Who Uses Services for Homeless People? An Investigation Amongst People Sleeping Rough in London

JANE FOUNTAIN, SAMANTHA HOWES, JOHN MARSDEN and JOHN STRANG

ABSTRACT
From a sample of 389 homeless people in London, the characteristics of those who used services for homeless people are presented and the implications for service planning and delivery explored. Staff providing services for this client group need knowledge about drug use and the confidence to work effectively with homeless drug users. Copyright (C., 2002 John Wiley & Sons, Ltd.
Key words: homelessness; service uptake; barriers; rough sleeping; substance use; service exclusion
 

INTRODUCTION
The rough sleepers unit (RSU) estimates that, in June 2000,1180 people slept rough (i.e. on the streets) in England on any one night-535 of them in London (RSU, 2000). However, this population is not stable: the numbers sleeping rough annually are probably five times higher than on any one night (Social Exclusion Unit, 1998) and some individuals move through cycles of rough sleeping to various forms of temporary and emergency accommodation. The RSU has a target of reducing these numbers to as near zero as possible, and by at least two-thirds, by 2002' (DETR, 1999, p. 7).

As part of a study designed to inform service-provision for the rough sleeping population, the uptake of seven services was investigated: cold weather shelters, rolling shelters, night shelters, day centres, services offered by an outreach team, hostel accommodation and food runs I. This paper provides data on the gender, race and age of the current users of each of these services; respondents' uptake and knowledge of homelessness services; the substance use of the current clients of each service; perceived barriers to accessing homelessness services and suggestions for overcoming them; and respondents' experiences of exclusion from these services.

METHODS

Between January and, October 2000, interviews using a structured questionnaire were conducted with a convenience sample of 389 people in London who had slept rough for at least six nights in the previous six months—the only criteria for inclusion in the study. Interviews took place in hostels, cold weather shelters, rolling shelters, day centres, drop-in centres, and in the street. In order to maximize participation by the marginalized population that was targeted, interviews were conducted by members of a team with experience of working sensitively with homeless people and respondents were paid £10. Three refusals were reported. The sample was typical of all those who had slept rough in inner London in 1998-2000 in terms of age, gender, race and the borough where the last rough sleeping episode occurred (Fountain et al., in press). Data were analysed using SPSS.
RESULTS
The data presented here do not include rolling shelters except for those pertaining to the last month, as the facility was not introduced until several months after interviews began.

Characteristics of current service users

Respondents comprised 81% (314) males and 19% (75) females. There were no gender differences in the use of different service types, except for rolling shelters. Thirty-one per cent of all females had used a rolling shelter in the last month compared to 19% of all males (x2= 4.571, p <0.05, dfl ).

Eighty-three per cent (324) of the sample described themselves as White. There was no difference in service utilization by race except for the use of cold weather shelters. Those who described themselves as White were significantly more likely than other ethnic groups to have used these shelters in the last month (31% : 17%; x2= 5.29, df 1, p> 0.05).

Twelve per cent (48) of respondents were aged 21 and under, and one-third (33%, 129) were aged 25 and under. Almost three-quarters (74%, 286) were aged 35 and under, and just 5% (18) aged 50 and over. The mean age of the whole sample was 31 (range 17-72).

There were no significant age differences in terms of the type of service utilized in the month prior to interview, except in the use of night shelters and day centres. Night shelters were most likely to be used by those aged 20-24: 56% of those who used night shelters were in this age group (x2= 21.02, dfl. p < 0.001). Day centres were most likely to be used by those aged 19 or under. Eighty-six per cent of this age group had used day centres in last month (x2 = 16.96, df5, p < 0.005). In all the services examined, males were on average older than females, except those who had used night shelters. Here, females were an average of 6 years older than males.

Eighteen per cent (70) of the sample had been homeless2 for 2 years or less, 20% (76) for 3-5 yeirs, 26% (102) for 6-10 years, and 36% (139) for more than 10 years. The mean length of time clients of each service had been homeless was more than 7 years. Those most recently homeless were least likely to have accessed each type of service.

