Understanding multiple complex needs and complex trauma

Published literature has found that people who are homeless or experiencing unstable housing can experience major health inequalities and complex co-morbidity. Research into the prevalence of various needs vary considerably depending on the study, however, a common combination of needs may include:

• Histories of childhood adversity, trauma, abuse and neglect
• Difficulties managing relationships, interpersonal issues and labels/diagnosis of Personality Disorder
• Drug and alcohol use
• Unusual experiences, hearing voices, or labels/diagnoses of Psychosis
• Low mood, depression, anxiety and other mental health issues
• Forensic histories and contact with the criminal justice system
• High suicidality, risk taking and self-harm
• Average life expectancy reported to be as low as 43 years old

Stating your case for PIE

Due to the complex needs of this population, they can struggle to access services in planned sustainable ways, services can fail to meet their needs and people may instead fall into cycles of presenting in crisis and avoiding planned care.

Homeless people are 3.2 times more likely to have a hospital admission than the general population and cost, on average, 1.5 times more; a gross cost of £76.2m pa (£85.6m when outpatient and A&E included).

Government recommendations and trauma literature therefore call for services to address the unmet psychological needs and trauma that precede, accompany and perpetuate homelessness, chaotic lifestyles and criminal justice contact using ‘Psychologically Informed Environment’ (PIE) and ‘Trauma Informed Care’ models.