A complex cases team has been set up in Leeds to work with street beggars.
As well as getting them engaged in substance misuse services, they help them access NHS services and testing.
The challenge
Leeds City Council has funded a successful street outreach programme for well over a decade.
The team works with rough sleepers, offering them advice and supporting them to access housing and other support services. In 2014 that remit was widened to include beggars.
The team now does daily sweeps of the city, talking to and engaging beggars. But the outreach workers soon started noticing that this group had extremely complex needs with substance misuse problems identified in nearly all the people they came across.
The solution
The council decided to provide funding to set up a complex cases team in 2017. It comprised of a generic outreach worker and two complex case workers – one supplied by the outreach team and one from the substance misuse service run by Change Grow Live and Forward Leeds respectively.
The two organisations now work together to identify the most entrenched rough sleepers and beggars and then provide them with support. That can include taking them to hospital, registering them with a GP or getting them involved in alcohol and drug treatment from detox programmes to needle exchange and blood borne virus testing.
Street Outreach Service Project Manager Lesley Howard said: “These people have really complicated needs – in some ways more complicated than rough sleepers.
“They may have accommodation but are in a cycle of begging, making good money from it which is funding their substance misuse habit.They don’t want to engage with services at all. Their physical health suffers, but they do not want to do anything about it. We have had people dying on the street so we knew we had to do more to help and engage them.
“The complex case workers have a case load of around 20 at any one time, that is not many but they need that time to help these people. They can spend a whole day with one person arranging appointments and attending them with them.”
The impact
The service is not yet a year old, but already it is having an impact.
During January, the team engaged with 79 different people, the overwhelming majority of whom had substance misuse problems. In total, 52 interventions took place in relation to physical health needs, seven for mental health and 32 for substance misuse.
The team accompanied 22 people to healthcare appointments and 12 to drug treatment appointments. Councillor Debra Coupar, the council’s Executive Member for Communities, said it was achieving real results and ensuring people get the support they need “whatever their circumstances”.
Lessons learned
Working with these complex cases has taught the team that they need to act quickly once you get them engaged.
Ms Howard said: “Having a worker from the substance misuse team means we can fasttrack them for appointments. We have been able to get them in that day. You need to do that.
“If you make an appointment for the following week or two the chances are that you will not find the individual again. But being able to take them to an appointment that day can make all the difference in getting them engaged.”
The team has also used novel techniques to get them involved. “We sometimes go out with other people on our sweeps,” said Ms Howard. “Having someone different with you can be a good way to gain their trust.
“We have done some with the Dog’s Trust and these have worked really well. By getting them talking about the welfare of their dog, you then create an opportunity to talk to them about other issues.”
How is the approach being sustained?
The sheer complexity of the cases has convinced the team they need more specialist help to do the outreach work.
Ms Howard said: “The biggest issue is mental health – and we are in talks about getting a mental health specialist out with us. When you have someone who refuses help and it is minus 5 degrees centigrade and snowing, it is nearly always because of mental health problems. If we had someone with specialist knowledge in that area it could make a big difference.”
Contact details
Ian Street Commissioning and Contracts Officer Adults and Health Directorate Leeds City Council [email protected]