Homelessness and poverty: a reflexive mapping exercise (RME) of services to improve accessibility and engagement of people with complex needs

Theme: Poverty

Background: The problem of homelessness in Scotland and its relations with poverty are strongly linked. The social vulnerabilities of this population must be an essential part of any public health agenda. Recent analysis highlighted poverty as a central factor for the generation of future populations of people experiencing homelessness. Over the three-year period 2014-17, one million people in Scotland were living in poverty. Increased poverty being observed as a 13% increase in ‘food bank' use in 2018. Changes in terms of complexity and the variety of reasons leading to homelessness have also been noted - almost half of all homeless applications now present more than one specific support needs beyond housing, such as mental health problems, physical disabilities etc. Therefore, people experiencing homelessness face complex health, physical and psychological needs which require good quality, easily accessible, person-centred and equitable integrated service provision. The reflexive mapping exercise framework was proposed to inform support service design and to promote multi-agency working for those experiencing homelessness.

Methods: The RME was conceived and developed to create more synergies and dialogue between different sectors to prevent and tackle homelessness. Adopting a participative and multi-agency approach the RME framework provides not only a geographical mapping but also a platform to discuss health and social care integration promoting better understanding of the current service provision covering eight areas of support in Scottish cities with high levels of social deprivation.

Results: The results indicate, that [1] there is an unequal spatial distribution of services, whit a concentration in central areas rather than in the most deprived areas; [2] the services provide support mainly for crisis periods and less for prevention and sustainability of life beyond the homelessness cycle.

Conclusions: The RME method can inform support service design, to achieve multi-agency working, better communication and to increase accessibility and engagement of vulnerable groups.