Homeless adults with complex needs: evidence review

Sun 11th February 2018 |

Last Friday Public Health England released their evidence review around ‘Homeless adults with complex needs’

The review is an overview of the homeless situation across England and aims to provide a perspective around the up to date evidence base and to support action to prevent and reduce homelessness.

The document is a really useful wide angle view of the current issue and examines key themes such as;

  • Definitions of homelessness
  • National profile of people who street beg and/or street sleep
  • What factors may be driving increases in homelessness?
  • Why do people street beg and/or street sleep?

More importantly the document reviews what works to prevent/ reduce street begging and rough sleeping and examines a matter close to our hearts here at Higher Learning; the impact of enforcement on street begging/street sleeping.

The review does not claim to be the definitive catch all guide to end homelessness but instead acts as a really useful first point of call and sense checking document (particularly for local authorities).

It unsurprisingly points to integrated and multi-agency working as a vital component to tackling the issue and advises that the most effective approach is for services to work together to provide support and seamless transitions for those leaving prisons and acute settings with the aim of  preventing those with vulnerabilities falling through the gaps and into rough sleeping. None of this is groundbreaking innovation and for those of us with a long enough memory and who can remember the halcyon days of functional prisons and probation services, properly funded substance misuse services with prison liaison workers and designated vulnerable peoples teams it will all sound fairly familiar.

Thankfully it also finds (and recommends) that prevention in all its forms (and not enforcement!) is essential – and that focusing on the individual at the point of homelessness is often too late.

The review captures the voice of many out in the front line and their evident frustrations, particularly around enforcement actions such as Public Space Protection Orders (PSPOs);

“PSPOs don’t alleviate hardship on any level. They are blunt instruments which fast-track so-called ‘offenders’ into the criminal justice system…handing hefty fines to homeless people … is obviously absurd, counterproductive and downright cruel”

It is made clear that the using of punitive powers only further serves to marginalise and criminalise the homeless and that there is no evidence hat banning people from geographical areas or fining individuals in any way solves the underlying issues that lead to and contribute homelessness or ‘street begging’.

The paper also states that vulnerable individuals are pushed further away from the services they need by PSPOs and describe enforcement as a ‘high risk strategy’ for those who were least likely to respond i.e those involved in substance misuse, a long history of street living, mental health and crime. Essentially the bulk of the cohort.

The full document can be found HERE




Sun 11th February 2018

Statistics on Drug Misuse: England, 2018

Thu 8th February 2018 |

The data contained within ‘Statistics on Drug Misuse: England, 2018’ is largely made up of data that has previously been published such as the Crime Survey, Office for National Statistics, deaths related to drug poisoning, National Drug Treatment Monitoring System (NDTMS) data, Adult Psychiatric Morbidity Survey (APMS) and the school based Smoking, Drinking and Drug use.

However; there is some newer additional data from Hospital Episode Statistics (HES) relating to drug-related hospital admissions.

Of particular interest are the hospital admissions with a primary diagnosis of drug-related mental and behavioural disorders which are reported as down 12% from 2015-16 (but still 12% higher than 2006-07). When you add secondary diagnosis to the statistics you get 82,134 admissions which is a similar number to the previous period of 2015-16 but this is still more than double the number captured in 2006-07

Hospital admissions with a primary diagnosis of poisoning by illicit drugs were 7% lower than 2015-16 but were 40% higher than those in 2006-07.

As we are all aware drug-related deaths are the highest since records began and we must focus all of our efforts to prioritise and address this issue. It is widely acknowledged that to reduce the numbers of drug-related deaths services must prioritise the engagement and retention of more individuals in quality treatment as half of the people who die each year are not in treatment. Perhaps services need to reflect on what the offer for those not yet ready to engage in the utopia of long term recovery is and make committing to treatment a worthwhile and suitable endeavour.

