Drop-in clinics are delivered through the outreach van in partnership with City and Hackney public health community wellbeing team. |
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diagnosis led to treatment, which she has now successfully completed. Since then, her engagement has continued to grow. She has agreed to further health testing for hepatitis B and HIV through outreach, connected with a local women’ s group, and is gradually working towards alcohol detox and stabilisation, important steps towards longer-term recovery. |
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The team works across a network of locations where homelessness and substance use intersect... Rather than expecting people to come to them, recovery workers bring support directly into these spaces.
CHANGING OUTCOMES For individuals experiencing homelessness, access to support is often shaped by systemic barriers, stigma and past trauma. By removing those barriers and rethinking how care is delivered, the rough sleepers team is not only improving access to treatment but helping to transform outcomes. While the team has supported individuals into detox and residential rehabilitation, success is often more gradual and rarely linear. Progress is measured in small but meaningful steps: someone sustaining accommodation for
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longer than before, taking mental health medication consistently, completing specialist assessments, or maintaining an opiate substitute prescription.
Much of this work begins while individuals are still rough sleeping. Early engagement helps build stability, increasing the chances of sustaining future accommodation. It also helps challenge stigma, supporting housing providers and partners to better understand and respond to drug and alcohol use. Each step forward lays the foundation for lasting change.
REAL IMPACT The true measure of outreach is not only in numbers, but in the lives changed through persistence, trust and adaptability.
Tim’ s story reflects the importance of consistency in the face of complexity. Over many years, he moved in and out of rough sleeping, interspersed with periods of sofa surfing and supported accommodation. His engagement with services was often inconsistent, and he was sometimes perceived as challenging or non-compliant.
When the rough sleepers team first began working with Tim, he was sleeping rough, injecting drugs and living with hepatitis C. Rather than disengaging when Tim did,
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the team made a conscious decision to remain working alongside him, maintaining contact and keeping treatment accessible even during periods when he struggled to engage. With a flexible approach to prescribing opioid substitution therapy and close coordination across a strong network of professionals, they were able to build a sustained relationship over time. That persistence ultimately paid off. Tim completed treatment and successfully cleared hepatitis C, a significant milestone in his recovery journey.
Maria’ s story highlights the impact of trauma-informed, accessible support. Following a relationship breakdown and experiences of domestic abuse, she began sofa surfing and sleeping rough. Severe anxiety made attending appointments extremely difficult, limiting her ability to progress in treatment. For Maria, the outreach model proved crucial. Regular contact through the community wellbeing van provided a consistent, low-pressure environment where trust could develop gradually. With support from the team, she began to engage at her own pace. Despite her fears, Maria agreed to a hepatitis C test with The Hepatitis C Trust. A positive
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LOOKING AHEAD While these stories demonstrate what’ s possible, they also highlight the wider challenges facing homelessness services. The funding and service landscape remains fragmented, often creating gaps for individuals with multiple and overlapping needs. Those with complex physical health conditions, mental health challenges and social care needs can struggle to engage with structured substance use treatment when their broader circumstances remain unstable.
In City of London and Hackney, a shortage of supported housing adds further strain, with existing services often under pressure. These challenges underline the need for a more integrated approach, one that brings together substance use services, mental health support and social care within homelessness provision.
The rough sleepers team is already working towards this model, connecting outreach, health services, housing support and partner agencies to provide more accessible and holistic care. Looking ahead, strengthening this collaborative approach will be key, both in improving outcomes and in creating a system that better responds to the realities of complex homelessness.
Jara Senar Villadeamigo is rough sleepers team strategic manager( City & Hackney) at Turning Point
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JUNE 2026 • DRINK AND DRUGS NEWS • 23 |