Safe accommodation for people experiencing multiple disadvantage during Covid-19: It’s not just what you do but how you do it
We are now a number of weeks into a global pandemic and things are moving fast; things that a matter of weeks ago we could not imagine. Many of the shifts we’ve seen we would be welcoming with open arms in more ordinary circumstances, but there is nothing normal about the current situation. The plans that local areas are putting into place at speed are mired in complexity and lacking the usual time that we would encourage a complex situation to be given.
Ten days ago local authorities were instructed to provide accommodation for every person experiencing homelessness, allowing them to self-isolate in line with Public Health England guidance. Whilst this is welcome, we know it presents a real challenge for many people who experience multiple disadvantage and those who support them.
We are hearing from areas across the country that they are struggling to support people who are unable to self-isolate and social distance in the way that they have been asked. Staff are understandably confused and worried about the how the national guidance can be followed by the people they support; people who often experience a range of intersecting difficulties which can include enduring mental health difficulties, drug and alcohol addictions, complex inter-dependent relationships and a need to generate income in ways that have rapidly become unavailable to them.
Whilst we can look to government for guidance on what we must do in this situation, of equal importance is how we do it and the answer to this is much more personal.
Why is self-isolation particularly challenging for people who experience multiple disadvantage?
As a country, or even a global population, we are all experiencing an unsettling, worrying and upsetting time. Things that we took for granted, such as seeing friends and family at will, have been taken from us. We are having to comply with measures that significantly impact our liberty and we are being asked put our trust in unfamiliar people. All of the anxieties that many of us are feeling are almost certainly intensified for people who were already experiencing significant difficulties in their lives. We have a duty to understand and respond to those anxieties.
We know that people who face multiple disadvantage have often had traumatic experiences both with people who should have cared for them, and with “the system” which has often failed them. There are three important effects of this that we must consider as we ask people to comply with self-isolation measures (which may involve people being asked to leave the place they call home):
Firstly, we know that support networks that many of us enjoy – family, long-term friends, partners – have long ago been shattered or are at best unstable for many people in this situation. As a result, friendships amongst peers can be experienced with a fierce intensity. The sense of community and peer support is often incredibly strong amongst homeless and recovery communities. A shared understanding and appreciation for what each other experiences is key to many people’s wellbeing. In asking people to isolate we are proposing they tear themselves away from something that feels safe and comforting. If and when people leave their assigned accommodation and meet with others, we must try to understand what needs they are meeting through this, rather than labelling people as “non-compliant”. Once we understand why a person is behaving the way they are, we are better positioned to adopt a trauma-informed response that is solution focused rather than be tempted towards a more punitive and ultimately ineffective approach.
Secondly, people facing multiple disadvantage have often been repeatedly failed by the system. “Services” often do not feel like a place of safety or a space where their needs are understood and met. Imagine the distress then, when overnight your autonomy to choose to engage or not engage with services is taken from you. You are forced to accept an “offer” of “help” with the prospect of criminal proceedings should you choose not to. Whilst not forgetting that we are in the middle of a health crisis that calls for unprecedented measures, we must remember to think about how this feels for those who are already on the margins of society, on whom we are currently imposing solutions. We must not expect them to automatically be grateful for something for which they have not asked.
Finally, in order to protect both their own health and the health of others in the communities around them, we are asking people to move away from the safety nets they have built. Many people who have experienced trauma, particularly in childhood, can have low regard for their own wellbeing. As a result, they can be more prone to participate in risk-taking behaviours. This is no different in a pandemic. It is a big ask to expect people to suddenly care for themselves and immediately give up these behaviours, particularly during a time of heightened anxiety, when this is something they have long struggled to do.
It is an equally big to ask to expect them to care for a community that they may feel marginalised from. I am by no means saying that every person will feel like this, but it is something to consider when trying to understand why people can’t or won’t “comply” with restrictions.
So what do we do, and how do we do it?
Across the country partnerships are being formed and conversations held around delivering local implementation plans for moving people experiencing homelessness into self-contained accommodation, based on national guidance. We now know what we are supposed to be doing. For local plans to be effective though, we must think carefully about how we deliver those plans.
