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Mental Health Services for Rough Sleepers

Volume 820: debated on Monday 21 March 2022


Asked by

To ask Her Majesty’s Government what assessment they have made of the effectiveness of the £30 million programme to provide specialist mental health services for people sleeping rough, as detailed in the NHS Long Term Plan; and what plans they have to publish an evaluation of the outcomes of that programme.

This Government are committed to ending rough sleeping by the end of this Parliament. The long-term plan set a target of 20 high-need areas to receive new specialist mental health provision for people sleeping rough by 2023-24. In fact, the NHS has exceeded that target, with 23 sites. There are plans to share learning from these sites to identify the key successes and effective approaches, and NHS England plans to undertake a formal evaluation before the end of the programme.

I thank the Minister for that Answer and look forward very much to the publication of that work. We know that common mental health conditions are twice as high among people who have experienced homelessness, and psychosis is 15 times as high. Obviously, I commend the Government’s commitment to end rough sleeping. Does the Minister know what figure has been settled on for the number of people sleeping rough with specialist mental health services needs? If one has been settled on, is that the criterion that will be used to review progress with the NHS long-term plan when that is refreshed?

I thank the noble Baroness for her Question and for her continued conversations with me on a number of different health-related issues; I am learning quite a lot from those. I understand that the data will be collected at some point, and I hope that that will be done regularly. If the noble Baroness will allow me, I write to her with more details, but I know that the top-level answer to that question is that we are about to get the data.

My Lords, about two-thirds of people who are homeless cite alcohol misuse as one of the reasons that first made them homeless, and for about one in 10 people who die homeless, alcohol is the main cause of death. Can the Minister assure us that all this work will include a proper alcohol treatment programme, so that the underlying problems are dealt with in addition to the other mental health problems?

The noble Baroness makes the very important point that a number of people who are homeless suffer from alcoholism and alcohol abuse—and indeed drug abuse. For some of these people, the issues they are suffering from are often interrelated. Therefore, in the joined-up thinking we are looking at, charities, civil society organisations and the NHS are making sure that we treat the various symptoms in an integrated way.

My Lords, given the success of the Everyone In campaign, through which 15,000 rough sleepers were given accommodation to protect them from Covid, does my noble friend agree that that progress must be maintained? Given that many rough sleepers have mental health issues, can my noble friend say whether the specialist funding for mental health services for rough sleepers will be extended beyond the next two years?

I thank my noble friend for raising that important point. The new rough sleeping strategy from the Department for Levelling Up, Housing and Communities will set out how departments will work together to end rough sleeping. This will build on the recent success to which my noble friend refers to ensure that rough sleeping is prevented in the first instance and responded to when it occurs. We are going to work closely with the Department for Levelling Up, Housing and Communities and other departments, as well the voluntary and social enterprise sector and others, to make sure that we are all joined up.

My Lords, the most common health problems among homeless people are substance abuse, as the Minister just mentioned, and mental health problems; often it is a combination of the two. Given this correlation, can the Minister say what the Government are doing to reconnect addiction services with health services in order to treat homeless people with multiple health problems? Does the Minister agree that specialist addiction services should be jointly commissioned by the NHS and local authorities to ensure full integration?

Like many other noble Lords, the noble Baroness has raised a very important aspect of this issue. She is absolutely right that people with drug addiction often have physical and mental health needs as well. Mental health problems and trauma are often central to an individual’s dependence on drugs, alcohol or other forms of abuse. As set out in the drugs strategy, we are working with NHS England to ensure that there is joined-up service provision between specialist mental health services and substance misuse services for people with co-occurring issues, including those who are experiencing rough sleeping. We are also going to make sure that the next phase of integrated care system development includes leadership on drugs and alcohol to integrate both physical and mental healthcare and substance misuse services.

My Lords, I commend to the Minister’s attention, if he is not already aware of it, the work of Art and Homelessness International and its 500 or so member organisations. In working with the NHS and local authorities on ways to support people sleeping rough, will Ministers take into account the impressive evidence that enabling them to engage with creative and cultural programmes— I think of The Choir With No Name, Streetwise Opera, Museum of Homelessness and the work of the Booth Centre—leads to improved well-being, resilience, agency and skills and thus to improved prospects for sustaining tenancies and employment?

I am sure we are all grateful that the noble Lord was able to ask his question on this issue. I pay particular tribute to the noble Lord for all his work and for raising awareness of the creative sector across a whole range of health and social care issues. I am not aware of the projects to which he refers, so I will be happy if he writes to me about them. In a previous political career as a Member of the European Parliament for London, I would meet lots of civil society organisations right across London, including homeless projects, and I was amazed by the diversity of provision. It was not a simple matter: they were tackling a number of different issues because often, the needs of homeless people are complex and there is not just one simple solution to the issue.

My Lords, my noble friend will know that the people who are still sleeping rough after a year are generally those who started off with mental health problems. What action are the Government taking to prevent people hitting the streets in the first place? Is there a co-ordinated approach with the housing sector?

My noble friend raises the very important issue of prevention. When we look at the causes of homelessness, they are often complex, and we might consider that all of us—including noble Lords, perhaps—are only one or two steps away from homelessness. Someone loses their job, their relationship breaks up and they then lose their home—or it is the other way around: their relationship breaks up and they lose their job, and after a while of relying on a friend’s good will, they stop sleeping on their sofa and they end up homeless. So, it is really important that we understand all the different steps by which people become homeless and make sure not just that they get accommodation but that we tackle the underlying problems that led to them being homeless.

My Lords, with a health audit by Homeless Link showing that some four out of five people experiencing homelessness need support with their mental health, how will the Government ensure that they get the help they need in areas that do not have the necessary specialist mental health services that are being funded through the long-term plan? Further to this, will the Minister commit to a continued expansion of specialist homeless healthcare services throughout the NHS as part of a renewed rough sleeping strategy?

I thank the noble Baroness for those questions on what are very important issues. Our plans to transform NHS mental health services as part of the long-term plan include investing an additional £2.3 billion a year by 2023-24, which we think will enable an extra 2 million people in England to access NHS-funded mental health support by 2023-24. On targeting much further down, we are hoping that some of the work we do through community mental health frameworks will give 370,000 adults with serious mental illness greater control over their care and support. We have to look at this in a multifaceted way, and we are looking at psychological therapies, improved physical healthcare, access to employment support, trauma-informed care and support for those with self-harm and substance misuse problems. We announced £30 million to establish these specialist mental health provisions, and we want to learn from those to see what the best way is of rolling out more in the future.

My Lords, have the Government carried out an analysis of why there has been a massive increase in the number of people rough sleeping on our streets? What does the analysis say, and what are the Government going to do about it?

Indeed, in some measures, the number of rough sleepers in every region of England have actually decreased. There were 2,440 people expected to have been sleeping rough on a single night in autumn 2021, which was an eight-year low. We have also seen some of the problems associated with experiencing homelessness, such as suicide, fall, but that is not a sign to get complacent. That is why we want to roll out this programme. We have exceeded the target of 20, and we will continue rolling it out.