Homelessness and, in particular, rough sleeping is often viewed as a problem which only exists in large cities. However, there are a significant number of people homeless and rough sleeping in Devon, not just in the larger urban areas such as Exeter, but also in the more rural and remote parts of the county.

Rough sleepers represent the smallest proportion of those who are homeless or in housing need and represent the most acute need. The latest rough sleeper count (November 2014) identified 73 individuals sleeping rough across Devon compared to 46 during the same period in 2013. 26% of these people were aged over 50 and 7% were under 25.

Homelessness can have a considerable impact on an individual’s health and wellbeing. It is also a complex issue that crosses departmental and organisational boundaries, covering health, social care, housing, criminal justice systems and welfare services.

Rough sleeping can be seen as the tip of the iceberg; it is the most visible form of homelessness, it is sometimes also referred to as chronic homelessness. The past few years has seen an increase in rough sleeping nationally, partly because the evaluation method was changed by the government in this period.

The homeless population often have a range of complex needs which makes engagement with health, social and welfare agencies difficult. These needs in isolation often do not solicit a response from statutory services as they do not meet the threshold for an intervention, however combined with other issues including lack of accommodation, poor budgeting skills, trauma, a lack of social skills and ‘anti-social behaviour’ some individuals are caught in a cycle of chronic exclusion, unable to get the support needed to cope with basic functions of everyday life.

Public Health have been working in partnership with key stakeholders to better coordinate a range of services for people with complex needs using the MEAM (Making Every Adult Matter) Approach. MEAM is a national coalition of Drugscope, Homeless Link, MIND and CLINKS who are giving time and sharing best practice to assist Devon to develop more inclusive services. A pilot cohort was selected in Exeter and the project developed in 2014 and 2015.