Understanding entrenched rough sleeping during COVID-19

Monday, 4 May 2020 - 3:49pm

People who have been sleeping rough for a long time, or who struggle to engage with change, may have particular needs affecting their ability to follow the advice given. This blog outlines what some of those things might be and where to get more information.

I recently wrote a blog on the importance of taking a trauma-informed approach while dealing with the new challenges posed by the coronavirus pandemic. Working with people in a way which appreciates that past trauma can shape their present, and looking to increase safety and empowerment, can really help to improve interactions and support.

While this approach should underpin your work at all times, there are particular support needs that may still make it difficult to engage people, for example those who have been sleeping rough for a long time and refusing offers of help. Equally, you may be struggling to support individuals in accommodation whose specific needs affect their ability to understand and follow guidance, such as social distancing or self-isolation.

It’s unlikely that you’ll know the specific conditions of people you’re trying to engage, but it is important to learn from your interactions and try different approaches, as this may make it easier for people to understand and respond to you. Other than complex trauma, things to consider are:


Research has shown that there is a higher prevalence of autism in the homelessness population compared to the general population. Autism may be a contributing factor to a person becoming homeless, as well as affecting how someone engages with support. Signs of autism include difficulties in social interactions, routine behaviours and under/over sensory stimulation. Further resources on autism and how to support people in different ways can be found here.

Acquired Brain Injury

ABIs are extremely prevalent in the homelessness community and can be both a cause and consequence of rough sleeping. Having an ABI can make it very difficult to engage with services as memory, planning and communication can be affected, along with the likelihood of increased challenging behaviour. Find out more about ABIs and how to support people here.

Mental Capacity

Some people sleeping rough may experience mental illness, whether ongoing or occasional, that affects their capacity to make decisions and may put them at risk of harm. Non-clinical staff can assess mental capacity around specific decisions at a point in time and use this assessment to raise concerns with mental health and social care teams. By understanding the language and principles of mental capacity workers can do this in an informed way, which is more likely to secure a response from statutory services should intervention be necessary. The Mental Health Interventions toolkit provides a step by step guide of what to consider and actions to take.

Working with people who refuse offers of support or seem unable to follow advice that will keep them safe can be really difficult. But we can’t expect everyone to engage if we use only one type of approach. We certainly shouldn’t expect people to welcome our support if they struggle to understand what we’re saying or offering. The resources shared in this blog will help you to increase your understanding of people through different lenses, and grow your confidence in adapting your approach to meet these needs.

To find out even more about autism, acquired brain injury and trauma listen to this webinar that we recorded a couple of years ago. And if you’re new to outreach or want to find out more, check out these training and resources: https://homeless.org.uk/street-outreach-resources


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Jo Prestidge

Senior Innovation and Good Practice Project Manager (Housing First)

Jo is a senior innovation and good practice project manager, leading the Housing First England project and advocating for Trauma Informed Care.