Author: Sam Fingland @NavSamJF
You know that moment when the best advice you can think of, at that absolute moment of crisis, is to tell someone the solution to their very serious problem is to commit a petty crime to get them ‘lifted’ for the weekend? No? Well welcome to the ‘Rubbish Advice by Sam Helpline’, where life was lived through rose coloured glasses, with the safety of a roof over her naïve head. Her only experience of homelessness was to rock up to her parents’ house at 3 in the morning after a night out. I digress. The reality was, 8 years ago, fresh out the private commercial sector wrapper I didn’t have a clue what I was doing. I admit it. Homelessness? Absolutely no idea!
I took a call from a young man. The most amazing yet disadvantaged kid. A complete character despite his life challenges (which we now understand to be Adverse Childhood Experiences (ACES), where most behaviour is symptomatic of a bigger problem). He had lost his tenancy to ‘creativity’, embarking on some ‘DIY’ to make money causing a few residents to become disgruntled and complain to the landlord. On the streets, in winter and weather not too dissimilar to what we have right now, he became a scared and lonely boy, a far cry from the jack the lad we knew and loved. The fear was evident in his voice. Gone was the bravado and cheeky banter. ‘I’m going to die Sam…. if the cold doesn’t kill me, some nutter will…. I’m going to have to sleep in the rafters of that bridge….I’ll fall in, I will….You have to help me….Please…..’
So I called the only organisation I could think of in my very limited expertise. They would save the day, said I, provide the much needed safe accommodation, I thought, after all that’s their job! Problem solved! Saving the day- go me! I patted myself on the back!
‘Hahaha’ was the first response I got (that threw me). Followed quickly by a ‘he won’t be getting accommodation this weekend’, and ’he’s got numerous alerts on the system', ‘and he’s 19’ (doesn’t that make him more vulnerable?)… 'time he stood on his own two feet'… ‘his bed, he can lie in it’…. as the line suddenly went dead…. ‘Fu..I mean, oh no’ thought I…..as I hung the phone up and put my head in my hands feeling worse than useless. And sick, I felt pretty nauseous.
After I relayed the absolute terrible advice to this boy (which I learned a few months later he didn’t take), I made a pact with myself to learn everything there was to know about homelessness, and to challenge the ‘he won’t be getting accommodation’ attitudes that I had witnessed.
I guess the point of the story is that we cannot possibly know everything, especially if it is not our area of expertise, and we shouldn’t feel bad for where gaps exist in our knowledge. Often, knowing the right people or service to direct a person to can make a huge difference and quite often, if not save a life, prevent other challenges from developing and manifesting into something chronic and long term. For now though, here is some information – please remember that this is based on Scots law so may differ in other areas outside of Scotland.
What Exactly Is Homelessness?
Homelessness is essentially not having a home, not having accommodation, somewhere to sleep at night, a place you feel safe. We are all too familiar with the terms sofa surfing…..roofless….skippering….rough sleeping. But under homelessness legislation, it goes beyond that. We hear often of the ‘hidden homeless’; but what does that mean?
The Housing Scotland Act 1987 defines Homelessness in the following way – ‘homeless persons and persons threatened with homelessness’. This includes those who are living in accommodation that is not ‘reasonable to occupy’ -so housing below tolerable standard (not air or watertight); those living with the threat of homelessness within 2 months (Private Landlords for example who have issued a notice to leave); living with or having the threat of violence; harassment; or overcrowding.
The Scottish Government homeless statistics for 2016 – 2017 recorded that of the 34,100 homeless applications made, 2,621 had rough slept at least once within the 3 months prior to the application, with 1,500 rough sleeping the night before application. That means the remaining 29,979 were affected by homelessness in some other way.
Some facts. I mean who doesn’t like a statistic right?
Things that we know about people that experience homelessness:
- The life expectancy is on average age 47 (43 if you are a woman)
- They are 13 times more likely to be a victim of violence if rough sleeping
- They are 9 times more likely to commit suicide
- 28% of homeless women have made an unwanted sexual partnership to get a roof over their head and a further 20% have engaged in prostitution in order to raise money for accommodation
- 32% of homeless women said that domestic abuse contributed to their homelessness.
If you are interested on finding out more, or in more detail then visit www.gov.scot/Topics/Statistics/Housing-Regeneration/RefTables
The ‘homeless application’
an easy process? You decide!
People who are homeless or about to be homeless have to attend a local homeless caseworker or council office and make a homeless application (this cannot be refused).
