Putting numbers to faces: a new map of substance misuse, homelessness and offending in England

Mental health, access to housing and effective offender rehabilitation must all figure in our response to complex needs
Sam Thomas
Monday, January 19, 2015

Statistics can be a limited and limiting way to understand social issues. When we focus on how many people are affected by a problem, or how much the government spends on tackling it, we start to see numbers instead of people. The opposite is also true, though: without statistical evidence, it’s hard to understand the scale of a problem.

For instance, we know that a small but significant number of people facing serious problems in their lives bounce between different kinds of support – drug and alcohol treatment, supported housing, mental health services, and sometimes prison.

However, because these services don’t share information at a national level, it’s hard to know where these individuals’ issues overlap and interact. DrugScope is one of four members of the Making Every Adult Matter coalition, which is committed to understanding and improving their lives, not least through Voices from the Frontline, the project I’m leading. What we’ve lacked, though, is solid data on the national picture – until now.

Pioneering new research from Heriot-Watt University, supported by the LankellyChase Foundation, has found that over 250,000 people in England experience problems with homelessness, substance misuse and offending in some combination. A smaller subset, estimated at 58,000 people, experience all three at the same time.

The research team spent several years analysing multiple official datasets – including the National Drug Treatment Monitoring System (NDTMS) – and building a composite picture. Their report out today, Hard Edges, provides the most detailed data we have yet on the extent and nature of severe and multiple disadvantage in England.

One thing is clearer than ever before from their findings: substance misuse features in a majority of people’s experiences of complex needs. Their analysis indicates that at least 190,000 people with a substance misuse issue also have problems with homelessness and/or offending: this is almost exactly the same number who have a substance misuse problem without these complicating factors.


This diagram estimates the number of people in England experiencing each kind of need, and how they overlap

It’s worth noting that these figures only cover those in treatment – the authors’ estimate including who are receiving no support for a drug or alcohol issues is even higher.

What’s more, the research cements what we already know about the strong link between substance misuse and mental health problems. People with a drug or alcohol problem who are not also homeless or offenders have the highest prevalence (58%) of mental health problems in the study. And those who are homeless and/or offenders are much more likely to have a mental health problem if they also misuse drugs or alcohol.

The report also provides a useful corrective to commonplace assumptions. Often, when we think of the most vulnerable in society, we focus on single, homeless men with no family connections. However, through an analysis of NDTMS data, the researchers show that of those with the most complex needs – the 58,000 people who have experience of homelessness, substance misuse and offending together – over 60% either live with children or have ongoing contact with them.

This echoes what we've heard from our Voices from the Frontline: for many people with complex needs, particularly women, the fear of losing access to children looms large. These findings also give us cause to revisit the Advisory Committee on the Misuse of Drugs’ 2003 recommendations, which set out the benefits to children of their parents receiving effective drug treatment.

More widely, what should the substance misuse sector take from this important research? First and foremost, the challenge it poses cannot be tackled by the substance misuse sector working alone. Better mental health, access to housing and effective offender rehabilitation must all figure in our response to complex needs.

All the same, any response must continue to include high-quality treatment for people with drug and alcohol problems. This treatment needs be made accessible to those who, because of the other problems they experience, cannot or will not access services through traditional routes. One model is provided by the MEAM Approach, which focuses on cross-sector partnership and having dedicated co-ordinators for people with multiple needs.

The findings in this report will not come as a surprise to substance misuse professionals - but understanding the scale of the challenge can help us make the case for better care.

Sam Thomas is the programme manager for Voices from the Frontline at DrugScope. Follow him @iamsamthomas on Twitter.