It will come as no surprise to most people reading this that homelessness has increased dramatically in recent years, by a huge 169% since 2010. On a single night around 4800 people sleep rough on the streets of England & Wales, 28% of them in London. 

But contrary to popular understanding, only around 2% of all homeless people are street homeless, the majority (320,000+ households) live in different types of temporary and supported accommodation and night shelters. Many more are what we call ‘hidden homeless’, sleeping on night buses, engaging in survival sex for accommodation or sofa-surfing with friends and relatives. 

Despite the relatively small numbers it’s for good reason that street homelessness grabs headlines and public attention. Experiencing street homelessness is a life-changing event with long-lasting consequences; the toll it takes on wellbeing, it’s impact on existing health conditions and a massively reduced life expectancy are profoundly negative and disturbing. Last week’s data release from the Office for National Statistics provided stark evidence of this, estimating that the number of homeless deaths has risen by 22% since last year. That’s at least 702 people who died prematurely in 2018, either on the streets or in night shelters and hostels, 1 person every 19 hours. 

World Homelessness Day gives us an opportunity to reflect on the crucial role that social workers play in addressing the harms of homelessness that result in this tragic and preventable loss of life.

1. Meaningful Holistic Assessment

In London, street homeless people are usually in a constant cycle of assessments, interviews, appointments and referrals. Some to prove entitlement to benefits, some to secure temporary housing, others to prove their residency in the UK. Rarely are people asked about their wellbeing, their ability to maintain relationships, how their health conditions impact on the outcomes they achieve in their lives and importantly, what and who would be needed to enable them to do so. 

The Care Act provides a powerful platform from which to understand the impact of street homelessness on existing mental and physical disabilities, and importantly it allows for these needs to be understood by their impact on wellbeing as well. In this respect social workers have an important opportunity to use holistic and person-centred assessment to meaningfully understand a person’s circumstances, advocate for their support and care needs to be met and to understand them as a whole person with a range of interconnected needs and goals. Rough sleeping is an experience not a characteristic.

2. Asset-Based Support Planning

As well as holistic assessment that considers a person’s whole circumstances and their effect on wellbeing, social works focus on asset-based support is crucial for working with street homeless people with care and support needs. Long periods of street homelessness can often leave a person so acutely aware of their deficits, risks, needs and personal failures that there is little room left to champion skills, qualities and goals.

Social work practitioners can open the door for people to see themselves in a positive light, to challenge internalised feelings of low self-worth, to build new relationships that encourage playfulness, friendship, self-care and mutual respect. In particular for people living with severe self-neglect, relational approaches to social work can have a profound and lasting impact on a person’s ability to care for themselves.

3. Multi-Disciplinary Practice

One of the reasons that people die on the streets is the failure of services to work in a genuinely flexible and collaborative way. For most frontline practitioners this is the goal but an increasingly difficult reality; the time and professional freedom to be persistent and creative are often simply not available.

But research shows us that street homelessness costs the public purse around £20,000 per year for every person it affects. This equates to hundreds of hours of wasted time and energy, numerous admissions to hospitals, countless assessments and referrals…in short, we spend the time on people anyway so why not make it count?

Social work has been at the heart of multi-disciplinary practice around homelessness for decades. Multi-disciplinary hospital Pathway Teams, embedded social workers in street outreach services, student placements in supported housing and hostel services to name but a few. Social work practitioners have the skillset to facilitate case conferences, develop joint support plans with other lead professionals and communicate effectively across disciplines and sectors. In this way social workers can coordinate complex networks of support services to work collaboratively, avoid duplication and share responsibilities.

4. Safeguarding

Safeguarding and homelessness have a complex relationship. There is significant ambiguity and interpretation about how the legislation protects homeless people, especially those suffering the complex effects of self-neglect. But one thing is clear, failing to appropriately safeguard homeless people results in premature death, like the experience of Howard who died in a bus shelter on the Isle of Wight last year.

One thing we can learn from what happened to Howard is the importance of hand offs, the transition between one service and another, from one place to the next, the old worker to the new. It’s in these periods of transition when people can be most at risk of deterioration, abuse, neglect and harm. One key space that social work can fill is in managing transitions to avoid hand offs, keeping practitioners engaged so that services and relationships overlap for the most vulnerable people, whose other safety nets have been lost along the way. 

5. Challenging Inequality

Homelessness remains an incredibly stigmatising experience, none more so than street homelessness which often seems indelibly linked to assumptions of addiction, criminality and risk. Rarely though is street homelessness linked with trauma, adverse childhood experiences, exploitation and vulnerability, and this is something that social work practitioners have the opportunity to shine a light on through their work. 

Social work was founded on the idea that social action could tackle the harms of poverty and inequality. Since then to the present day it’s teaching and practice has drawn attention to the issues facing societies most vulnerable and marginalised people. Social work practitioners are in the business of seeking and exploring solutions to complex problems, enabling people to secure or regain independence and live the lives they want to lead. Navigating and challenging the inequality of access to health and social care entitlements services is one of the most significant contributions that social workers can make to tackle homelessness.

Expert blog by Gill Taylor – Strategic Lead, Single Homelessness & Vulnerable Adults, Strategic Commissioning, London Borough of Haringey.