LSAB Briefing: Adults Living Street-Based Lives

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  • Context

    This briefing relates to what we have learned about people who live street-based lives and what we can do differently to improve how we support and safeguard individuals. It is based on the extensive work undertaken by the Leeds Safeguarding Adults Board in relation to self-neglect including a Thematic Review of People Living a Street Based Life and learning from Safeguarding Adults Reviews.

    People who live street-based lives

    Did you know that…?

    In 2017 there were an estimated 597 deaths of homeless people in England and Wales. Men made up 84% of deaths of homeless people and over half of all deaths were due to 3 causes: drug poisoning (40%), liver disease (9%) and suicide (13%). Street-based life activity includes begging, street drinking, street-based drug use and street-based sex work. People leading street-based lives have a range of housing and support needs and are often vulnerable or contribute to the vulnerability of others. Leading a street-based life can increase the risk of street homelessness. Street-based life activity is often highly visible and causes concerns for local communities. The majority of people living street-based lives felt unsafe, citing reports of assault, theft and feeling vulnerable (both from fellow rough sleepers and the wider community).

    (From the Leeds Thematic Review 2019)

    What we have learned about supporting and safeguarding people who live                                street-based lives

    ALWAYS respond to self-neglect, small steps make a big difference: Awareness, Look for the person, What is really happening? Assess the risk, Your time to act, Solutions focussed

    The key messages from what we have learned are set out below using the 'Always' concept developed by the LSAB to help support and strengthen safeguarding practice.

    Awareness: be aware of the signs and symptoms. Develop your skills and knowledge about living a street-based life and what self- neglect is:

    • People living street-based lives are more likely to suffer from anxiety, depression, personality disorders, addictions, accidents, violence, suicide and infectious diseases (e.g. Hepatitis B/C, HIV, TB), alcohol dependence resulting in liver disease, peptic ulcers and brain damage.
    • The use of drugs and alcohol is prevalent for some, street activities such as begging, street drinking and drug taking are often linked.
    • For many a street-based life offers an extended social network, a community.

    Look for the person behind the behaviour. Be interested about a person's life, their aspirations, history, identity, strengths and individual needs, as well as the help they want:

    • There is a higher likelihood that people have experienced trauma in childhood and/or adult life, and institutions: prisons, the care system or the armed forces.
    • Complex needs and lack of trust in services complicate accessing support. Some people living street-based lives are unwilling, and can be directly opposed, to engage with services. This requires persistence, assertiveness and possibly enforcement, alongside offers of support.
    • Building-based and/or appointment-based services may not be the right approach for the person and so potentially limit the provision of support.
    • People's motivation for change and willingness to engage may be influenced by the ease of ongoing treatment, the use of hospital, withdrawal and relapse, and the level of support available from family and friends.

    What is really happening? Does the person have the mental capacity to make these decisions?

    • Every person will have aspirations and those aspirations will not be to live on the street.
    • Mental capacity assessments should explore rather than simply accept notions of 'lifestyle choice'. Consider executive capacity and how adverse childhood experiences, trauma, brain injury, and 'enmeshed' situations can affect decision making.
    • Take a strengths-based, person-centred approach, recognise that something may be causing the situation, keep in contact especially when appointments are missed and help and support is declined.
    • Recognise that a person may have capacity to live a street-based life.
    • Recognise the impact of long-standing drug and alcohol misuse when assessing a person's mental capacity.

    Assess the risk and the person's needs. Does anything seem or feel wrong or not quite right?

    • It takes time to build trusting relationships so it is important to go at the person's pace and be patient. Be realistic and recognise that seemingly 'small' achievements may have real significance.
    • Support needs increase with age and are commensurate with the time someone stays on the streets.
    • Women are more likely to have specific support needs and to have experienced trauma, including domestic abuse, mental health, substance misuse and self-harm.
    • Consider all the person's physical health needs, how these impact on the person's daily life and how this in turn can affect how they access health services.

    Your time to act: engage with other agencies, seek advice, share information, access services, go that little bit further.

    • Good and timely communication is essential.
    • Make all contacts count and be flexible in your way of working - what works for one person doesn't always work for another.
    • Know where to go for advice, support and supervision.
    • Have confidence to challenge the practice and responses of others.
    • Information sharing policies, agreements and protocols are in place to support effective multi-agency working. Your organisation will have these, the LSAB has a multi-agency information sharing policy.
    • The Exceptional Risk Forum  has been set up by the Leeds Safeguarding Adults Board to respond to those situations where despite everyone's best efforts to support someone, an exceptional risk to their safety may remain.

    Solutions focussed: be creative, work alongside the person to identify solutions that suit them:

    • Street-based life is not simply a 'housing' issue and effective joint working to respond to people living in these circumstances requires acknowledgement of other risk factors, for example drug and alcohol misuse, severe mental ill health, domestic abuse, childhood neglect, having been looked after as a child and having been in prison.
    • Find out what the person wants: if we keep offering options that the person doesn't want then we shouldn't be surprised that they turn down offers of support.
    • A strengths-based, person-centred and trauma informed approach can enhance working with people about their wishes and aspirations.
    • Understand who needs to be involved and when, always consider different options and plans, and recognise strengths and the pace of change for the person.
    • Use a multi-agency approach together with the person to develop a robust plan using appropriate resources of specialists, support and advice, networks and community.

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