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Alice, our Multiple Disadvantage Caseworker, discusses the challenges facing women guests she has been supporting this winter.

15th March 2024

My work as a Multiple Disadvantage Caseworker 

As the Multiple Disadvantage caseworker, I work with guests who may be experiencing complex issues and have a number of different support needs. These could include mental health issues, drug and alcohol dependence, fleeing domestic abuse or having a long history of entrenched homelessness. I work across all the daytime services and have more time to work more intensively with the guests on my caseload.  

My experiences from the front-line  

Many of the challenges faced this winter night shelter season have been barriers to women guests accessing mental health support. We’ve had guests presenting with complex mental health issues such as symptoms of psychosis, chronic delusional beliefs, and a lack of insight into their own mental health. 

Due to the limited resources of mental health services in London, services are often reluctant to work with a guest until they have reached crisis point.

This presents challenges for front line services like Glass Door, as we are left to monitor and manage guests with complex mental health issues.   


Meet CB, a Guest staying at our Womens Night Shelter

CB was referred to Alice as there was concern over her mental health. CB had attended Glass Door drop-in services reporting that she was rough sleeping and was offered a space in our women’s winter night shelter.  

CB had abandoned her flat in the north of England and been reported missing by her family. She had a history of self-neglect linked to her mental health issues and a pattern of behaviour that involved fleeing when mental health services intervened. 

Alice is linked in with a local specialist mental health service who agreed to meet with CB in the night shelter. Alice facilitated the meeting, and it was established that a Mental Health Act Assessment (MHAA) was needed. A Mental Health Act Assessment is an assessment to decide whether someone should be detained in hospital under the Mental Health Act. However, several barriers arose. The service could only complete a MHAA in their borough, and since the shelters changed location each night and some locations fell outside of the borough, this restricted the days they would be able to attendWhat’s more, they relied on the police to agree to a date and time to attend; this eventually took over 2 weeks to arrange. 

A few days before the MHAA was due to take place, CB abandoned the night shelter. Unfortunately, this pattern is being repeated at another service in another part of London, further delaying CB from getting the support and care that she needs.  


Womens homelessness & mental health  

The Women’s Census report ‘Making Women Count defined women’s rough sleeping as ‘often transient, intermittent and hidden’. Women's homelessness is often not accurately recorded or understood. Women who are experiencing street homelessness face significant risks, yet are often less visible to traditional street outreach services as they are less likely to bed down.

Women who rough sleep may spend some nights sofa surfing, some nights outside, some nights on public transport, supplementing with Glass Door shelters and other services.

Some guests stay in our women’s night shelter for short periods of time, leaving and disengaging with our service, and then returning. This is partly driven by the challenges of night shelter provision, such as a shared sleeping space, and moving locations of shelters, which doesn’t suit everyone. Erratic engagement further delays substantive work getting done to support them.  

It is particularly difficult to get mental health services to accept responsibility for guests who have had a chaotic history of rough sleeping and who move across boroughs. We have seen delays in arranging Mental Health Care Act Assessments because guests need to be present in the borough, as in the case of CB, and evidence that they have a connection to the borough. Long delays put further pressure on the Casework Team and night shelter staff to deliver appropriate support and more stable accommodation. 


How to better support women experiencing multiple disadvantage  

There are many changes I would like to see that would make an immediate positive impact on the lives of the women I work with.  

We need better funding and more resources for homeless mental health services.  

We also need fewer barriers to women accessing support related to borough boundaries. Currently many services have strict rules that they will only work within the boundary of their own borough. However, when working with people sleeping rough this is a problem, as many people we work with move between boroughs daily and have more chaotic and unpredictable routines. Often mental health teams will be reluctant to work with one of our guests if they are moving between boroughs regularly. This causes delays which can often have very detrimental effects on our guests getting the help they need. 

Removing or relaxing these rules would equate to a quicker turnaround of support for women experiencing homelessness and complex mental health issues.

Read Alice's blog about why trust is crucial as a caseworker