Many of New Labour's welfare initiatives were underpinned by a stated desire to combat social exclusion among disadvantaged sections of the population. Allied to this, a commitment to end street homelessness/rough sleeping was an enduring feature of their term in office (for example SEU, 1998; DCLG, 2008). Of course, concerns about social exclusion predate New Labour, and a lack of meaningful involvement in many key areas of wider social life (for example, democratic and legal systems, the labour market, the welfare state, familial and (local) community networks) have long been identified as symptomatic of social exclusion (Commins, 1993). Previous research has also noted that homelessness rarely occurs in isolation and that many homeless people often carry with them a variety of other problems and experiences. It is clear that many homeless people experience ‘exclusion across more than one domain or dimension of disadvantage, resulting in severe negative consequences for [their] quality of life, well-being and future life chances’ (Levitas et al., Reference Levitas, Pantazis, Fahmy, Gordon, Lloyd and Patsios2007: 9), and, as such, can be viewed as experiencing multiple and/or deep social exclusion. This situation has been recognised by Carter (Reference Carter2007) who, noting a lack of resources, rights and opportunities, adopts the phrase ‘multiple exclusion homelessness’ (MEH) as a shorthand term to characterise the reality of many homeless peoples’ lives.
New Labour acknowledged that a range of issues (a lack of basic skills, mental health problems, substance misuse, debt, relationship breakdown, etc.) may all play a part in exacerbating the deep exclusion endemic in many homeless peoples’ lives and promised personalised packages to be delivered by an array of agencies, to support multiply excluded homeless people (MEHP). For example, homeless people became the focus of policies, such as the Adults Facing Chronic Exclusion pilots, which attempted to tackle the causes of their social exclusion (SET, 2007). Similarly, the ‘Respect Action Plan’ (Respect Task Force, 2006) contained an abundance of initiatives, many aiming to address what were seen as the ‘lifestyle’ problems of multiply excluded homeless people.
Substantial funds were made available to local authorities by New Labour under its Supporting People Programme, with an element of this money financing homelessness support and the housing of vulnerable people. However, consistent with New Labour's welfare project, homelessness service providers were expected to endorse a more overtly interventionist approach to tackling homelessness and deliver on a series of targets, beyond providing accommodation, intended to tackle the more complex needs of many homeless people to promote and sustain long-term independent living and social inclusion. Likewise, homeless service users were expected to play an active role in overcoming their difficulties by accepting offers of support focused on addressing any problematic behaviour, and/or lack of life and skills that were deemed to be sustaining their exclusion.
More recently a key factor in developing the agenda on multiple social exclusion has been the formation of Making Every Adult Matter (MEAM), a coalition of four national charities (Clinks, DrugScope, Homeless Link and Mind), to influence policy and services for adults with multiple needs and exclusions. Together the charities represent over 1,600 frontline organisations working in the criminal justice, drug treatment, homelessness and mental health sectors. MEAM published a manifesto in September 2009, which highlights the need for research in this area, while at the same time setting out important issues for the researchers to consider (MEAM, 2009).
The first point in MEAM's manifesto is that the government should ‘identify people with multiple needs and exclusions at the local level using national guidance’ (MEAM, 2009: 8). The Social Exclusion Task Force under the Labour government had already estimated that around 2–3 per cent of the population in England (1–1.5 million people) suffer from deep and persistent exclusion (Cabinet Office, 2007: 5). The existence of people with multiple needs and exclusions was first highlighted by government in a report by the Cabinet Office (2006) and MEAM state that these people are a subset of the deeply excluded. They draw upon a number of studies (Bloor et al., Reference Bloor, Crome, Astari, Molesworth and Freeman2007; Schneider, Reference Schneider2007; Rinaldi et al., Reference Rinaldi, Linnell and Clenaghan2008) to define this subset as those who:
• ‘experience a combination of issues that impact adversely on their lives
• are routinely excluded from effective contact with services they need
• tend to lead chaotic lives that are costly to society.’ (MEAM, 2009: 8)
There are a number of problems with this definition, some of which are explored by contributors to this themed section. For example, what counts as ‘routinely excluded’ or ‘effective contact with services’? How might a ‘chaotic’ life be defined? Nevertheless, MEAM believe that ‘most individuals with multiple needs and exclusions find themselves in prison or the homelessness population’ (MEAM, 2009: 8). They calculate that there are 81,162 in the prison population (based on Home Office, 2009), 42,000 in the non-statutory homeless sector (based on Homeless Link, 2009), 15,000 in statutory homelessness temporary accommodation (DCLG, 2009a), and 483 sleeping rough on any given night (DCLG, 2009b), totalling 140,000 as the very minimum figure (MEAM, 2009: 20). Given the vagueness of the definition, this is perhaps a classic case of false precision. Such discussions are useful, however, in drawing attention to the fact that people with multiple needs and exclusions are most likely to be in prison, with homelessness as their next most likely situation. Interestingly, it also appears that the proportion of these populations who are said to have multiple needs is similar in both cases. For example, Schneider (Reference Schneider2007: 15) notes that 40 per cent of people in prison suffer from mental illness and substance misuse and 41 per cent of people in homelessness projects have been identified as having multiple needs (Homeless Link, 2009: 64).
