The stories of seven men who died while homeless in Manchester in just five months
A report commissioned by Manchester’s Safeguarding Partnership found a number of ‘repeating themes’men
Seven men died while homeless in Manchester in the space of just five months, a report has revealed.
The deaths happened between June and October 2018 and Manchester’s Safeguarding Partnership decided to commission a ‘thematic learning review’ to understand what could be learned.
The review, authored by Prof Michael Preston-Shoot of the University of Bedfordshire, was published last year and is highlighted in the first annual report of the Safeguarding Partnership, which recently merged adult and children’s services under one roof.
The report found that while some ‘brilliant work’ is being done to support people who are homeless in Manchester, ‘systemic changes’ are needed.
A number of ‘repeating themes’ among those who die while homeless were established.
These included drugs and alcohol misuse, mental health problems, lack of accommodation, family breakdown, domestic violence and abuse, childhood abuse and time spent in prison.
None of the seven men who died were identified, but the author gave a ‘pen picture’ of each individual using pseudonyms.
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David is believed to have first become homeless aged just 15, the report said.
It is believed he was the victim of domestic abuse and suffered from anxiety and depression.
He had a history of criminal offending as a young person and adult.
David frequently attended A&E departments and had a history of living in ‘squalid conditions’ and abandoning tenancies, the report said.
While he frequently had dealings with a number of agencies, the report says there is ‘no recorded evidence’ as to his ‘wishes, feelings, experiences and desired outcomes beyond one reference from the National Probation Service that he wanted to be on the streets and was using drugs to cope.’
Although David had been known to Children’s Services, the report found he was not referred to Adult Social Care or adult safeguarding.
“It is not clear what, if any, liaison there had been between Children’s Social Care and other services earlier in his life, for example relating to his [criminal] offending,” the report said.
“The combined chronology does not indicate that staff in different services liaised, for example, healthcare practitioners within the Prison Service with community-based staff.”
David died aged 44 due to drug misuse, liver disease, lower limb cellulitis and pneumonia.
Stephen had a history of criminal offending including violence, drug misuse and domestic abuse.
He was described as a ‘risk to children’ and was subject to a Multi-Agency Public Protection Arrangement (MAPPA).
He was homeless immediately on release from prison.
Adult Social Care had no known involvement with Stephen and there was limited involvement of mental health providers and housing/homeless teams, the report found.
“In summary, despite being seen by different agencies at various times, it is unclear from the chronology what, if any, coordination there was,” it added.
Stephen died of drowning associated with multiple drug use (Heroin, Cocaine,Diazepam), aged 40.
Luke died aged 37 in hospital with cause of death being hypoxic brain injury, pneumonia, intestinal mucosal infarction, coupled with near drowning and combined toxicity from recreational use of heroin, cocaine and synthetic cannabinoids and chronic Hepatitis C infection.
He had a twenty-year history of criminal offending for offences including theft, public order, violence and drugs, sometimes resulting in custodial sentences.
Luke was known by various agencies to have been physically and sexually abused as a child, the report says.
He is recorded as experiencing flashbacks and depression as a result.
Luke had a history of perpetrating domestic abuse incidents, the report said.
He also had a pattern of attendance at A&E, sometimes leaving before seen.
He had problems with alcohol and drug misuse, depression, panic attacks, flashbacks and nightmares (PTSD), self-harm, leg ulcers and hepatitis, the report said.
He would access services including the Booth Centre, Urban Village, Riverside, the council’s Outreach Team but would sometimes disengage or not attend.
Luke had periods in emergency accommodation but asked to leave because of bullying, intimidation and theft from other residents, or because he felt unsafe, the report said.
Lester died aged 28 from a drug overdose.
Records show he alleged that he had been physically and sexually abused as a child.
He also had a history of domestic and sexual violence incidents as the perpetrator.
Lester was known to self-harm and received inpatient treatment both as informal patient and under section due to psychosis.
He had diagnosis of borderline personal disorder and was assessed as emotionally unstable.
Lester found temporary accommodation but became ‘intentionally homeless’ as he would not follow the rules and conditions of tenancy, the report said.
Larry died aged 31 from heroin toxicity, the report said.
He had a history of drug misuse from an early age.
Mental health records for Larry refer to his ‘very dysfunctional family, including abuse by his mother and neighbours’, the report says.
He is described as having ’emotional dysregulation and poor impulse control’.
“Anger management had been a key challenge for him. These are common manifestations of trauma,” the report adds.
Larry had patterns of overdoses, self-harm and depression, sometimes prompting emergency hospital admissions.