Use of services .for homeless people

The sample's contact with services for homeless people was high. In the year before the interview, 90% (351) had used at least one service which provided temporary and emergency accommodation. Nevertheless, in the same year, 62% (241) respondents had been homeless for more than 6 years and almost half (48%, 187) had slept rough for more than 6 months.

Only 1.5% (6) of respondents had not used any homeless services in the year before the interview, with 2.6% (10) having used all six services. Individuals had typically used four different services throughout the previous year (mean 3.73, SD 1.30, range 1-6), most commonly day centres, food runs, outreach teams and cold weather shelters.

Knowledge of services in London for homeless people

Respondents were knowledgeable about each of the seven services provided for homeless people in London. The majority knew where there was a day centre (369, 95%) and a hostel (364, 94%). The service least respondents knew about was a night shelter, although almost two-thirds (63%, 224) knew where there was one.

There were significant differences in knowledge of homelessness services (except hostels) according to the length of time respondents had been homeless. In general, those who had been homeless for 2 years or less were not as likely to know of services compared to those who had been homeless for more than 2 years.

Use of services for homeless people by substance users

in the month before the interview, 83% (324) of the sample had used a drug and 96% (372) had used a drug and alcohol. Dependence was measured on the main substance respondents reported using in last month, using a DSM-IV and ICD- I 0 compatible screening questionnaire for harmful substance use and dependence (WHO, 1992; APA, 1994). Eighty per cent (312) of the sample were dependent on their main substance, including 36% (139) on heroin and 25% (97) on alcohol.

In the last month, over three-quarters of all service users had used a drug and at least half of the clients of each service were dependent on a drug (excluding alcohol), other than those who had used night shelters, where the proportion was 44%. The proportion of current clients of each service who were dependent on alcohol was lower, ranging from 22-28%, except in cold weather shelters, where 356, were alcohol dependent.

Barriers to using services for homeless people

If respondents had never used each of the list of types of services for homeless people, they were asked if they would consider using one in the future. If they had used a service, they were asked if they would use it again. If they answered 'no' to either of these questions, they were asked why they would not use the service. Overall, all the respondents would use at least one type of service (again). The main reasons for not using a specific service were that there was too much substance use, violence and chaos there (other than food runs, where the main reason for non-use was a dislike of the food) and that respondents did not know where to find it (apart from hostels).

Those who would not use a particular type of service for homeless people were asked how it could be improved to encourage them to use it. Overall, the most common response was 'nothing', although respondents had few suggestions for improvements which would encourage them to use each service.

Exclusion from services for homeless people

In the year before the interview, over a third of the sample (39%, 150) had been excluded from one or more type of homelessness service, most often a hostel. The main reasons for exclusion were physical violence towards other clients (34%. 51), followed by drug use (25%, 37). Seventeen per cent (26) had been excluded from a service because of their alcohol use.

Those using alcohol were more likely than non-alcohol users to have been excluded from homeless services, with 45% of those who had used alcohol in the last month having been excluded, compared to 26% of those who had not used alcohol in the last month (x2= 13.06, df I ,p <0.001). Those who had used crack cocaine in the last month were also more likely to have been excluded from a service than those who had not used the drug in the last month (44% compared to 35%; x2= 4.20, df I , p <0.05).

Respondents who had been excluded from any homeless service were more likely to score as dependent on the main substance they had used in the last month than those who did not (x2= 9.34, df l, p < 0.005). Forty-two per cent of those who were dependent on drugs or alcohol were excluded from services, compared to 23% of non-dependent substance users.

DISCUSSION

Those interviewed for this study showed high levels of knowledge and uptake of services which provided temporary or emergency accommodation. Despite this, a move to permanent accommodation had not followed, or if it had, it failed.