If they happen to live in Glasgow they can access the Hamish Allan Centre (now open at weekends only), where emergency accommodation will be provided (no homeless applications can be made here) or the ‘multi-disciplinary hub model’ based at Glasgow City Mission for those seeking emergency accommodation evenings and through the night Monday to Friday. I have provided contact details for similar Scotland-wide services at the bottom of the page. They will either be provided with emergency/temporary accommodation. This includes B&B’s; Hotels (these should be last resort only – and by the way, nothing like those we would ordinarily encounter, can you believe one has a ½ star rating!); Refuge; Hostels; Temporary Furnished Flats (TFF’s) while the homeless application is investigated.
A ‘Homeless Test’ must be carried out in order:
- They are homeless
- They are not intentionally homeless
- They have, what is known as, a local connection.
This CANNOT be decided at the point of application so under section 29 of the Housing (Scotland) Act – the council has a duty to provide interim accommodation until the application has been investigated, which must be completed within 28 days of the application.
From there a decision letter is issued informing the person of the council’s obligation or duty to rehouse (or not as sometimes the case may be). If it is a positive decision – ie. unintentionally homeless - they will be called for a ‘Prospects Interview’ and section 5 will be activated. The council will undertake a duty to provide them with permanent or settled accommodation and once this has been achieved; their duty will be discharged.
It is estimated that a person will spend at least 6 months in the homeless system, but the reality for most, is a lot longer.
How can someone be intentionally homeless though?
Well, the council must first prove this. And to do this it has to make enquiries. Common causes are rent arrears and anti-social behaviour. There are 21 days from the date the decision is issued to appeal. And we advise where possible to get expert advice and assistance or legal advice! It’s always possible to appeal an intentionally homeless decision – let’s be honest, its unlikely homelessness has come in isolation! And with so many social issues facing people it is inevitable that somewhere along the line someone will just simply ‘mess up’ a little bit, get involved in something crazy, or maybe just find their priorities are lying elsewhere (feeding children for example rather than paying rent). I have my opinion on intentionality, but to keep it clean, it’s surely in the interest of social disadvantaged individuals to provide them with at the very least a roof over their head- a place of relative safety, in order that they can be supported to look beyond their current predicaments, access the correct supports and services, and give them a fighting chance of not becoming (if they aren’t one already) one of the afore mentioned statistics?
But by law, in Scotland, local authorities must offer a minimum of temporary accommodation, advice and assistance to all homeless households and those at risk of homelessness. It’s a legal entitlement!! So ‘intentionally’ homeless or not, this is what people are legally entitled to and it’s important to remember that.
This is how the application process should run (should!). But unfortunately for many, the process doesn’t run quite so smoothly. Waiting times to make an application can often be long (full days) while on some occasions people may be asked to return if they are not looking for emergency accommodation due to a triaging system being in operation. Many people affected by homelessness, particularly those living on the streets, tend to have multiple barriers which prevent them from managing the temporary accommodation sourced for them and this creates additional challenges when trying to support them into settled and permanent accommodation. Often there is a history of poverty, trauma, addiction and mental health coupled with social isolation and a lack of family structure. These issues rarely come in isolation. The young man mentioned earlier in this blog grew up in a broken home; had an absent mother and a father who spend significant periods in prison resulting in him having numerous foster placements, time spent in the care system and very little by the way of education. Here he developed a dependency on many different substances which fuelled anti-social behaviour and resulted in him losing many emergency accommodation placements as he didn’t have the social skills or the emotional maturity to manage such responsibility. He was 19 years old. Fight. Flight. Freeze. Unfortunately due to resources many temporary accommodations are unable to support such needs and so the cycle of homelessness continues. Some are just simply unsuitable.
So what can the hospital do?
Here’s the legal bit…..(Scotland again remember!)
The ‘Code of Guidance on Homelessness’ specific to hospitals states in section 2.30 that:
‘All health boards have developed health and homelessness action plans which should set out how they plan to ensure that the health needs of homeless people are met’; that ‘Local authorities should liaise closely with health boards and individual hospitals in order to develop discharge protocols, and these may be included as part of the action plans’.
With section 2.31 further adding that ‘arrangements for accommodation in the community should be made as quickly as possible, to prevent people being kept inappropriately in hospital’.
So…essentially if a homeless person is admitted to hospital, assurances should be given that upon discharge they will not be returning to rough sleeping and if no such guarantee can be made, then the person should remain in hospital until suitable accommodation can be found.
Emergency departments have no statutory obligation to admit a patient affected by homelessness if they are medically fit to be discharged.
Oh! And really, really, really importantly! If you have a patient who you are admitting and are living in temporary homeless accommodation, please, please, please make a point of contacting their accommodation. Do not be a bystander and think ‘someone else will do it’. This could be critical to them keeping their placement. Often emergency / temporary accommodation has a one night rule and if the person does not return, their bed will clinically be shut without question first thing the following day.