He also had a history of perpetrating domestic violence towards his family and prison sentences.
Larry showed some engagement with drug and alcohol services, counselling and accommodation.
But he was ‘unable to sustain his own accommodation or maintain hostel place’, the report said.
Larry was referred to adult safeguarding in 2017 by his GP.
Darren died aged 38 and his caused of death has ‘not yet been established’, the report says.
He had an extensive history of criminal offending from the age of 12.
Offences included burglary, theft, criminal damage, assault, public order and Darren served time in prison for these offences or breach of orders.
Darren may also have suffered ‘adverse childhood experiences’ and he also had a history of perpetrating domestic violence incidents.
He had been diagnosed with schizophrenia.
Darren was known to Riverside Housing, Booth Centre, the drugs and alcohol service CGL and Greater Manchester Mental Health Foundation Trust.
He was often unable to sustain engagement and hostel places or temporary accommodation.
He had a pattern of A&E attendance.
Darren was the only one of the seven men to have a ‘key worker’, but the report says ‘it is unclear how formalised this arrangement was or for how long it lasted.’
Jacob died aged 60 from bronchopneumonia and alcohol toxicity.
He was an immigrant to the UK and had ‘no recourse to public funds’, the report said.
He was a heavy drinker and had lost employment due to an accident and was unable to work.
The Immigration Removal Centre was twice involved with Jacob.
He was described as ‘very disabled’.
Jacob had intermittent contact with agencies and one ‘unsuccessful’ stay in hostel accommodation.
He was twice the victim of crime and required an interpreter to access services.
Although Jacob was known to multiple agencies, including a GP, hospital and police, there was ‘no obvious liaison’ between them, the report says.
“Despite a Consultant writing to request temporary accommodation because of the impact on his health and disability of being homeless, he remained without accommodation,” the report says.
“No referrals were made to Adult Social Care or adult safeguarding despite concerns about his disability and self-neglect.
“The question to ask is ‘why?’ Services should reflect together whether this is due to lack of agency operational guidance/protocols for working with people who are homeless and/or lack of responsiveness in the past to referrals and/or concerns about the impact of referrals on overstretched provision and/or some other reasons.”
‘It should not be assumed to be a lifestyle choice’
The report found there does not appear to have been any multi-agency risk management meetings or complex case discussions in any of the seven cases.
It described each of the men as having experienced ‘extreme marginalisation’ – against a background of personal trauma, physical and mental ill-health, substance misuse and experiences of institutional care.
Some had adverse experiences in childhood including abuse and neglect, domestic violence, poverty and parental mental illness or substance misuse.
“It requires time to uncover what might lie behind a person’s homelessness and street sleeping,” the report says.
“It should not be assumed to be a lifestyle choice. However, as recognised at the learning event, meeting complex needs as they come to be understood can be challenging, even when individuals are provided with somewhere to stay.”
Making some conclusions, the report says in several instances there was not sufficient planning around the discharge of the men from hospital or prison.
“Section 76 (Care Act 2014) requires the local authority in which a prison is situated to assess an individual when they appear to have care and support needs,” the report says.
“Eligible needs must be met whilst in prison and plans prepared to meet eligible needs on release. It does not appear that any of the individuals in this review’s sample were so assessed.
“The subjects of this review who had been in prison frequently had little health information shared between the prison and their General Practitioner or with the relevant local authority on discharge; this needs to be reviewed along with effective discharge from prison into the community.”
The report said a survey of agencies involved with the homeless found there is ‘need for cultural change.’
With ‘stretched resources’, services are ‘struggling to keep pace with changes in the homeless and street sleeping population’, the survey found.
One example given was the lack of service provision for ‘the increasing numbers of women and of young people, many with complex needs, living on the street.’
National policies such as the roll-out of Universal Credit have had a ‘negative impact’, while the bedroom tax has ‘impacted on parents temporarily unable to live with their children, again increasing the risk of homelessness’.
“A whole system approach is required if issues that are associated with street homelessness are to be tackled effectively,” the report says.
“That includes begging and sex work to provide an income source, the need for a ‘care of’ address to access welfare benefits, and the alignment of housing benefit with city rents.
“The lack of alignment here makes prevention of ongoing homelessness more difficult; people cannot be moved on and so remain trapped in homelessness; landlords reluctant to take on tenants claiming benefits.”
The review concludes that ‘further systemic changes are also required’ and makes 19 recommendations for change to both Manchester’s homelessness strategy and its approach to the contributory factors.
The Safeguarding Partnership says these recommendations have been ‘accepted’ and will be the subject of an ‘interagency action plan’ overseen by the MSP over the next year.
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