This is the moment to end homelessness in the UK—here's how it should be done

Coronavirus has shown that the impossible can be possible. But the government needs to remember that effective policy can't just be about accommodation but also about holistic care

August 06, 2020
A man wearing a mask walks past the belongings of a homeless person in a doorway at the Marble Arch end of Oxford Street in London, England, on March 28, 2020. Government ministers have urged local authorities to find accommodation for all rough sleepers
A man wearing a mask walks past the belongings of a homeless person in a doorway at the Marble Arch end of Oxford Street in London, England, on March 28, 2020. Government ministers have urged local authorities to find accommodation for all rough sleepers

All homeless people in the UK were supposed to be offered accommodation by local councils according to government guidance published in March, which was extended in June. Compared to other European countries, this response to the ongoing pandemic was more generous than expected, despite budget concerns.

But it isn’t altogether surprising that there were still people left outside despite this offer. Many homeless people we have encountered in our research since 2011 struggle with living under the rules that come with institutional accommodation. This speaks to a broader problem. Homelessness is not just a question of housing, central as it is, but also about providing care and support for a range of issues.

A host of different needs

Just before the Covid-19 outbreak, we started research with a homeless organisation in a university town. The organisation helps provide emergency housing for people sleeping rough—and then assists them to find more long-term housing to move onto, ideally within 28 days. It also provides some move-on houses themselves, where people are offered (supported and mostly shared) accommodation for several years. During that period, so the assumption goes, the residents would be able to access council housing or the private rental market.

We have worked with an emergency shelter over the past months, where we’ve talked to the team and residents. Throughout lockdown, they coped extraordinarily well. While it took a period of adjustment, staff were mostly able to successfully support residents. Their accommodation was open throughout, and they were able to help find residents longer-term housing which, in turn, opened up spaces for new people from the street, albeit subject to passing additional virus-related safety checks. People in short-term housing were served food daily by volunteers, and were offered as much support as possible when it came to their needs and mundane but nagging issues, such as boredom, as they stayed indoors all day.

Most importantly, however, many residents have to deal with what is termed "complex needs," combining mental health and substance use issues. In its last comprehensive survey, Homeless Link reported in 2014 that around 80 per cent of homeless people in the UK report struggles with mental health problems, and many cases involve substance use, schizophrenia or severe depression. A recent government report found that 32 per cent of all deaths among homeless people are due to drug poisoning. Taking care of these needs as part of any homeless policy is just as crucial as providing accommodation. The pandemic only demonstrated this even more.

A lessening of support

The current approach has its limits. Supporting people with managing their addictions, for instance, was complicated during the first weeks of lockdown. It wasn’t possible to conduct drug tests throughout the stay at home orders, leading to a number of relapses; specialized mental health support was temporarily not accessible either. Methadone scripts, prescribed as harm-reduction substitute therapy for opiate users, were provided, but many drug users will often take opiates in addition to their script—a behaviour that further increased during lockdown due to stress, mental health and boredom alike.

All these conditions were exacerbated by the fact that support from key workers or group sessions was now done online, which many residents did not find as helpful. Rules against drug use in most accommodation meant that those in need couldn’t consume in their rooms, and police presence—as well as increased visibility—outside was exponentially increased.

Additionally, it would be highly difficult to put the responsibility of care for substance use on mostly untrained staff at an emergency hostel. Having something like a safe injection facility where people can inject under medical supervision, like in Paris or Vancouver, would have been very helpful, indeed. In fact, a proposal to open the first of its kind in Glasgow was quickly shut down about four years ago. Perhaps it is a good time to start rethinking longer-term developments in that direction but ensure, at the very least, that more people in accommodation are adequately and comprehensively trained.

An accidental pillar

Historically, the government’s approach to homelessness has led to a fragmentation and segmentation of services exemplified by what we saw on the ground during Covid-19. Accommodation takes centre stage, while services dealing with, for instance, mental health and addiction—but also training and education—are mostly outsourced to a different set of “specialized service providers.” This fragmentation creates a lack of self-sufficiency and can make the ecosystem as a whole more vulnerable: if one service provider supporting people with their mental health drops out, all of the other institutions depending on it are in jeopardy. And those impacted most are the homeless people who may be left with inadequate support and care.

Paradoxically, another part of the Covid-19 response has accidentally and serendipitously tackled this very issue. While many people sleeping rough have been housed in hotels and other non-specialized accommodation throughout the country, further support and care has come in the form of key workers, as well as a rise in food and specialised services. Instead of just providing empty hotel rooms to people, many councils rolled out a network of support. Officials seem to already see the benefits of this approach as more and more previously "disengaged" people—who are often called entrenched rough sleepers—are willing to enter conversations about long term solutions to their needs.

This was especially evident as lockdown progressed and increasingly, people housed in hotels are moving into longer-term housing. It is now time to build on this initial support and support people further into longer term solutions. Obviously, the question of immediately available budgets remains (despite the proven long-term savings of approaches like housing first) but we believe this is a unique moment given the political will to act.

The pandemic has unexpectedly led to a sudden increase in attention for homeless people in the UK. It has provided us with an unexpected opportunity to examine what works and what doesn’t. If the right steps are taken (and people are not just put back onto the streets) it could lead to a massive alleviation of the situation for homeless people in urgent need of support and care. We need to quickly find longer term accommodation for people currently in hotels but also ensure they have the holistic support they need. Only then will the solutions we come up also be sustainable—both financially and for the people themselves.