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Homeless people are amongst the most drastically and chronically marginalized groups in the UK. Upon coming to the attention of statutory and charitable services, they are almost invariably identified as struggling with substantial and complex physical and mental health challenges, requiring considerable medical, practical and psychological assistance. Histories of horrific sexual, physical and emotional abuse, profound neglect, criminal exploitation, precarious and substandard housing, exclusion from mainstream education, abandonment to growing up in care and repeated contact with the Criminal Justice System are just some of the many cumulative traumas homeless people routinely identify in their life experiences. Where referrals to mental health services are made, homeless folk frequently fail to meet even broad and inclusive referral criteria, their ‘needs’ generally being deemed ‘too complex’, their behaviour ‘too chaotic’ or ‘too challenging’ or their being inadmissible to therapeutic assistance due to their status as ‘dual diagnosis’, that is, actively using drugs or alcohol concurrent with one or multiple mental health diagnoses.
On the occasions homeless people do successfully access services and treatments, they all too often report that experiences of treatment frequently result in retraumatization and iatrogenic harm, instilling in them further mistrust and avoidance of ‘the system’. Drug and/or alcohol dependency, pronounced emotional dysregulation, unpredictable acting out and refusal of social norms such as accepted standards around personal hygiene or adhering to socially appropriate speech in shared spaces mark the homeless person out as a social problem and public health issue. As such, their behaviours are abnormalized, their distress pathologized. Care and treatment plans tend to be reduced to pharmacological and behavioural interventions, focused on removing or suppressing, rather than understanding or illuminating, presenting problems; a model tha