LankellyChase Foundation are known for being at the forefront of tackling what they have coined as ‘severe and multiple disadvantage’ (SMD). You may know it as complex needs, or multiple exclusions, or people with SMD might otherwise be labelled as ‘difficult to engage’. You might have come across these issues through our Making Every Adult Matter (MEAM) coalition with Homeless Link, DrugScope and Mind, which was established to raise awareness and provide some solutions to the people that find themselves on the margins of society because of addiction, homelessness, mental ill-health, and contact with the Criminal Justice System. Or you might have come across the project MEAM has started that aims to amplify ‘voices from the frontline’ by giving people with SMD a greater voice in policy making.

Hard Edges: Mapping severe and multiple disadvantage - download here

A serious interrogation of the data

This new report, prepared by Heriot-Watt University (led by Professors Suzanne Fitzpatrick and Glen Bramley), is the first in a series looking into the profile and needs of people suffering SMD in England. It analyses and compares data from across different sources to develop a ‘statistical profile’ of people with SMD.

The report delves into prior research such as the ‘Multiple Exclusion Homeless’ (MEH) survey (Fitzpatrick et. al., 2013) and the ESRC ‘Poverty and Social Exclusion’ (PSE) survey 2012. It also interrogates the data captured by 3 sources:

• Offender Assessment System  (OASys)
• National Drug Treatment Monitoring System (NDTMS)
• Supporting People data (SP) alongside ‘In-Form’ data gathered by major homelessness service providers in England with the help of Homeless Link

The outcome of bringing all this data together, along with interviews across the voluntary and statutory sectors, is to shed light on the important question of how many people we’re talking about, who they are, what issues they’re grappling with, where they are accessing services, and where they live.

Key findings from the report

I have picked out some of the main findings, which provide a detailed picture of the people who find themselves characterised by SMD.  

• Over 250,000 in England are tackling at least two of the following issues: homelessness, substance misuse, and involvement in the Criminal Justice System. A conservative total of 58,000 people have contact with all three.

• We’re mainly talking about white men between the ages of 25-44 with long histories of social and economic marginalisation and childhood trauma.
• The majority are single but do have regular contact with young people.
• Poverty, very poor educational attainment, and very difficult family relationships, are the main root causes of SMD, with mental health as a frequent and serious complicating factor.
• There is a heavy concentration of SMD in northern cities, some London boroughs, and seaside towns.

There is much that we can learn from these findings, and the hope is that it sparks some debate and action. The fact that most local authorities can expect an average of 1,470 SMD cases per year, coupled with an estimated annual cost of £10.1 billion (nationally), shows why we need a better response.

We are primarily talking about white adult men, which helps to target support, but it would be a mistake to suggest that we shouldn’t consider the different needs of women, people from BAME communities, young people and young adults. We know that many will have contact with young people, this should focus attention on how we address the negative impact of SMD on their lives, possibly by joining up with Troubled Families initiatives and the plethora of good quality family services in the voluntary sector.  The issue of entrenched poverty and very low educational attainment highlight the need for targeted early intervention that diverts people into preventative services rather than crisis interventions.  Mental health services need to play a core part in averting people’s descent into SMD, and link with other services in a more co-ordinated way. And finally, we need to seriously consider where these people live and how that changes the way we allocate resources to allow for greater local autonomy. We can’t assume that any one solution will work across England, neither can we assume that there is any sense in scaling up services in all areas.  

Change is necessary, but progress is slow

What is perhaps as interesting as the research itself is the problematic nature of getting the data, analysing it in a comparable way, and trying to assess where the overlaps are between these different data sets. This stems from the way in which we characterise, or label, people; which is often by the issue we (or our organisation) are trying to address. So if you have a drug problem you’re a drug user, or you might be homeless, or have mental health issues, or be an offender.

As helpful as these labels might be to identify who we’re working with, and to explain to the public or our funders what we do, they are a meaningless compartmentalisation which can be fundamentally damaging to our institutions and services in the public and voluntary sector. As a result of these labels we see policy being created in silos, contradictory requirements for support, missed opportunities to make savings through better coordination, and a fragmented approach to addressing the consequences of childhood trauma, a lack of education, poverty, and the added complication of mental ill-health.

The Criminal Justice System, and all the partners working within it, are as guilty as any other institution in struggling to patch together services. This is clearly shown by the very high ‘probability of general re-offending’ amongst people facing SMD captured by the OASys General Reoffending Predictor (OGP) which is highlighted in Hard Edges.

We know that new services are emerging to tackle these issues, and we know that innovative responses are being led by our members in the voluntary sector. If you are delivering services in this area please feel free to comment and share your experience below.