Against this backdrop, in 2009 the Economic and Social Research Council (ESRC) commissioned four studies under a Multiple Exclusion Homelessness programme which it jointly funded with the Joseph Rowntree Foundation, the Department of Communities and Local Government, the Housing Corporation (now the Homes and Community Agency) and the Department of Health. The initiative did not attempt to pre-define the deep social exclusion of those who might be identified as MEHP, but rather expected the meaning to emerge from a focus on the ‘self-definitions’ of the people directly affected. The idea was that researchers should not presume that any particular problem, such as homelessness, takes priority over any other in people's lives. Rather, there is a need for better understanding of the relationships between different issues that people may have and of how people cope with complex combinations of issues. The initiative expected that such improved understanding would then inform more effective social interventions across a range of policy areas.
Before offering a more detailed outline of the various articles, it is important to comment on the much changed wider political and financial context into which the research projects included in this themed section will report their findings and recommendations. An important theme in MEAM (2009), which is particularly relevant in these times of public expenditure cuts, is that expenditure on certain services for people with multiple needs and exclusions can be highly cost effective. Studies show that drug treatment services and homelessness services in particular achieve considerable savings in health and criminal justice budgets. It makes good sense, therefore, for governments to invest in these services if they want to reduce public expenditure overall. That said, in the current financial climate, cuts rather than investment, appears to be the most likely scenario. Proposed reductions in the Supporting People programme announced by the Coalition Government potentially herald drastic reductions in homelessness support services and hostel places in the near future (Butler, Reference Butler2011).
The articles
This themed section presents articles from each of the four studies funded under the ESRC programme. Alongside these are other substantive articles which have been solely written or co-authored by emerging early career researchers whose doctoral studies focus on aspects of homelessness and social exclusion. The themed section represents an important opportunity to bring together people from a range of disciplinary backgrounds (including Social Policy, Housing/Urban Studies, Psychology, Social Work and Social Care), at different stages of their careers, to offer a focused discussion of multiple exclusion homelessness.
The article by Suzanne Fitzpatrick, Sarah Johnsen and Michael White presents preliminary results from a quantitative survey of MEH carried out in seven cities in England. Whilst the authors of this article recognise that there has been a good deal of qualitative research conducted on homelessness that provides in depth insights into the lives and experiences of homeless people with multiple and complex needs, the key aim of their article is to ‘provide a statistically robust and detailed account of the nature and patterns of multiple exclusion homelessness across the UK’. Early key findings reported here confirm the interplay and importance of four specified key indicators of social exclusion among the sample of low threshold service users that were surveyed. Over three quarters of those sampled had slept rough and the article similarly highlights ‘strikingly high’ levels of backgrounds of institutional care (for example, prison, admission to hospital with mental health issues and/or experience of local authority care in childhood), serious substance misuse and begging and ‘survival shoplifting’. This leads the authors to conclude that those experiencing MEH are an ‘exceptionally vulnerable subgroup’ within the wider population of homeless people.
The next two articles in the themed section focus on the ways in which the multitude of agencies working with homeless people go about their work. Cornes et al. follow the experiences of thirty-two homeless people being supported by three different housing support services, over a six month period, in three locations across England. The authors identify the growing importance of personalised and integrated care planning and individual case management within the health and social care policy literature and the attendant need for agencies involved in supporting homeless people to engage in ‘joined up’ working to best meet their clients’ often complex needs. The key question that this article addresses is the extent to which ‘joined up’ working actually occurs across the various professional and occupational teams who might be working with MEHP. Cornes et al. conclude that rhetoric does not match reality, and that many multiply excluded homeless people find themselves ‘bounced between services or let out in the cold’ as different specialist services fail to engage in proper interagency co-operation. Also considering interagency working, the article by Joly et al. first offers an overview of the health of MEHP and the services designed to meet their healthcare needs. They move on to explore the extent and types of interagency working that goes on between statutory and voluntary sector services concerned with improving the health of people experiencing homelessness. The authors use network theory to analyse professional responses to the management of risks related to tuberculosis, antisocial behaviour and drug treatment. A key finding of this discussion is that ‘patterns of interagency working are driven by different factors, which do not necessarily engage with or account for the health priorities of people who are homeless’. Tuberculosis intervention was the area that provided the most evidence of interagency working by different actors within a network. This was not driven by the demands of homeless service users, but rather appears to be related to concerns about wider public health risks.
