This blog is the first in a series of three by The People’s Recovery Project (TPRP), a charity that aims to build sustained recovery for people experiencing homelessness and addiction. As a follow up to their involvement in the NIHR SSCR funded Strengthening adult safeguarding responses to homelessness and self-neglect study, HSCWRU invited TPRP to host an event at King’s with invited stakeholders. This was an opportunity to share ideas with a wide spectrum of perspectives from across the homelessness and substance misuse sectors, including safeguarding, commissioners, health, mental health, grassroots organisations, experts by experience and researchers. This blog by co-founders Ed Addison (left) and Nathan Rosier highlights messages from the 2023 event and introduces TPRP’s work.

Why does TPRP exist?

Last year over 1300 people died while experiencing homelessness and over one third of these deaths were related to drugs or alcohol: over two thirds of people who are experiencing homelessness have a drug or alcohol need. In recent years there has been a yearly increase in the numbers of people dying as a result of drug use in the UK: people are not getting access to the drug and alcohol treatment they need. TPRP aims to improve routes into sustained recovery and make residential treatment a more available and viable option for people on the streets and in unstable accommodation.

We have worked on the streets for many years in frontline services with people who are experiencing multiple exclusion homelessness. We witnessed the significant challenge that many individuals face in moving away from the streets and ending their reliance on homelessness services. There are many issues which prevent someone from moving on, and the way that different support systems interact can cause people to lose hope. When you add drugs and alcohol into this context, people often become trapped and accustomed to just surviving day to day. For many, this becomes unsustainable and the harm caused by chaotic drug and alcohol use means that people are dying prematurely, often in preventable circumstances. Our work experience has given us a deep understanding of the difficulties in supporting someone to access any form of treatment for drug and alcohol use, but crucially, people experiencing homelessness rarely get the opportunity to go to residential treatment. When someone is afforded this opportunity there is an overwhelmingly positive impact on their life and subsequent transformation.

Improvements are possible

The Dame Carol Black review has stated that we need to transform our approach to treatment for people who are using drugs and that there is a need for investment in innovation. Recommendation 11 in Part 2 of the review recommends that local authorities “commission a full range of evidence-based harm reduction and treatment services to meet the needs of their local population in line with the new national Commissioning Quality Standard.” People experiencing street homelessness rarely access recovery opportunities. We have undertaken focus groups in treatment services around the country: the feedback is that people who are experiencing street homelessness are not getting funding opportunities to access residential treatment. And yet we know that the cost of doing nothing is exorbitant, as people continue to access costly emergency responses. We believe that improving access to residential treatment for people when they want and need it will not only be positive for the individual, but will have a net positive impact for society.

Building and Evidencing Sustained Recovery

One of the often cited reasons heard when applying (and being rejected) for funding for residential detox and rehabilitation for someone  is that there is no evidence base demonstrating success. This is used as a rationale to refuse funding for someone with a history of homelessness. Through our own Freedom of Information requests to local authorities submitted in January 2023 we have ascertained that people who have experience of homelessness and addiction are not getting opportunities to access residential treatment. Information held by local authorities is far from comprehensive; however, our research shows that only half of existing local authority budgets for residential treatment are being spent. Additionally, in areas we did receive a response less than 15% of people who have received funding for residential treatment in the previous two years have a history of homelessness. While there are indicators where people have successfully completed treatment, this does not differentiate between those housed and those experiencing homelessness, and following discharge from a treatment service there is little follow up. The result is a lack of clear evidence to prove that residential treatment is an effective intervention to support people to build sustained recovery and exit homelessness.

We believe that there is an opportunity to build the evidence base that residential treatment can benefit individuals and the wider community. The People’s Recovery Project intends to demonstrate that, by building the right community support networks, we can support individuals to build sustained recovery into their lives, and through robust evaluation over time, prove that it is more effective to provide residential drug treatment to people when they are asking for it, without conditions or delay.

Ed Addison and Nathan Rosier are co-founders of The People’s Recovery Project.

Other blogs in this three-part series:

Blog 2: A community approach to safer working practice with homelessness and addiction: an individual experience informing The People’s Recovery Project

Blog 3: A peer-led community – improving routes into residential treatment