In March 2022, the National Institute for Health and Care Excellence (NICE) published new guidance on Integrating Health and Social Care for People Experiencing Homelessness. These guidelines aim to improve access and engagement of health and social care and sets out recommendations for health care providers, commissioners, researchers and other services, to ensure coordinated care.
People who are experiencing homelessness often have multiple disadvantages and challenges accessing mental health, substance misuse and physical health services. There is very often experience of psychological trauma and as a consequence and significant unmet need, resulting in this population cohort having poor health outcomes and an average age of death around 30 years lower than the general population.
The new NICE guidelines outline general principles for the health and social care of people experiencing homelessness, recommendations for planning and commissioning, and includes further recommendations on:
Multidisciplinary service provision, including homelessness multidisciplinary teams, homelessness leads and intermediate care
This includes the adoption of Psychologically Informed Environments which provide trauma-informed care across the system to support front line staff, peer workers, managers and people who experience homelessness The guidelines recommend delivering trauma informed care which is person-centred, empathic and recognises the diverse experiences of homeless populations.
The guidelines ask healthcare providers to consider having reduced caseloads in recognition that additional resources and targeted service delivery are necessary to overcome barriers of support.
Improving access to and engagement with services, including outreach, the role of peers and long-term support
The guidelines recognise that more assertive and targeted approaches are often needed to ensure health and social care for people experiencing homelessness is available, accessible and provided at the same standards and quality as the general population. NICE highlight the importance of having longer contact times in order to develop and sustain trusting relationships between frontline staff and those experiencing homelessness.
It is also recommended commissioners of health, social care and housing services should work together to undertake needs assessments, to plan and to fund integrated multi-disciplinary health and social care services for people experiencing homeless. These teams should aim to identify people experiencing homelessness through outreach, inreach into day centres and hostels or when they present to health and social care services, as well as supporting mainstream services.
Peer support is central to the guidelines. This includes the co-designing and co-delivering services to improve the quality of health and social care; for peer workers to directly deliver health and social care interventions, provide training for health and social care staff and carrying out participatory research and data collection.
NICE suggests service consideration of moving people up waiting lists for assessment and intervention due to higher risks of deterioration, loss to follow up support through disengagement and premature death. Services should take into account the social determinants of health to improve long term outcomes and address health equalities.
NICE recommends commissioners and planners avoid policies that withdraw support and close cases after a standard duration unless a safe transfer of care to another service has been agreed with the person or the person agrees that they no longer need the service.
Service users experiencing mental illness and substance dependency can often fall between agency eligibility criteria and when this is compounded by homelessness, access and engagement becomes significantly difficult. This is corroborated by Dame Carol Black’s Review of Drugs Part 2, a government commissioned report, which highlights mental health and trauma are an integral part of drug dependency and services need to be radically improved to make it possible for people to receive good mental health care. Additional funding has been made available to support these recommendations.
Colm Gallagher, Clinical Lead for Homelessness, Mental Health and Homeless Team at Greater Manchester Mental Health said:
“People who are hidden from us are normally those who are most in need. I also hope it will provide an impetus for all services to provide a comprehensive assessment of the persons physical, mental health and social care needs and that services understand the need to respond to health inequalities and be adaptive to diversity and inclusion health needs. The guidelines have been well received thus far and we recommend that all services review their provision against the guidelines for people experiencing homelessness.”
Greater Manchester Mental Health NHS Foundation Trust (GMMH) are one of the lead providers for NHS homeless mental health, dual diagnosis and substance misuse services across Greater Manchester. GMMH Homeless Services have a hub and spoke delivery model, whereby the hub has a number of specialist homeless services such as the Manchester Mental Health Homeless Team, Rough Sleeper Initiative, Housing First and the spoke represents the Homeless Leads in GMMH mainstream services.
Cathy Lovatt, Service Manager, Addiction Services, said:
“The Trust is proud to have a Housing Strategy (2019-2022), which commits to addressing the needs of those experiencing homelessness across its services. We are really pleased to see this guidance and recognise there is a benchmarking exercise required to ensure all of its services review their provision against the guidelines for people experiencing homelessness.”
Find the full guidance and associated resources here: https://www.nice.org.uk/guidance/ng214