First time Other times % % Whether a factor at all Respondent Partner 6 2 Parent 9 Counselling might have helped Total * * (Base) (117) (117) 40

48 Table A10 Factors more likely to sleep rough than find accommodation Friends on the streets 26 No commitments 23 No rent to pay 16 Drink when want 15 Free food available 13 No dealings with authorities 12 Use drugs when want 10 Free clothing available 8 Nothing at all 59 Total * (Base) (120) % Table A13 Multiple problems (See Note) Mental health 51 Mental health and drink 16 Mental health and drugs 13 Mental health, drink and drugs 8 Total * (Base) (120) Note: Whether respondents might have multiple needs was drawn from responses to several different questions. Indicators of mental health problems were: if they had ever seen a mental health professional, or reported having had mental health problems which had made it difficult to find or keep a place to live, or had ever been in a psychiatric unit. Indicators of drink problems were: if drinking had been a factor in their first or later episodes of sleeping rough, or they had ever been in an alcohol unit. Indicators of drugs problems were: if drugs had been a factor in their first or later episodes of sleeping rough, or they had ever been in a drugs unit. % Table A11 Anything at all liked about sleeping rough No commitments 27 Friends on the streets 23 Freedom generally 14 Use drink/drugs when want 11 No dealings with authorities 10 No rent to pay 9 Other 8 Nothing at all 54 Total * (Base) (120) % Table A14 Whether ever experienced any risk factor/crisis point Marriage/long-term relationship breakdown 45 Asked to leave parents/step-parents 39 Serious disputes with step-parents 31 Exclusion from school 28 Eviction from rented/owned home 22 Rent/mortgage arrears or other large debts 21 None of these 14 Total * (Base) (120) % Table A12 Experience of institutions Prison/Young offenders institution 49 In care 32 Alcohol/Drugs unit 18 Armed forces/merchant navy 17 Psychiatric unit 16 General hospital (3 months or more) 9 Total * (Base) (120) % 41

49 Appendix 2 Research methods Survey of rough sleepers A structured interview survey was carried out with 120 people who had recent experience of sleeping rough. Fifty-nine interviews were carried out at seven day centres in central London which were thought to have high proportions of rough sleepers among their clients. At each interview session, staff were asked to identify which of that day s users they thought would meet the eligibility criterion, namely, who had slept rough within the previous 12 months. Interviewers then approached users and invited them to take part in the survey. A further 61 interviews were held at five winter shelters and two direct access hostels in central London, also known to be used by rough sleepers. Interviewers selected at random from the current register people known by staff to be eligible, namely, who had slept rough in the 12 months immediately before moving in. All respondents were asked filter questions that were used to check again they were eligible and had not been interviewed for the same survey at another shelter, hostel or day centre. A total of 143 people were invited to take part. There were 17 refusals and a further five people whose interviews did not take place for various reasons. One interview was abandoned because the respondent declined to answer further questions. The 120 interviews achieved represent a response rate of 84 per cent. The day centres, hostels and winter shelters where people were interviewed are listed below. Day centres Manna Centre North Lambeth Day Centre Spectrum Day Centre St Martin s Day Centre St Giles Trust The Passage The London Connection Hostels and winter shelters Centrepoint Winter Shelter Crisis Winter Shelter English Churches Bedford Place Winter Shelter Look Ahead Marsham Street Winter Shelter St Mungo s Cedars Road hostel St Mungo s Great Guildford Street hostel St Mungo s Kingsgate House Winter Shelter Interviews with agencies Semi-structured interviews were carried out with staff from 19 agencies which have developed services or schemes to prevent homelessness. A topic guide covering the areas for discussion was sent to each in advance. The agencies were: Alcohol Recovery Project Camden Community Support Alone in London Service Bristol Cyrenians (Education Projects) Bristol HUB Centrepoint (Peer Education) Depaul Trust One-to-One Project First Key Housing and Personal Support Service Kipper Project Magnet Phoenix House Revolving Doors Safe in the City (Centrepoint and Peabody Trust) SSAFA St Giles Day Centre Thames Reach The London Connection Threshold Women s Link 42

