Remembering Jeremy Swain and his contribution to our work on homelessness

Posted on July 23, 2024 by Stephen Martineau

Maureen Crane, Visiting Senior Research Fellow, King’s College London.

Jeremy Swain

It was with deep sadness I heard about the death on 27 May 2024 of Jeremy Swain. He was a key figure in tackling homelessness and particularly rough sleeping for decades. Following a volunteering experience with the Cyrenians in London, Jeremy became a street outreach worker at Thames Reach in 1984 followed by periods as a resettlement worker and then a housing service manager within the organisation. He became Chief Executive of Thames Reach in 1999 and remained in the post until 2018, when he became Deputy Director for Homelessness and Rough Sleeping Delivery at the Ministry of Housing, Communities and Local Government. He was responsible for overseeing programmes developed through the Rough Sleeping Strategy, and later became a senior adviser for the Covid-19 Rough Sleeping Task Force. In 2017 he received a City Lit Lifetime Achievement Award for his contribution in helping people who had been homeless to develop the skills and confidence to gain employment.

I first met Jeremy in 1994 when starting fieldwork for my PhD. I was keen to interview older people who were homeless and he gave permission for me to visit Thames Reach’s hostels to see if any residents would be willing to take part. He showed great interest and enthusiasm in research on homelessness and understanding why people become homeless and what is needed to help them move on. He commissioned Tony Warnes (former Professor of Social Gerontology, University of Sheffield) and myself to undertake evaluations of programmes and services within Thames Reach, and he worked closely with many other homelessness sector service providers in London, including with Charles Fraser, former Chief Executive of St Mungo’s. Collectively these organisations commissioned us to undertake comprehensive studies of the needs of single people in London who were homeless and of the role of hostels in the early 21^st century.

Over the years Jeremy continued to be a great supporter of my research on homelessness, both at the University of Sheffield and at King’s College London. He was always keen for his organisation to participate in our government-funded research, and Thames Reach staff and service users played an active role in studies such as the Three-Nation Study of the causes of homelessness among older people, the FOR-HOME study and Rebuilding Lives. Through his knowledge, guidance and support over many years, he helped steer our Homelessness Research Programme to what it is today – from relatively small evaluations of services to large scale, multi-site studies concerning people who are homeless and services for them.

Using the Mental Capacity Act 2005 with those experiencing Multiple Exclusion Homelessness – Challenges, Debates & Resources

Posted on July 19, 2024 by Stephen Martineau

Stephen Martineau (KCL) reports from the latest webinar in the Homelessness series, part of the Homelessness Research Programme at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (855 words)

Over 220 people attended yesterday’s webinar in which Jess Harris presented early emerging findings from the NIHR HSDR-funded study, Use of the Mental Capacity Act 2005 (MCA) with people experiencing multiple exclusion homelessness in England. The findings were drawn from a set of scoping interviews with a range of senior professionals working with this population. The presentation focused on the professionals’ views of the challenges around use of the MCA in this space. These interviews have already informed the development of our national survey of health, social care and homelessness practitioners which is the next stage of the study, and which is currently live (and takes about 10 minutes). We plan to report on our analysis of findings from this survey later in 2024 at another webinar in the Homelessness series.

Please sign up if you would like to hear about future events in this series, or get in touch if you would like to present research: jess.harris@kcl.ac.uk
Presentation slides from the webinar
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The presentation provoked thoughts from attendees about various aspects of this topic, together with suggestions of some useful resources. We have collated some of these below. Among a lot of valuable contributions, two stood out as particularly interesting. One was about the ‘diagnostic test’. This has come up in practitioner interviews – specifically the question of how practitioners are approaching this element of the capacity assessment with people where substance use may feature in combination with (and possibly masking) mental illness. The other was the suggestion that the MCA is a poor fit when it comes to compulsive behaviours. It will be interesting to explore this further during the fieldwork part of this study (starting in autumn 2024) in light of London Borough of Tower Hamlets v PB [2020] EWCOP 34 (see Kane et al. (2023) Shades of grey: choice, control and capacity in alcohol-related brain damage).

General issues raised at the webinar by attendees

Problem of exclusion of rough sleepers from needs assessments under the Care Act 2014.
Dual diagnosis is a particular challenge because of the lack of services in many areas.
Lack of suitability of interventions available to social care – a commissioning issue, but also a systemic issue, across Health, Social Care, Housing.
It was suggested that early release schemes from prison are going to be a big issue for this population.

