Opening the “too difficult box”: Strengthening adult safeguarding responses to homelessness and self-neglect

TY - BOOK

T1 - Opening the “too difficult box”: Strengthening adult safeguarding responses to homelessness and self-neglect

AU - Harris, Jess

AU - Martineau, Stephen

AU - Cornes, Michelle

AU - Manthorpe, Jill

AU - Tinelli, Michela

AU - Ornelas, Bruno

AU - Burridge, Stan

PY - 2025/5/19

Y1 - 2025/5/19

N2 - BACKGROUNDThe average age at death for people experiencing homelessness is 43.2 years for women and 45.4 years for men. With such high risks of mortality, it is important that statutory services across England work effectively to safeguard individuals experiencing extreme forms of homelessness. This study focuses on adult safeguarding responses for people who are experiencing ‘multiple exclusion homelessness’ (MEH), a term used to capture overlapping experiences associated with profound social exclusion, including not just homelessness but also institutional care, mental ill health, substance use, and ‘street culture’ activities. One of the risks of MEH is ‘self-neglect’ (severely neglecting one’s health, nutrition and hygiene). The cross-government 2022 Rough Sleeping Strategy states ‘Rough sleeping and multiple disadvantage is a safeguarding issue’. This study explored attitudes, understanding and practice approaches, to identify ways of strengthening responses to homelessness and self-neglect and to improve outcomes for individuals.SUMMARY OF FINDINGS• Across England, adult safeguarding is not working to address self-neglect where people are experiencing multiple exclusion homelessness. While there is good practice, there are also negative practitioner attitudes, service gaps and structural barriers across local systems that inhibit effective statutory responses.• The specialist homelessness social work role is potentially an important contribution to resolving this problem. It offers expertise in, and flexibility to work with, complex situations, to help address inequalities in access to statutory assessment, support and risk management.• Negative experiences of services, stigma and discrimination contribute to high levels of service mistrust and deter people experiencing MEH from seeking or accepting help. However, people with ‘lived experience’ told us that they are grateful when someone sticks with them.• Economic modelling found that shifting from limited, fragmented support, with repeated use of emergency services, to planned and timely multidisciplinary support, could lead to cost savings.

AB - BACKGROUNDThe average age at death for people experiencing homelessness is 43.2 years for women and 45.4 years for men. With such high risks of mortality, it is important that statutory services across England work effectively to safeguard individuals experiencing extreme forms of homelessness. This study focuses on adult safeguarding responses for people who are experiencing ‘multiple exclusion homelessness’ (MEH), a term used to capture overlapping experiences associated with profound social exclusion, including not just homelessness but also institutional care, mental ill health, substance use, and ‘street culture’ activities. One of the risks of MEH is ‘self-neglect’ (severely neglecting one’s health, nutrition and hygiene). The cross-government 2022 Rough Sleeping Strategy states ‘Rough sleeping and multiple disadvantage is a safeguarding issue’. This study explored attitudes, understanding and practice approaches, to identify ways of strengthening responses to homelessness and self-neglect and to improve outcomes for individuals.SUMMARY OF FINDINGS• Across England, adult safeguarding is not working to address self-neglect where people are experiencing multiple exclusion homelessness. While there is good practice, there are also negative practitioner attitudes, service gaps and structural barriers across local systems that inhibit effective statutory responses.• The specialist homelessness social work role is potentially an important contribution to resolving this problem. It offers expertise in, and flexibility to work with, complex situations, to help address inequalities in access to statutory assessment, support and risk management.• Negative experiences of services, stigma and discrimination contribute to high levels of service mistrust and deter people experiencing MEH from seeking or accepting help. However, people with ‘lived experience’ told us that they are grateful when someone sticks with them.• Economic modelling found that shifting from limited, fragmented support, with repeated use of emergency services, to planned and timely multidisciplinary support, could lead to cost savings.

UR - https://www.kcl.ac.uk/research/homelessness-and-self-neglect

UR - https://www.kcl.ac.uk/research/homelessness-and-self-neglect

M3 - Report

BT - Opening the “too difficult box”: Strengthening adult safeguarding responses to homelessness and self-neglect

PB - NIHR School for Social Care Research

CY - York

ER -