50 References Anderson, I., Kemp, P. and Quilgars, D. (1993) Single Homeless People, HMSO. Attwood, N. (1998) London is not the only option, The Magnet Project. Barter, C. (1996) Nowhere to Hide: Giving Young Runaways a Voice, Centrepoint. Bruegel, I. and Smith, J. (1999) Taking risks, Safe in the City. Craig, T. and others (1995) The Homeless Mentally Ill Initiative: an evaluation of four clinical teams, Department of Health. Craig, T., Hodson, S. and Woodward, S. (1993) Off to a Bad Start: social and medical correlates of homeless youth. Interim progress report, UMDS, St Thomas Hospital (unpublished). Crane, M. (1997) Homeless Truths: challenging the myths about older homeless people, Help the Aged and Crisis. Crisis, (1997) Literature Review Mental Health and Homelessness, Crisis. Currie and others (1997) Review of the pilot scheme for mentally vulnerable offenders based at St Giles Trust, St Giles. Carlisle, B. (1993) Count Me In: an investigation into the housing needs of single homeless people in Greater Manchester, Manchester City Council. Carlisle, J. (1996) The Housing needs of ex-prisoners, University of York. DoH (1999) Leaving care: the Government s response to the Children s Safeguards Review, Circular LAC(99) 16, DoH. Evans, A. (1996) We Don t Choose to be Homeless. Report to the National Inquiry into Preventing Youth Homelessness, CHAR. Flemen, K. (1997) Homelessness is habit forming: You can t tackle youth homelessness without facing up to the issue of drugs, Inside Housing, 14 February, Gill B., Meltzer, H. and Hinds, K. (1996) The Prevalence of Psychiatric Morbidity among Homeless Adults. OPCS Surveys of Psychiatric Morbidity in Great Britain, Bulletin No. 3, OPCS. Gunner, G. and Knott, H. (1997) Homeless on Civvy Street: survey of homelessness amongst ex-servicemen in London 1997, Sir Oswald Stoll Foundation. House of Commons Health Committee (1994) Better Off in the Community? The care of people who are seriously mentally ill, First Report, Volume 1, HMSO. HSA (1998) Outreach Directory Annual Statistics , HSA. Jones, H. (1992) Revolving Doors. Report of the Telethon Inquiry into the relationship between mental health, homelessness, and criminal justice, NACRO. Llewellin, S. and Murdoch, A. (1996) Saving the Day: the importance of Day Centres for homeless people, CHAR. O Leary, J. (1997) Beyond Help? Improving service provision for street homeless people with mental health and alcohol or drug dependency problems, National Homeless Alliance. Pannell, J. and Parry, S. (1998) An appraisal of the Bristol multi-agency approach to the needs of single homeless people, University of the West of England (unpublished). Revolving Doors Agency (1997) The Circular (Newsletter). Searle-Mbullu, R. (1997) There s a lot more I need to know, Centrepoint. Searle-Mbullu, R. (1998) Challenging attitudes: changing lives, Centrepoint. Smith, J., Gilford, S. and O Sullivan, A. (1997) The Family Background of Young Homeless People, Housing Research Findings, No. 229, Joseph Rowntree Foundation. Social Exclusion Unit (1998) Rough sleeping: report by the Social Exclusion Unit, HMSO. Stein, M. (1997) What works in leaving care, Barnado s. Randall, G. (1998) Rough sleeping: a review of the research, DETR. Randall, G. and Brown, S. (1993) The Rough Sleepers Initiative: an evaluation, HMSO. Randall, G. and Brown, S. (1994) Falling Out: a research study of homeless ex-service people, Crisis. Randall, G. and Brown, S. (1996) From Street to Home: an evaluation of Phase 2 of the Rough Sleepers Initiative, The Stationery Office. Randall, G. and Brown, S. (1999) Ending exclusion: employment and training schemes for homeless young people, Joseph Rowntree Foundation. 43

51 Acknowledgements Many people have contributed to this report. We are particularly grateful to the homeless people who agreed to be interviewed about their experiences of sleeping rough, often telling us about painful events in their lives. We would also like to thank the staff of the projects for the time they gave to discuss their homelessness prevention work; also the staff of the day centres, hostels and winter shelters, who made it possible for us to interview their clients. There are too many people to list individually, but all the agencies are given in Appendix 2. Kate Tomlinson at Crisis provided very helpful comments on the draft report. As always, we appreciate the skills and patience of our interviewers: Helen Austerberry, Christine Billington, Sarah James, Maggie Russell and Joyce Virgo. 44