Using the MCA

It was suggested that the MCA is a poor fit for complexity within the MEH population, particularly around compulsive behaviours.
Executive function: importance of longitudinal capacity assessments was stressed by some. Also, Occupational Therapist and Speech and Language Therapist involvement in assessments.
On the ‘diagnostic test’ and this population. There was debate in the chat as to whether the Court of Protection requires a formal diagnosis. North Bristol was cited in support of the argument that a formal diagnosis is not required. (North Bristol NHS Trust v R [2023] EWCOP 5).
Importance of recognizing the knowledge and potential input (to capacity assessments etc.) of non-statutory practitioners. Support workers’ and outreach workers’ knowledge of the person may be overlooked. A clinical psychologist in a third sector organisation made a similar point, speaking of a power imbalance.
There was mention in the chat of detox being provided under Deprivation of Liberty Safeguards, in at least one site in England, if there is a plan for Alcohol Related Brain Injury rehab.
It was suggested self-discharge from hospital and mental capacity is a key concern.

Continue reading →

Introducing a community approach to practice with homelessness and addiction

Posted on November 20, 2023 by Stephen Martineau

Ed Addison and Nathan Rosier

This blog is the third in a series of three by The People’s Recovery Project (TPRP), a charity building sustained recovery for people experiencing homelessness and addiction. As a follow up to their involvement in the HSCWRU Strengthening adult safeguarding responses to homelessness and self-neglect study, HSCWRU invited TPRP to facilitate an event at King’s.

This blog by TPRP co-founders Ed Addison and Nathan Rosier shares final messages from this event on re-thinking approaches to supporting people to move on from multiple exclusion homelessness (MEH), with a focus on building new communities.

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

As we continue to develop The People’s Recovery Project (TPRP) we emphasise the importance of a peer-led community in guiding and supporting our approach. In the previous blog in this series we heard from Danny, an active TPRP community member, about his experience of street homelessness, residential treatment and recovery from addiction. Danny’s story is an example of how getting the opportunity to access residential rehabilitation can contribute to individuals making huge and positive life changes. Despite the many obstacles faced by our community members experiencing MEH, Danny is not the only one who has managed to embark on a journey of recovery. Through building a peer-led community in recovery from homelessness and addiction, we are striving to create the conditions that will allow members to use their own experiences to demonstrate to those living on the streets that a permanent recovery from street homelessness is possible. Continue reading →

New study at the Unit on capacity assessment and homelessness

Posted on October 16, 2023 by Stephen Martineau

This month sees the start of a new study at the NIHR Health and Social Care Workforce Research Unit, King’s College London. Over the next two and a half years researchers will work with people with experience of homelessness and professionals who work with them to examine mental capacity assessments and multiple exclusion homelessness in England. Stephen Martineau, Research Fellow at the Unit, introduces the study, which is funded by the NIHR Health and Social Care Delivery Research (HSDR) Programme.

At the Unit this month we are starting a study, ‘Use of the Mental Capacity Act 2005 with people experiencing multiple exclusion homelessness in England’. The co-Principal Investigators are Kritika Samsi (KCL) and Michelle Cornes (Salford & KCL), with the main researchers being Jess Harris (KCL) and Stephen Martineau (KCL). The lived-experience Advisory Group (PPIE) is led by Stan Burridge, who, as a member of the research team, will also be carrying out interviews with people experiencing homelessness. The other research team members are: Alex Ruck Keene KC (Hon), KCL and 39 Essex Chambers; Nathan Davies, UCL; Alex Bax, Pathway; Sam Dorney-Smith, Pathway; Bruno Ornelas.

After an evidence review, interviews with national experts and a national practitioner survey, we will focus on three contrasting sites in England – interviewing people with experience of homelessness and a range of professionals engaged in their support and care. Finally, informed by our findings, we plan to bring together stakeholders and, in consensus, revise a pre-existing capacity assessment Tools and Guidance document for practitioners working with people experiencing homelessness.

Background

About a decade ago in the London Borough of Lambeth, a review into the death of a 63-year-old man who had been sleeping on the streets recommended work on ‘understanding how the Mental Capacity Act (2005) [MCA] can be used to safeguard people in this context.’* One consequence came in the form of a pioneering Tools and Guidance document – now in its third edition (2017) – that places the MCA in context with the Mental Health Act 1983 (MHA), risk assessment, adult safeguarding and hospital admission procedures, all calibrated for those working with people who are street sleeping. Continue reading →

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

Posted on August 15, 2023 by Stephen Martineau

This blog is the second 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. This blog by TPRP co-founders Ed Addison and Nathan Rosier shares further messages from this event and focuses on ‘lived experience’.