Where would be without some hospital homeless trivia?
Ok, so the answers will be directly underneath, but hopefully they will get you thinking about possible issues some patients present with and offer something of a solution to maybe help them find a way out of the situation they find themselves in. And actually, you might find some additional information not covered elsewhere in this blog along the way! (Real cases by the way….)
Patient presents agitated and states he is feeling suicidal. He advises you that things have gotten too much and that when he returned to his home today, his landlord was waiting, took his keys from him, and changed his locks. The patient is very distressed.
This is an illegal eviction and a police matter. Tenants cannot be evicted from a property, regardless of the situation, without a court order. This has to be obtained before eviction can take place. This can be reported like any other crime and the patient should be given full back full access to his tenancy, however in addition to this, he should be directed for legal advice and assistance as he will most likely incur the legal cost for the court order! If indeed the correct paperwork to end the tenancy has been issued in the first place.
Patient presents and tells you that they want to kill their neighbour. They tell you that they can no longer live there they will be charged with murder if they stay. The patient explains that the neighbour has been bullying their autistic child
Patient qualifies under homeless legislation and can make a homeless application however their registered social landlord also has a statutory obligation to ensure tenant safety and that they live free from harassment. Homelessness is not always a route that people want to go down particularly if they have children however legislation covers most housing issues meaning these issues can be resolved positively for the tenant affected. Again, if unsure, direct them to specialised services – a note of which is provided below.
Patient presents and discloses they are a victim of domestic abuse however they are not from the local area. They advise that they do not wish to return home as it is unsafe for them to do so.
Domestic abuse does not require the person to have a link to the local community. All councils have a statutory duty to provide emergency or temporary accommodation including victims of domestic abuse. Patient can attend local casework team; liaise with hospital homeless liaison team or if out of hours, the City Missions in order to obtain emergency/temporary accommodation and make a homeless application. The council cannot refuse the application – remember ALL homeless applications have to be investigated and a decision issued. However what makes domestic abuse application slightly different is that it is exempt from the link to the local community. It will be investigated as to wither the perpetrator has a link to any council area that the applicant is looking to move too.
Patient presents with a Valium overdose. Patient has history of depression and discloses they have recently relapsed following a significant period of sobriety. Patient advises that their housing conditions are chronic and despite repeated attempts at contacting their private landlord, nothing has been done. The house is sinking, the ceiling is falling down and the carpets are wet. The patient also advises that they have had no hot water or heating for 2 years due to the boiler breaking and their request for repair ignored.
Patient qualifies under homeless legislation that their home is not ‘reasonable to occupy’. The property is not air and water tight. They are therefore entitled to make a homeless application and be provided with temporary accommodation with a view to obtaining a new permanent tenancy as any other homeless applicant. Similarly it is up to the council to investigate this. The investigation will include wither the landlord have failed to keep the property to tolerable standard (air and water tight). Subsequent action will be taken.
So that’s a brief whistle stop tour into homelessness. For the young man mentioned earlier in this blog, the advice and assistance would have been very different had he called today including challenging that the council has a legal obligation to provide him with emergency accommodation, advice and assistance. It cannot be underestimated the pressure, stress and strain that people endure while following the process of making a homeless application. As streamlined as the process is, the reality of it is often significantly different. Just even the length of time people can spend in homelessness can have a massive negative impact on the individual or family’s health and wellbeing. Additionally the complexities of individual needs can mean they drop in and out of the process and this can often exacerbate their underlying and/or more obvious issues. Not to mention the strong possibility of encountering people who are living often more chaotic lifestyles than your own, sometimes with the introduction to situations you would not ordinarily be part of. I’ve witnessed many people enter the homeless system drug free and leave with chronic heroin addiction or with some sort of criminal charge – sometimes due to it being the only coping strategy available to them. But as a service, having an understanding, even at a basic level, of the complexities of the homeless system and the agencies that people affected by this issue can be directed to for advice and assistance, is worth its weight in gold and could prevent another person from sleeping rough on the streets or living in conditions that restrict the likelihood of a positive outcome.
If you work in a hospital setting, please remember the hospital guidelines on homelessness. Oh! And please remember! Don’t ever go recommending they get themselves ‘lifted’……!
Shelter Scotland – 0808 800 444
Govan Law Centre – 0141 440 2503
Legal Services Agency – 0141 353 3354
Rough Sleepers and Vulnerable People – Simon Community – 0800 027 7466 (24 hours)
Street Work – 0808 178 2323
CATH – 01738 580 188
Highland Homeless Trust – 01463 718 693
Aberdeen Cyrenians – 01224 625 732