People are unsettled and they are scared. The three responses to fear are well known – fight, flight or freeze – and we will see all of these responses play out over coming weeks. Some people will display challenging behaviour as they push back on the restrictions imposed on their freedom. Some will refuse to accept accommodation offered to them, preferring to stay where they feel their needs are better met, wherever that may be. Others will abandon their assigned accommodation. We may find that people we have worked with for a long time are lost, preferring to go under the radar rather than be forced into isolation.
The potential breakdown in relationships as a result of new regimes is a real worry and if it happens will be a further tragedy of the virus. We mustn’t let this situation undo years of hard work in re-building trust between people and “the system” set out to support them. Otherwise more lives will be lost in the longer term.
Of course we must think about what needs to happen in the immediate future. But we must also consider the impact actions taken now will have beyond the crisis. Will the most vulnerable people in our communities feel that they were heard, that they were safe and they were cared for? Achieving that will ensure a better chance of supporting people throughout Covid-19 and beyond.
Much of this will come down to relationships, the way in which plans are made and communicated, and the degree to which a person’s changing needs are met within the current environment. Over the years of supporting people with multiple disadvantage, we have learned a lot about what works. Now more than ever, we must draw on this learning and find ways to ensure that these approaches are not lost.
- Listen to people
Nobody has all the answers to the myriad of complex questions that the pandemic is revealing. However, a vital contributor of information, ideas, collaboration and innovation in your local area will always be those people experiencing the problem you are trying to solve. As you and your partners tackle some of these complex questions, remember that people living with those problems will give you invaluable insights as to the solutions. You may not be able to do everything that is asked of you, but be transparent and explain the limitations. Empower people to understand their situation and be part of the solution. Ensuring people feel heard is key to maintaining good relationships now more so than ever.
- Be flexible and responsive
There is no “one size fits all” solution to any complex question. This is clearly true in the current situation, particularly when it comes to moving people into new accommodation. It is almost certainly the case that securing one type of emergency accommodation will not meet the needs of every person. Be prepared to respond to a range of fluctuating needs that this group will have. As far as possible, offer a range of accommodation options based on whatever will give the person the best chance of staying safe. Consider intersecting characteristics that may increase vulnerability and require a specific response, in particular gender. Needs will change during this time and we must have the flexibility to respond accordingly.
- Avoid punitive responses
Under times of such immense stress, the temptation to move towards a punitive approach may be strong. It must be avoided. As staff work long hours in unpredictable environments, it is natural that when people display challenging behaviour it may be seen as ungratefulness for the support being provided. However, we must be aware of this perception and be ready to challenge it. The people we support do not need to be grateful, they didn’t ask for this. For many the behaviour will be a reaction to being frightened.
When we understand challenging behaviour as a person trying to meet their personal needs, we are better equipped to respond effectively and with empathy. Be ready to welcome people back into the system rapidly if they disappear and then return. Put in place a range of options so that everyone can be safe. Nobody should be left out of or excluded from this response, regardless of the challenge they present.
- Look after your staff
Recognise the enormity of the task that frontline workers in the homelessness sector are being asked to do. Protect yourselves and each other as much as you can, both physically and mentally. Get help, support and input from health colleagues. Offer online training on trauma if staff have not already done this. A good understanding of trauma and the impact on behaviour is both liberating and empowering for staff. It will improve relationships, which are so vital both now and for the future. Understand that staff may experience vicarious trauma as a result of this situation. Offer reflective practice if you can, allow space for discussion, reflection and learning.
For many people, these practices are so embedded in the way they work that this will happen naturally, and we will almost certainly see better responses where this is the case. However, in a crisis situation where people and resources are stretched, emotions are running high, and we are surrounded by fear, our own responses can change due to personal concerns and frustrations. For the best outcomes for the most marginalised people in our communities, both now and beyond Covid-19, be mindful of this. Reflect on your approach and ensure that your services are as responsive as they possibly can be to meet the needs of the people you serve and the people supporting them.
Head of Network and Operations