Review recommends more support for homeless after two Somerset deaths
Independent review finds vulnerable men “fell through the cracks” of homelessness support
An independent review following the death of two Somerset men has called for more support to be provided for those experiencing homelessness in the county.
Between 2023 and 2024, safeguarding referrals were made regarding three men who had experienced homelessness in Somerset.
Two of the men have since passed away, with the third receiving care and support from various agencies.
Following these referrals, the Somerset Safeguarding Adults Board (SSAB) commissioned a review of homelessness support from Gill Taylor, an “independent reviewer with 20 years’ expertise” in this area.
She has made a series of recommendations to improve how Somerset’s homeless population is supported in order to prevent further deaths and ensure those deemed “high risk” do not slip through the cracks.
All three men who were the subject of the review had either mental health issues, a history of drug or alcohol dependency, involvement with the criminal justice system or a history of abuse or other trauma.
All three were “at risk of experiencing self-neglect” as well as at risk of being harmed or exploited by others, including the risk of physical violence.
The first man (known only as Mr A) was evicted from his accommodation following an “escalation in incidents related to this alcohol use” – but he was evicted before any risk assessment had been undertaken on the prospect of him rough sleeping during the cold winter months.
The second man (Mr B) died within a week of leaving prison – with Ms Taylor finding his required mental health care “had not been reinstated” upon his release, he had been prescribed too high a quantity of medication (given his history of suicide attempts) and had been sent to live with his mother (which was “a known trigger”).
The third man (Mr C) was evicted from supported housing in late-2022 and spent the best part of the next two years rough sleeping “in increasingly dangerous and uninhabitable situations”, with “no onward long-term plan” being in place to help him.
Ms Taylor expressed her “deepest condolences” to the family and friends of Messrs A and B, and thanked the “front-line practitioners and support services” for their “honest and conscientious” contributions to her review.
She also acknowledged opportunities to improve homeless support through national initiatives, including the NHS ten-year plan and changes brought in following the ‘Everyone In’ approach taken during the coronavirus pandemic.
She said the following improvements were required to ensure no-one else had to ensure the same fates:
Improved availability for “legal literacy training” for front-line staff in the council’s housing and adult social care teams
Events to be staged to explore how family, friends and partners can be effectively involved in support for adults with mental health and substance abuse issues
A review by the council of safeguarding concerns raised about people experiencing homelessness, focusing on improved practice
Resources should be agreed between the council and the Ministry of Housing, Communities and Local Government (MHCLG) to pay for a Somerset-wide dedicated homelessness social workers
An update from the NHS Somerset integrated care board about how NHS England’s “inclusion health framework” is being implemented
Local prison governors should meet to discuss discharge arrangements for “highly vulnerable adults”
The SSAB should make homelessness a “strategic priority” within its next holistic plan
The council’s public health team should inform the SSAB how the UK-wide suicide prevention strategy will be implemented, with a focus on support for high-risk groups such as “those experiencing homelessness, living with addiction and neurodivergent adults”
The SSAB brings together numerous organisations which seek to prevent the neglect and abuse of adults – including Somerset Council, the NHS Somerset integrated care board, the Somerset NHS Foundation Trust, Avon and Somerset Constabulary and the National Probation Service.
SSAB chairman Professor Michael Preston-Shoot welcomed Ms Taylor’s report, stating: “These reviews are not about apportioning blame, they are about making sure lessons are learned and improvements are made.
“We sought to explore this in some detail in relation to three people, who were experiencing multiple exclusion homelessness to review the support of agencies working across Somerset, to learn lessons from the circumstances.
“It is clear that there is no one typical person who is experiencing homelessness.
“The learning from this review is put into effective practice through four domains: direct work with individuals, the team around the person, organisational support for the team, and governance.
“We are grateful to those who knew or worked to support these individuals for their contribution towards the review, and for their insight towards what might have made a difference in these cases.
“In addition to the recommendations made by Mr Taylor, we have agreed to arrange an event which will focus on homelessness and how we can work together to reach those experiencing it.”