The health and homelessness sectors are closely interconnected. Ill health can cause and contribute to homelessness, while simultaneously the lack of adequate housing has a significant impact on the physical and mental well-being of individuals. Homelessness comes with deep social exclusion and marginalisation which in turn have direct consequences on the health of those living in precarious housing, in emergency accommodation, or sleeping rough. Experiencing homelessness, even for a short period of time, translates into living under a great deal of physical and psychological stress, which has far-reaching health consequences.

This report is the first step in creating a map of health services throughout the homelessness sector. It provides an overview of the typologies of interventions developed within the sector, looking at a total of 23 types, as well as case examples from homelessness services offering medical support. By reflecting on existing services we may see the practical manifestation of the intersections of health and homelessness, learn good practices, and reinforce the role of housing in healthcare.

P.12 5. Trauma-informed care Implementing trauma-informed care in homeless shelters acknowledges the complex needs and experiences of individuals who have faced trauma, aiming to provide an environment that promotes healing, trust, and a sense of safety. Trauma Informed Care (TIC) and Psychologically Informed Environments (PIE) do not rely on either diagnosis or formal therapy, rather they provide a framework that emphasises the impact of trauma and encourages the development of strategies for better responding to the needs of trauma survivors. At the very least the overt and conscious aim is to “do no harm and to avoid retraumatisation or blaming clients for their efforts to manage their traumatic reactions”. Such approaches have been continuously developed in the homelessness sector, including when healthcare services were being developed, and growing attention has been given to trauma informed care in connection with different groups of people pushed into homelessness.

6. Harm reduction programs Harm reduction programs focusing on reducing the negative consequences of drug/alcohol use without requiring abstinence can help reduce the health risks associated with substance misuse. Such programs have been implemented in the homelessness sector and further training and promoting of this type on initiatives are ongoing. Examples of how these programs are typically implemented include: needle exchange programs, access to naloxone (shelters might provide training and access to naloxone, a medication that can reverse opioid overdoses), safe consumption spaces (individuals can use substances under supervision, reducing the risk of overdoses and providing immediate assistance if needed), and referrals to treatment and support services.