Page 11 - TSAB Adult B FINAL (1)

This document was classified as: OFFICIAL

RESPONSE TO HOMELESSNESS

6.2. On presentation on Day 1, Josh stated that he was homeless. The initial focus was on stabilising his
diabetes and to understand his mental health state in order to inform a view regarding the level of
mental illness that may have led to his current circumstances. This was good practice. His clinical needs
were the main priority on admission. Josh was reported to be low in mood and expressing suicidal
thoughts.

6.3. There is a high percentage of homeless people who have mental health issues; therefore, this
assessment was essential. Homelessness can occur because people with mental health issues may have
difficulties in managing their day to day life, resulting in employment issues and financial management
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issues. However, the experience of being homeless can be a lonely and traumatic experience thereby
may lead to mental ill health and in the extreme, suicide.

6.4. At the time Josh was discharged in a taxi to the homeless service in Area B, there was no referral system
in place. When Josh presented to the homeless service, they were reliant on the information given to
them by Josh. This information only included his homeless situation and that his ID had been left in a
‘crack house’ in Area A and that he was unable to retrieve it.

6.5. The homeless advice coordinator was not aware of Josh’s history that would indicate his vulnerability or
his diabetes. Josh was advised that as his local connection was in Area A, he would need to present
there if he wanted emergency funded housing but that he could be housed in Area B if he could self-
fund. To do this Josh would need £50 and ID. As Josh could not provide ID, he quickly got agitated and
left.

6.6. This became a feature each time he attended housing, with the second occasion resulting in him taking
an overdose of insulin whilst at the offices. It is apparent that in all of the conversations that
professionals had with each other regarding housing, the technical reasons that Josh could not be
housed without money and ID were not fully understood by other professionals. This meant that the
circumstances could not be explained fully to Josh by personnel that he had a good relationship with.
This was particularly true of the acute hospital staff who were only able to fully understand the housing
for the homeless system from this review process.

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6.7. Due to the national issues that homelessness presents, The Homelessness Reduction Act (2017) came
into force in April 2018. This Act was therefore very new at the time that Josh was presenting as
homeless. The ‘duty to refer’ element that would have meant that the acute hospital would have a duty
to refer Josh directly to homeless services, did not become law until October 2018. Had this been in
place at the time, homeless services would have had more direct information from acute hospital staff.
As a response to this new duty to refer, Area B Housing Group have employed a duty to refer
coordinator who is based in the acute hospital emergency department. The role includes training and
support for hospital staff regarding the duty and supporting housing issues that are presented by

3 Preventing suicide in homeless services https://www.homeless.org.uk/connect/blogs/2018/jan/04/preventing-suicide-in-homelessness-
services Accessed 24 May 2019
4 http://www.legislation.gov.uk/ukpga/2017/13/pdfs/ukpga_20170013_en.pdf Accessed 24 May 2019

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