The People’s Recovery Project event at HSCWRU brought together individuals from across the homelessness and substance misuse sectors, and within the group were many people with both expertise and lived experience. From the foundation of TPRP, at the core of development has been the involvement of people with lived experience of both homelessness and substance use. At the event we heard from community member Danny who has been supporting the development of the charity over the past year, and who spoke of his personal lived experience of addiction and of being on the streets:

Danny’s story

Danny

I was homeless in Westminster for about 20 years. In this time, I was in and out of homelessness services, police custody and incarcerated in prison on a number of occasions. I never wanted to go to rehab and did not see this as an option. The first time I went was due to a drug rehabilitation requirement issued by the court, and it was a way of getting me out of prison. I was not ready for rehab at this point.

When you are accessing different homelessness services, such as hostels and day centres, it is really difficult to access rehab: you have to jump through so many hoops. It felt like there was always a constant block and if it was not the limitations of one service it was due to the requirement of another organisation, or legislation that says you have to have a local connection, live in the right catchment area, or meet a certain criteria. Continue reading →

Overdose Prevention Centres – lessons from abroad

Posted on July 4, 2023 by Stephen Martineau

Carolin Hess is a PhD student in the NIHR Policy Research Unit in Health and Social Care Workforce who has been awarded Doctoral funding from the NIHR School for Social Care Research. (701 words)

Over 280 participants joined Ben Scher, a PhD candidate in Social Intervention and Policy Evaluation at the University of Oxford and outreach worker at St. Mungo’s, for the latest webinar of the HSCWRU Homelessness series on how low-barrier drug interventions can reach people experiencing homelessness and drug-related harms. Presenting findings of his doctoral project, which compares the lived experience of street-based drug dependency based on people’s access to low-barrier overdose prevention centres (OPC) across sites in Vancouver (Canada), Birmingham (UK), and Athens (Greece), he provided ethnographic evidence on the effectiveness and feasibility of implementing OPCs.

OPCs are “safer consumption spaces” where drug consumption is monitored by medically-trained professionals. Substantial observational evidence across the 15 countries currently operating OPCs has demonstrated how these centres can be successful in preventing fatal overdoses, reducing risk of blood borne diseases, and increasing safer injecting practices and engagement with substance treatment services. Continue reading →

Improving routes into sustained recovery for people experiencing street homelessness: introducing The People’s Recovery Project

Posted on June 15, 2023 by Stephen Martineau

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. Continue reading →

Tracing the significance of executive functioning among people experiencing homelessness

Posted on June 5, 2023 by Stephen Martineau

Carolin Hess

In the latest webinar in the HSCWRU Homelessness series, 225 participants joined Ellie Atkins, a senior social worker and Safeguarding lead, for a presentation which asked, What does research and expert practice tell us about the importance of executive functioning assessments? The topic builds on themes from last month’s webinar, exploring mechanisms of agency and choice, and how self-neglect among homeless populations can be addressed by strengthening safeguarding responses.

The presentation opened with the question of why the Everyone In Initiative, a £3.2 million emergency fund set up during the COVID-19 pandemic to house people in the UK who were rough sleeping, did not end rough sleeping for all individuals. The scheme was widely hailed as a success, with organisations praising the unprecedented effort and rapid response to homelessness through increased partnership working and communication, which supported over 30,000 people into accessing accommodation. Continue reading →

Agency and choice in multiple exclusion homelessness

Posted on May 2, 2023 by Stephen Martineau

Carolin Hess is a PhD student at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (583 words)

Carolin Hess As part of the NIHR Policy Research Unit in Health and Social Care Workforce Homelessness Series, Research Fellow at the Unit, Jess Harris, and Stan Burridge (public contributor) recently presented ‘lived experience’ perspectives from the emerging findings of an NIHR School for Social Care Research funded national study of homelessness, self-neglect, and safeguarding. The event, held on 25 April, was attended by over 180 people.

In light of a recent report that revealed that 1313 people died while homeless (including people sleeping rough, in emergency or other insecure settings) in the UK during 2022, an 85% increase on the number recorded in 2019, the research could not be more timely.

Bringing together the voices of multi-disciplinary practitioners and people with lived experience, the study findings highlight the complexities of safeguarding but also offer suggestions on how to strengthen safeguarding responses and more effectively support people who face multiple exclusion homelessness (MEH). Continue reading →

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