Those who had been homeless for 2 years or less were less likely to know about services for homeless people than those who had been homeless for longer. Services for homeless people should be publicized amongst those newly-homeless and this initiative should also be incorporated into primary prevention strategies.

An extremely high proportion of those who had accessed a service for homeless people had used a drug, and around half were dependent on the main drug they used (Fountain el al., in press). Staff providing services for this client group clearly need knowledge about drug use and the confidence to work effectively with homeless drug users.

Over one-third of the sample had been excluded from one or more services in the year before the interview, mostly from hostels and mainly for physical violence towards other clients and drug use. Those who had been excluded were more likely to use crack cocaine or alcohol than any other substance, and more likely to be dependent on the main substance they used. Environments should be created, particularly in hostels, where situations leading to physical violence can be minimized. Whilst illicit drug use cannot be condoned, it would be helpful if more agencies—especially hostels—could offer services to support those who continue to use drugs, even if they are not currently seeking help.

Overall, respondents' opinions of services for homeless people appeared favourable. The main barriers to using services were that there was too much substance use, violence and chaos there (apart from food runs). Thus, whilst many services for homeless people are supposedly substance-free, it appears that they are not perceived as such by some of those in need of them. Nevertheless, the most common response when respondents were asked for suggestions for improvements that would encourage them to use each service was 'nothing'. These respondents are likely to be those who are the most entrenched in a lifestyle which involves sleeping rough and are the most difficult for services to attract and engage. Aspects of services for homeless people which lead to a high level of uptake should be identified, publicized amongst those sleeping rough, and strengthened, in order to maximize uptake.

1 Cold weather shelters, rolling shelters, night shelters and hostels pr vide various forms of emergency and temporary accommodation for people sleeping rough. Clients needs are assessed and support services, or access to them. are also provided. Cold weather shelters and lolling shelters are open for only a few months. Some hostels provide long-term accommodation and some cater for specific needs.
Day centres do not provide accommodation but in addition to providing other services may also refer clients to those providing accommodation.
Outreach teams, which include both generic and specialist workers, work with people sleeping rough. conducting needs assessments and brokering access to accommodation and other services.
Food runs provide food for people sleeping rough.

21n this paper. 'homeless' refers to all those who have no home, and includes those living in hostels fir homeless people. in temporary accommodation provided for homeless people, and sleeping on the streets. 'Sleeping rough' refers specifically to homeless people who are sleeping on the streets.

ACKNOWLEDGEMENTS

The authors are grateful to Crisis for funding support for the survey from which the data for this paper were taken, and to staff from St Mungo's Substance Use Team for conducting the interviews with homeless people. Paul Griffiths and Colin Taylor, from the National Addiction Centre, London, are thanked for their valuable help on the project. The views expressed are those of the authors.

Copies of the full report on the project from which the data for this paper were taken can be obtained from Jane Fountain.

REFERENCES
American Psychiatric Association (APA). 1994. Diagnostic and Statistical Manual of Mental Disorders (4th edn). APA: Washington, DC.
Department of the Environment. Transport and the Regions (DETR). 1999. Coming in from the Cold: The Government's Strategy on Rough Sleeping. Rough Sleepers Unit. DETR: London.
Fountain J. Howes S, Marsden J, Taylor C, Strang J. Drugs and alcohol and the link with homelessness: results from a survey of homeless people in london. Addiction Research and Theory (in press).
Rough Sleepers Unit (RSU). 2000. 1999 Estimate of the Number of People Sleeping Rough in England. Statistics provided by Rough Sleepers Unit to the authors.
Social Exclusion Unit. 1998. Rough Sleeping: Report by the Social Exclusion Unit. Cabinet Office: London.
World Health Organization (WHO). 1992. International Statistical Classification of Diseases and Related Health Problems (10th edn). WHO: Geneva.
Copyright ( 2002 John Wiley & Sons. Ltd.    J. Community App!. Soc. Psycho).. 12: 71-75 (2002)