Multiple needs and exclusions

People facing multiple needs and exclusions are in every community in Britain:

They experience several problems at the same time, such as mental ill health, homelessness, drug and alcohol misuse, offending and family breakdown. They may have one main need complicated by others, or a combination of lower level issues which together are a cause for concern. These problems often develop after traumatic experiences such as abuse or bereavement. They live in poverty and experience stigma and discrimination.

They have ineffective contact with services. People facing multiple needs usually look for help, but most public services are designed to deal with one problem at a time and to support people with single, severe conditions. As a result, professionals often see people with multiple needs (some of which may fall below service thresholds) as ‘hard to reach’ or ‘not my problem’. For the person seeking help this can make services seem unhelpful and uncaring. In contrast to when children are involved, no one takes overall responsibility.

And they are living chaotic lives. Facing multiple problems that exacerbate each other, and lacking effective support from services, people easily end up in a downward spiral of mental ill health, drug and alcohol problems, crime and homelessness. They become trapped, living chaotic lives where escape seems impossible, with no one offering a way out.

We estimate that there are approximately 60,000 adults in this situation at any one time in England, with more people constantly moving in and out of the group. While relatively small in number, this group imposes disproportionate costs on government and society.


MEAM and Revolving Doors (2011) Turning the Tide: A vision paper for multiple needs and exclusions, MEAM/RDA, London, p.4

MEAM (2009) A four-point manifesto for tackling multiple needs and exclusions, MEAM, London, p.8