Key points:

• Many aspects of women’s routes into and experiences of severe and multiple disadvantage (SMD) – here defined as the co-occurrence of homelessness, substance use, and offending behaviour – are highly gendered.
• Experience of violence – especially sexual violence and domestic abuse – is horrifyingly prominent in the life histories of women affected by SMD. For many, such experiences have been extreme and/or endured over long periods, typically since childhood.
• It is critical that the severity of trauma that these women have sustained and its impact on service engagement is adequately acknowledged in policy and practice. Their susceptibility to being targeted by predatory men in the longer term should also be recognised (including after they have been rehoused and/or engaged with treatment).
• The combination of SMD experiences heightens barriers to services. Difficulties accessing support are exacerbated where these intersect with other social categorisations such as being from a minoritised ethnic group, having a longstanding physical illness or disability, or experiencing neurodivergence (e.g. Autism).
• Women affected by SMD will often go to extreme lengths to conceal or downplay the severity of their circumstances. Many are fearful of using services and/or the potential consequences of disclosing vulnerabilities. Their need for support often goes unnoticed until they are in a crisis situation.
• Many professional stakeholders have invested intensive effort in attempts to break down the barriers that women (and men) experiencing SMD face in recent years. Progress has however usually hinged on the goodwill of committed individuals at the local level rather than being symptomatic of broader systems change.
• Pockets of good practice in the provision of effective trauma-informed and gender-informed support do exist. Their availability is very uneven, however. Furthermore, most mainstream services cater for one SMD domain only, hence women are frequently shunted between services that are poorly equipped to meet their needs.
• There is an urgent imperative for stakeholders across relevant sectors – mental health and social services in particular – to share both responsibility and risk in responding to the needs of women affected by SMD. Until this happens vulnerable women will remain caught in a pernicious cycle of exclusion and exploitation.