The distribution of Naloxone needs to be improved as evidenced by the recent national survey conducted by Release that highlighted that only an average of 12 take-home naloxone kits were given out for every 100 people using opiates – equivalent to just 12% coverage; the evidence is clear that naloxone saves lives by reversing the effects of an overdose and increased provision of take-home naloxone kits, especially for those at risk of greater of harm i.e prison leavers.

In 2017 the UK made up 31% of European drug related deaths. With further reductions to the public health grant and local authority budgets the treatment system looks to be in further peril of catastrophic and life threatening budget cuts.

Another point of note within the statistical release was around young people. The report highlights that in 2016, 24% of pupils reported they had ever taken drugs. Compared to 15% in 2014.

The likelihood of having ever taken drugs increased with age, from 11% of 11 year olds to 37 per cent of 15 year olds.

We can most likely attribute this rise to the inclusion of a question about nitrous oxide within the most recent school survey on smoking, drinking and drug use. However, and as the report highlights “this still represents a large increase which has not been observed in other data sources. Therefore an estimate from the next survey in 2018 is required before we can be confident that these survey results reflect a genuine trend in the wider population”.

The full release can be viewed here: http://digital.nhs.uk/catalogue/PUB30210


Thu 8th February 2018

Homelessness set to surge

Sun 4th February 2018 |

Recently released figures show that for the seventh consecutive year the numbers or rough sleepers in England has once again risen, and the grim reality is that this current data most likely does not show the true level of street homeless on our streets today.

These figures make depressing reading, and only account for the individuals sleeping rough for one night and it is estimated that there are thousands more who are ‘hidden’ and not captured within these official statistics; young people for example, sofa-surfing, sleeping on public transport or staying wherever they can to avoid sleeping on the streets.

The “Rough Sleeping Statistics Autumn 2017, England” published by the Ministry of Housing, Communities and Local Government back last month show that an estimated 4,751 people slept outside overnight in 2017. This is an  15% increase on the previous years statistics and are up 169% since 2010.

The reasons behind this sharp increase are complex and while they cannot be attributed to one single cause we cannot ignore the actions and policy of the current government who’s austerity driven manifesto has reduced local authority funding, failed to investment in affordable homes and made cuts to housing benefit that can only be seen as a huge contributor to what we are all too regularly seeing in towns and cities across the country.

Reductions to the public health grant has also led to huge disinvestment and reduced funding for substance misuse, mental health, school nursing, health visiting and other services aimed at reducing inequalities and preventing ill health.

Homeless charity Crisis have issued a warning about the consequences of failing to address the issues at the root of the problem.

Their recently released report predicts that the core homeless population (now at 236,000 people) is set to increase by more than a quarter over the next ten years, with those sleeping rough in the United Kingdom due to swell by 76 per cent should current harmful policies not be halted.


Sun 4th February 2018

Preventing Prevention?

Thu 31st August 2017 |

Following the release of the 2017 UK drug strategy there was much criticism of the lack of bravery or willingness on behalf of the Conservative Government to try any more sensible, evidence based or honest approaches to tackling the issues associated with problematic drug use. As gnarly old public health practitioner and former substance misuse worker with a background in both adult and under 18’s services it was no great surprise that the strategy only gave the most tertiary and fleeting mention to young people; after all; we are used to being an afterthought despite it being my longstanding belief that the spend is weighted the wrong way round and much greater gains would be made by spending the bulk of drug budgets on young peoples services. Recreational and non-problematic drug use is also given little attention and the one mention of ‘harm reduction’ is used in relation to the use of tobacco. It would appear that ‘recovery’ is still the one and only goal despite the alarming (yet predictable) increase in drug related death rates published just last month.

The one welcome addition to the strategy was the reference to a commitment around a preventative approach across the life course that utilises the Healthy Child Programme as a framework for delivery. The funding of Mentor-Adepis as a source of evidence-based information and tools for alcohol and drug education and prevention for schools is to be celebrated as for those of us who have worked with schools around substance misuse education and prevention have all too often seen the delivery of the ‘scare tactics’ and potentially harmful programmes that the 2017 strategy makes reference to and seeks to guide education settings away from.

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Thu 31st August 2017