In a change of focus, Graham Bowpitt et al. explore the ways in which gender may be a significant factor in influencing three aspects of individuals’ experiences of multiply exclusion homelessness; these are susceptibility to homelessness, experiences of homelessness and encounters with accommodation services. The article draws on data generated in 106 qualitative interviews with single multiply excluded homeless men and women in London and Nottingham. A key finding of the article is that, in line with the broader reality of a gendered society, single men and women experience, and to some extent deal with, multiple exclusion homelessness differently, but not perhaps to the degree implied in some earlier homeless research. Although women are more likely to be victims of domestic violence than men, a background of violence within family relationships was a common experience in the lives of both men and women. Moreover, both genders have equally high levels of substance use, trauma and mental health problems. It is also the case that homeless women without care of dependent children are every bit as likely to encounter obstacles in securing accommodation as homeless men.
Rachel Dobson draws on work from her Ph.D. to explore the ways in which conditionality, a central element of New Labour's rights and responsibilities agenda, is played out in the context of the day-to-day practice of managers and workers at Drop-in Centres for homeless people. In many ways, this is a nuanced case study of the how the conditional rhetoric of politics and policy is managed and interpreted by those delivering frontline services to homeless people with complex needs. Following a discussion of the ways in which a more conditional and regulatory approach to offering support to MEHP has permeated many services, she draws a distinction between the ‘disciplining’ and ‘therapeutic’ approaches that are sometimes utilised in contradictory ways by frontline workers trying to challenge their clients’ behaviour. She concludes by arguing that less conditional approaches may well be a more viable way of offering support and bringing about meaningful change in the lives homeless people with complex needs.
Somerville et al. begin with a critical review of work on multiple exclusion homelessness and young homeless peoples’ experiences of hostels. They note that within much of the available literature there is a tendency for authors to emphasise either ‘structuralist’ or ‘individualist’ approaches to understanding and explaining homelessness and assert that we need to move beyond this dichotomy. They make the case for using a life course approach, built around narrative biographical interviews with MEHP, as one way of building a more nuanced appreciation of individual pathways into and out of homelessness. Presenting an analysis of data from twelve interviews with young homeless people living in a YMCA hostel in Stoke on Trent, they conclude that although some participants in their study reported problems with hostel life, ‘most interviewees reported that the YMCA had effected a big improvement in their lives and, in some cases, a real turning point towards a more stable future adult life’.
Jenny McNeil's article draws on work undertaken as part of her Ph.D. and offers insights from a qualitative longitudinal study with thirty homeless and vulnerably housed people on their motivations to enter paid work. For some time now, securing paid work has been seen by many as central to the successful resettlement of homeless people with complex and multiple needs. Identifying four different, work-related pathways (that is, ‘work focused’, ‘deferred focus’, ‘uncertain focus’ and ‘resettlement focused’) within her sample, McNeil assets that movement within and across the various pathways and, therefore, the usefulness of employment-based strategies, varies according to the personal biographies, resources, housing situation and support needs of individuals at different points on their homelessness journeys. Perhaps not unsurprisingly, given their shared histories of homelessness, the majority of participants in the study prioritised attaining secure and safe housing above paid employment. In one sense, therefore, the article serves as a timely reminder of the importance of attending to housing needs when looking to support MEHP.
The final substantive piece within the themed section, by Dobson and McNeil, offers a review of the key themes and discourses that were central to homelessness and housing support policy under New Labour. Here they stress the importance of the (previously noted) twin themes of social exclusion and conditionality, and outline the extent to which homelessness and welfare-to-work employment strategies became entwined as successive New Labour governments looked to promote responsible behaviour among those MEHP deemed to be making matters worse for both themselves and wider society by continuing to lead chaotic and problematic lives. Towards the end of the piece, Dobson and McNeil turn their attention towards the emerging policies of the new Coalition government in the UK and note that cajoling or compelling MEHP into paid employment is likely to feature even more strongly as a necessary step along the pathway to resettlement in the future. Following this final article a range of resources are presented.
We hope that this collection of articles will prove to be a useful resource for academics, researchers, students, policymakers and service providers looking to better understand and prevent multiple exclusion homelessness in the future.
