Industry Intel

Mental health assessment in homelessness

Richard Bucklow

Senior Manager

Jul 20, 2022

Homelessness in the UK continues to be a prevalent issue in political discourse. With figures continually changing, it can often be difficult to get a grasp of the scale of the problem.

However, a renewed focus on the issue, along with a greater acknowledgment of mental health issues surrounding homelessness, has helped launch a cohesive government-led effort to address the issues of homelessness and mental health.

Rough sleeping is defined as people sleeping, about to bed, or actually bedded down in the open air[1]. The Homelessness Reduction Act 2017 has been regarded as one of the biggest and most influential changes to homelessness legislation in the last four decades; placing new legal duties on local authorities to provide meaningful help to anyone who is homeless, or is at risk of homelessness.

The housing and homelessness charity Shelter, has been quick to recognise mental health as a serious and pervading problem among the ‘rough sleeper’ community. In a government study, carried out in London between 2017 and 2018, 50% of rough sleeper respondents reported mental health issues, 43% experienced alcohol misuse issues, and 40% had drug misuse problems[2]. The link between mental health and substance abuse is clear and thus political and media focus on the issue continues to intensify.

Homelessness: what is being done to address it?

Coupled with government funding, local authorities have been steadily reducing the number of people sleeping rough in England, with the Rough Sleeping Initiative (RSI) proving to be a resounding success. In its first year, the initiative managed to provide 1,750 new beds spaces for homeless individuals and 500 new staff to 83 local authority areas with high levels of rough sleeping.

The primary aim of the initiative is to support rough sleepers' well-being and stability, and is part of the wider Rough Sleeping Strategy, aiming to halve the number of people sleeping on the streets in 2022. Spread across 83 local authority areas, the scheme observed a net reduction of 1,321 people sleeping rough across these 83 areas, or 15.9 people per RSI area[3]. While this concerted effort represents a considerable success, greater focus still needs to be placed on mental health and its impact and effect on the homeless population.

As mental health continues to become a focal point of research for organisations such as Shelter, and drastic legislative changes begin to place responsibility in the hands of local authorities to actively prevent homelessness with initiatives like the Homelessness Reduction Act, it is clear headway is being made in the field.

Mental health services and vulnerability assessments

Fundamental to ensuring the homelessness problem is dealt with in conjunction with the mental health issue is the effective assessment of the vulnerability of rough sleepers. As mentioned earlier, Shelter has been a charity at the forefront of effective vulnerability screening; working alongside medical professionals, social services, and the third sector, they have been able to utilise their expertise in the field to develop a framework for assessing vulnerability in the homeless population or those threatened by homelessness.

The Homelessness Code of Guidance, published by the Ministry of Housing, Communities & Local Government in 2018, has been instrumental in assisting local authorities and housing associations in effectively assessing an individual's vulnerability to homelessness; taking into account the nature of the illness, relationship between the illness and housing and the relationship between the illness substance abuse, behaviors, and age[4].

Working in tandem with housing services, mental health services will be able to advise and support decisions made by local authorities on the vulnerability of its constituents, whilst gaining a far greater understanding of the individuals involved. By working together, effective diagnosis of mental health issues can go hand in hand with effective housing allocation and can begin to alleviate the homelessness problem and mental health issues, found predominantly in urban areas. Without an effective diagnosis of mental health issues, a lot of these individuals will not have access to the financial support needed to get them off the street.

Using medical professionals will greatly assist local authorities in making such assessments and initiatives such as the RSI have been credited with bringing specialist staff to the sector. New services for rough sleepers have already seen faster diagnoses of mental health issues and an NHS-funded scheme targeting mental health issues in the rough sleeper community will see far greater cooperation between local authorities and mental health professionals.

Greater accessibility to mental health and accommodation services provided by local authorities will go a long way in addressing the issue. By creating greater levels of co-operation between sectors, outreach teams – made up of NHS and local authority staff -will be able to identify those most in need of help and help them gain access to much-needed health services[5].

What does the future look like?

While the results to date have been excellent, the issues surrounding mental health in the homeless population continue to linger. That said, initiatives such as the RSI have been incredibly effective at getting rough sleepers off the streets and introducing mental health professionals into the housing sector.

The skills that mental health professionals bring to the sector mean they will not only free up local authority staff to deal with other issues, but also bring skills to the housing sector that may otherwise be nascent. The ambitious NHS-funded outreach program has further illustrated the government’s commitment to the issue.

An additional £46m has already been allocated to the 2019/20 RSI and by 2023/24 the NHS expects to have specialist teams set up in at least 20 areas that experience high levels of rough sleeping. This financial commitment illustrates the importance of the issue for both the government and local authorities.

With year-on-year decreases in homelessness and renewed public spending in the sector, it seems like we are on the right path. Ensuring that those areas with the highest level of rough sleepers retain access to funding and that we are able to continue to place more mental health assessors on the ground with local authorities, is critical to building on the aforementioned success stories.


[1] 7/2/2020

[2] Ministry of Housing, Communities & Local Government., (2019), Rough Sleeping Statistics Autumn 2018, England (Revised). Available at https://assets.publishing.serv... 7/2/2020

[3] Ministry of Housing, Communities & Local Government., (2019) Impact evaluation of the Rough Sleeping Initiative 2018. Available at https://assets.publishing.serv... [Accessed on 6th February 2020]

[4] Shelter., (2019) People with mental illness or physical disabilities. Available at;[Accessed on 6th February 2020]

[5]NHS., (2019) Rough sleeper in homeless hotspots to benefit from NHS mental health outreach. Available at [Accessed on 6th February 2020]

Share this article

Senior Manager

Richard Bucklow

Richard started out in Oyster in 2014, working in Housing Needs, and honestly? It was a bit of a slow start. Recruitment is rarely an easy ride, but Rich stuck it out and started to build and grow his team. Over time, what became increasingly clear is that Rich is a decent recruiter, but a much better manager. Which is lucky because his team has grown exponentially over time, becoming increasingly diversified, and successful. It’s not looking like it’s going to slow down any time soon.

More from our blog