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September 01 2021

How can services be more accessible to homeless people labelled ‘hard to reach’? Clinical psychologist Dr Ben Campbell asked

Anyone with experience working in outreach or crisis services may be familiar with the description of 'hard to reach': a label used to describe people who need support, but, for one reason or another, aren't getting the help they need. However, what if we flipped that and asked: “What makes these services hard to reach for the people that need them?”

That question formed the basis of research I started in 2019 through the University of Liverpool. It put the voices of homeless people at the forefront of real-world conversations on getting access to support.

Nowhere was it more vital to highlight current issues in homeless care provision than in the cases of rough sleepers; those most vulnerable to physical and psychological injury as a result of their circumstances. ‘Good enough’ care, a term coined by psychoanalyst Donald Winnicott to describe care that need not be perfect but must meet core needs of stability and safety, was the yardstick in relation to how people (both service users and providers) interacted with the structures built to offer such care and I found frustrations on both sides of the conversation.

Thanks to ©Juliet Young for this graphic depicting a cycle of the effects of rejection and compassion. Her Instagram: @creative.clinical.psychologist

Participants spoke about the many hurdles to getting help. Rules often felt exclusionary and frustrating. The result? For those most vulnerable and those who are experiencing the dual difficulties of homelessness and addiction, mainstream services such as community mental health teams are often beyond their reach.

Accounts of dehumanisation and frustration was nowhere more apparent than in the story of Kate.

She told me about repeated assaults and abuse from the public, from the police, and when she did get support from statutory services, she was sectioned and driven far away from home only to be discharged back to the streets again with no support network or safety net.

“They sectioned me... [put me] in a hospital transport with blacked-out windows, they took me there, and I didn't know where I was. My mind wasn't functioning. Didn't have any form of contact with anyone, didn't know where I was. I was on my own, they wouldn’t tell me where I was, they wouldn't pull over so I could have a smoke. It was scary. It's like being passed from pillar to post. I felt really bad. I wanted to finish my life."

For Kate, the ‘cracks’ or gaps in services seem obvious. For others, it was frustrating asking for help, and for those that did, they were often told they didn’t meet criteria. In the case of many hostels, rules were enforced strictly, and this meant not always being able to get somewhere to stay overnight. Kelly spoke about her experiences in a particular hostel:

“I don’t think [hostels] look at the vulnerabilities of the person, at [this hostel] if you’re not back by a certain time they won’t let you back in, which is ridiculous. You’ve got lots of women prostituting themselves, escorting. There’s men there smoking spliffs, and the staff don’t say anything. And I just think, what? When did this happen? it's a roof over your head but it's not good for people, not for vulnerable people.”

It was clear also that ‘gaps’ and ‘hoops’ were present for the professionals attempting to provide care as best as they could within a framework that is ultimately too resource-scarce to make a longlasting impact and create change.

It is my hope that this research can contribute to meaningful progress, both in real-world care systems and in further study of such issues as they exist today.

Moving forward

Here are some of Ben's recommendations for people developing support services for homeless people:

  • Systemic improvements, such as sharing basic information, improving referral pathways and supporting agencies to cooperate with one another, would improve the practical dayto-day running of many agencies and community organisations.

  • Accessing support for difficulties with drugs and alcohol was incredibly difficult for the participants in this research. Reducing barriers to this type of support and exploring novel approaches to substance use may be of benefit.