1. Pathways into Multiple Exclusion Homelessness in the UK Dr Sarah Johnsen Prof Suzanne Fitzpatrick Prof Glen Bramley

2. Defining Multiple Exclusion Homelessness People have experienced MEH if they have been ‘homeless’ (incl.experience of temporary/unsuitable accommodation as well as sleeping rough) and have also experienced at least one of the following: ‘institutional care’: prison, local authority care, mental health hospitals/wards ‘substance misuse’: drug, alcohol, solvent or gas misuse ‘street culture activities’: begging, street drinking, 'survival' shoplifting or sex work 2

3. Methods Large-scale survey in 7 cities: Belfast, Birmingham, Bristol, Cardiff, Glasgow, Leeds, Westminster (London) Three stages: 1.Identification of all relevant ‘low threshold services’; random selection of 6 in each city 2.‘Census questionnaire’ survey of all service users over a 2 week ‘time window’ = 1,286 short questionnaires returned 3.‘Extended interview’ survey with service users who had experienced MEH = 452 interviews completed 3

4. Census Survey: overlap of experiences

5. Prevalence of Key Experiences Most prevalent (over ½ sample) - all forms of homelessness; MH problems; alcohol problems; street drinking Medium prevalence (between ¼ and ½ sample) - prison; hard drugs; divorce; victim of violent crime; survival shoplifting; thrown out; begged; admitted to hospital because of a MH issue; injected drugs; eviction. Least prevalent (less than ¼ sample) - redundancy; solvents etc.; LA care; partner died; sex work; repossession; bankruptcy 5

6. Complexity of Experiences 6 More complexLess complex  Male  Middle years (esp. 30s)  Childhood physical abuse, neglect, hunger, homelessness  Parents with drug, alcohol, DV or MH problems  Poor school experiences (truancy, exclusion, victim of bullying)  On benefits most of adult life Female Younger (under 20) and older (over 50) Migrants Westminster In steady work most of adult life

7. Clusters of Experiences 1. ‘Mainly homelessness’ (24%) = least complex (5 experiences on average); male + over 35; migrants; Westminster 2. ‘Homelessness + MH’ (28%) = moderate complexity (avg. 9 experiences); disproportionately female 3. ‘Homelessness, MH + victimisation’ (9%) = much more complex (avg. 15 experiences); suicide attempts, self-harm; victim of violence; LA care and prison; younger than average 4. ‘Homelessness + street drinking’ (14%) = moderate complexity (avg. 11 experiences); high levels of rough sleeping + street culture; male + over 35; Glasgow 5. ‘Homelessness + hard drugs’ (25%) = most complex (avg. 16 experiences); very high across all domains, especially substance misuse and street culture; most in their 30s 7

8. Individual Sequences Four broad phases in individual pathways: Early: solvents etc., leaving home/care, drugs/alcohol Early-middle: MH problems, survival shoplifting, survival prostitution, victim of violence, sofa-surfing, prison, redundancy Middle-late: sleeping rough, begging, injecting drug use, admitted to hospital with MH issue, divorce, bankruptcy Late: hostels/TA etc., applying as homeless, eviction, repossession, death of a partner These were generally consistent across all five clusters 8

9. Implications Need to co-ordinate responses across all aspects of individuals’ lives, rather than view them through separate professional ‘lenses’ (e.g. homelessness, substance misuse, criminal justice etc.) Need for bespoke services for migrants Need to redress relative ‘neglect’ of ‘forgotten middle’ of men in 30s who face most extreme forms of MEH The widespread practice of extrapolating London homelessness statistics to other parts of UK is inappropriate Preventative interventions need to focus on earlier signs of distress, given that homelessness is often a ‘late’ sign of deep exclusion 9

10. Study outputs can be downloaded (free of charge) from: www.sbe.hw.ac.uk/research/ihurer/homelessness-social- exclusion/multiple-exclusion-homelessness.htm