Written evidence from the Homeless Link response (DEG0149)

Introduction

Homeless Link is the national membership charity for frontline homelessness agencies and the wider housing with health, care and support sector in England. Our mission is to develop, inspire, support and sustain a movement of organisations working together to achieve positive futures for people who are homeless or vulnerably housed. With over 800 members across the country, we work together to gather evidence and intelligence, improve services and campaign for the social change needed to ensure that everyone has a place to call home and the support they need to keep it.

We are a member of the Making Every Adult Matter Coalition (MEAM), alongside Clinks and Mind, formed to improve policy and services for people facing multiple needs. Together the charities represent over 1,300 frontline organisations that have an interest in the criminal justice, substance misuse, homelessness and mental health sectors. We support partnerships across the country to develop effective, coordinated approaches to multiple needs that can increase wellbeing, reduce costs to public services and improve people’s lives.

1. Are some disabled people (for example, young disabled people or people with different health conditions) more at risk of unemployment or economic activity than others?

1.1. Compromised health is rife amongst people who do not have a home. Yet disability in the homeless population is often not recognised. This is despite the very nature of having no home, or living in unsuitable insecure housing, being damaging to both physical and mental health. Whilst the rate of mental health issues in the general population is one in four[1] it’s twice as high for people who are homeless. But this figure is just for those who have had a diagnosis.[2] When taking into consideration people with no home who have not been diagnosed, the prevalence of mental health problems is eight in ten.[3]

source: [4]

1.2. Even when compared with the most deprived people who do have a home, people who are homeless are significantly more likely to experience chronic, debilitating health conditions. Research has also highlighted the prevalence of levels of frailty amongst the homeless population, comparable to that of 89-year-olds in the general population.[5] In terms of multimorbidity, people with no home have an average of seven long-term health conditions, far higher than that for people in their 90s.[6]

1.3. And yet it is open to question whether those working to better the employment prospects of disabled people even recognise that very many people without a home fall into the category of disabled people. Just as for many years people with mental health issues were not recognised as disabled to the same degree as those with physical health limitations, so disabled people who have no home are invisible when considered alongside housed disabled people.

1.4. The greatest barrier to determining whether a person with no fixed address is disabled is the all too frequent and unlawful practice of refusing access to primary care services. Gatekeeping by reception staff is a significant barrier to GP registration.[7] Without access to healthcare services, those with debilitating physical and/or mental health conditions cannot establish disability. And without this, disabled people who have no home cannot access DWP programmes designed to support disabled people into employment. Yet people experiencing debilitating health conditions, in addition to having no home, are among the groups of people in need of intense support to get back into work.[8] And this is in the context of as few as 2–14% of people living in homeless hostels and supported housing being engaged in paid employment.[9]

2. Evidence of what works

2.1. The DWP conditionality regime can compromise trust and alienate disabled people who are homeless.[10] In contrast, a key characteristic of support provided by our members is it’s voluntary nature, both in terms of volunteers with lived experience being involved in services design and delivery and in that engaging in support programmes is voluntary and is without penalty. Additionally, as discussed below, support which engenders confidence and self-esteem, builds the foundation upon which profoundly disadvantaged people who find themselves without a home, can secure and keep work.

2.2. To maximise the likelihood of a positive, sustainable employment outcome, DWP need to recognise that those they are supporting into employment have needs other than for employment support that must also be met. In her exploration of support services designed to move people with lived experience of homelessness into employment, Jones found that services did not offer narrowly defined employment support. Alongside employment support, services provided digital and budgetary training; access to support to improve literacy and numeracy skills – as well as more vocational activities such as cooking classes and creative writing groups.[11] Critically, this broad menu of activities was developed in response to needs that those using the services identified themselves and built on existing skills and experience. Supporting those using the services to recognise their existent skills, experience and knowledge, bolsters confidence and self-esteem - critical success factors.

3. What is the right support balance? What improvements should DWP make to the support it offers to unemployed disabled people via Jobcentre Plus?

3.1. A number of our member organisations offer employment support programmes. The most comprehensive will feature work experience, training, mentoring and support - both before securing work and in-work. Following this model, the House of St Barnabas Employment Academy programme led to three quarters (71%) of those who secured work - previously unemployed for five years or more - kept that work for at least six months.[12]

3.2. We believe that for DWP to offer the most effective support it can, it needs to embrace positive approaches to supporting people. There is growing awareness that people experiencing multiple disadvantage, such as disability and homelessness, have had adverse experiences in their past and for those with more complex needs (including debilitating physical and/or mental health issues), that adversity is likely to have started in childhood. A reaction to adversity can be trauma. Many people experiencing disability and homelessness have long histories of adversity resulting in complex trauma.

3.3. Strengths-based practice is about transforming relationships between staff providing support and the people they work with. It addresses the power imbalance, which can otherwise compound clients’ trauma. This practice also encourages staff to recognise that they should not, and arguably cannot, determine a client’s rate or direction of progression. Rather, their role could and should be one of facilitating a strengths-based focus with open-ended availability of support.

3.4. As well as applying a strengths-based approach, DWP should adopt the psychologically informed environment (PIE) framework to effectively meet the psychological needs of those they are supporting. The PIE framework is designed to improve relationships, between staff and clients, as well as within staff teams and so working environments. Trauma Informed Care (TIC) is a form of PIE that uses trauma theory and research as the psychological approach so that every element of the service delivery is designed through a ‘lens of trauma’. It is designed to raise awareness of the impact of trauma and ensure the likelihood of re-traumatisation in services is minimised.

3.5. DWP could also improve its JCP offer via co-production, that is, involving the end-user of JCP services in the design of those services. Services that are co-produced have greater resonance for the people using them, with service offers more closely matched to what clients/claimants want and need - as opposed to what professionals may assume they need. Claimants and those who have been claimants, have a vast amount of knowledge about what is needed to deliver effective employment support, making them experts by experience.

3.6. Also fundamental to maximising claimants’ ability to seek, secure and keep employment is the physical safety of safe, warm, dry housing that they have a right to occupy. Without this stability, claimants’ work-focus will be compromised. With fragmented sleep and/or the risk of physical and/or sexual violence, with nowhere to launder clothes or maintain personal hygiene and no safe secure place to keep belongings, people with no home simply cannot operate at their optimum.

4. What would you hope to see in the Government’s National Strategy for Disabled People?

4.1. An overt and explicit recognition and inclusion of people who are homeless and living with debilitating health conditions as disabled people.

5. How should DWP look to engage disabled people and the organisations that represent them in formulating the Strategy?

5.1. A perennial, critical issue when engaging disadvantaged people, whose life experience has taught them to distrust state agencies, is trust. Lack of trust and communication has been associated with greater difficulty finding work. Employment support programmes for disabled people who are also homeless, must be sensitive to homelessness-specific experiences that may make establishing trust difficult and should be designed so that claimants work exclusively with one employment support provider to maximise the development of trust.[13] Homeless Link, as the membership body for frontline services with established, trusting relationships with some of the most chronically and profoundly disadvantaged people, is very well placed to act as conduit to disabled homeless people and the organisations that support them. We would welcome the opportunity to support Government in the development of its National Strategy for Disabled People.

December 2020