Assertive support for people in any out of hours crisis

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The context

We know people’s interactions with the more ‘crisis’ focused parts of the health service (such as Accident & Emergency (A&E); admissions for injury, substance use or acute mental health) generally rise in the period leading up to homelessness. It’s possible interactions with the ‘crisis’ focused parts of the criminal justice system – mainly the police – show a similar pattern.

Whilst some people experiencing a crisis due to health, substances or crime (victim or perpetrator) may already be homeless, others may be struggling to keep their home, and perhaps, engage in support. So a universal crisis-response service sensitive to the signs of potential housing breakdown may play a key role in preventing homelessness.

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The intervention

The Crisis Response Outreach Team started as a 12-month ‘test of change’ service across South Lanarkshire in spring 2021, funded by a combination of RRTP and Alcohol and Drug Partnership (ADP) monies. The team, comprising two harm reduction practitioners and two peer workers, operates entirely out of hours, Thursday to Sunday. It aims to respond to the age-old issue whereby many crises people experience (such as suicidal ideation, self-harm, substance misuse, leaving prison) don’t happen in ‘office hours’ when routine support services tend to be available.

The team offer a rapid, flexible response to anyone in crisis, using an assertive outreach approach which prioritises face to face contact and home visits. Referrals can be made via a free-phone number, or by email from people themselves, friends or family, emergency services or other professionals. Workers can also check in proactively on people known to be at risk of crisis at key times. They offer a range of interventions, focused on harm reduction in the widest
sense (i.e. not only in relation to substance misuse). This includes immediate emotional support, wellbeing conversations, supply of injecting equipment/ naloxone, emergency supplies i.e. food, mobile ‘phone, and engagement with family.

The purpose is to keep people safe, reduce harm and connect - or reconnect - them into mainstream services/supports after crisis. This includes advocacy, assertive linkage into treatment and addressing any access or engagement barriers. People referred may be housed or homeless: sustaining housing (or occasionally, arranging temporary accommodation) is a key element of the work. Where tenancy breakdown is a potential consequence of someone’s life spiralling into crisis, the service provides a protective buffer and bridge into onward support to prevent this, for example, referral to, or coordination of, housing or other agency support. A number of people referred have one or more issue which may impact on their housing stability

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The outcome

In its first six months, the service received almost 200 referrals and completed over 250 interventions, with a low non-engagement rate (7%, most recently). More than half of people were visited at home. Over half referrals related to substance use and over a fifth to suicidal ideation or self-harm; other common issues were physical health, violence/domestic abuse, social isolation or leaving prison/court. Housing agencies (including Council housing teams, Housing First and temporary accommodation) made over 70% of referrals. The great majority of people were able to be connected or reconnected to onward support.

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Key insights

•  responding quickly and supportively to a person in a crisis can generate engagement which can be hard to achieve by appointment in office hours; following up after the crisis is equally vital
• a team offering responsive support for any crisis – rather than only a specific type of crisis - is especially beneficial from a housing lens, as any type of crisis could contribute to homelessness
• visiting people at home is preferable: support offered face-to-face is more impactful and a visit gives workers a full sense of the person’s living conditions, practices and risks

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Find out more…

Thomas Hobbes, Service Manager, Crisis Response Outreach Team, TPS
thomasjhobbs@turningpointscotland.com