Mental Health

What works in homelessness and rough sleeping

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Jason Lowther

We’ve just started a new series of Inlogov blogs summarising the growing body of evaluation evidence in local government, and what it tells us about how councils are learning what works. Nowhere is that learning more urgent or more complex than in homelessness and rough sleeping. A series of recent national evaluations provide a rich, if sometimes uncomfortable, picture of how programmes are operating on the ground, what difference they are making, and where the system continues to struggle. 

Systems‑wide evaluation of homelessness and rough sleeping

The systems‑wide evaluation represents a deliberate attempt to step back from individual programmes and understand homelessness as a complex, interconnected system rather than a set of discrete services. Led by the Centre for Homelessness Impact with research partners, the early reports combine systems‑mapping, policy analysis and qualitative fieldwork in five local authority areas.

The core finding is stark: the system is not working as intended. Public spending and organisational effort are disproportionately focused on crisis response rather than prevention, even though this approach places increasing pressure on local authorities and delivers poorer outcomes. Fragmented funding streams, short‑term grants and inconsistent incentives across departments actively undermine joined‑up working. The evaluation does find examples of strong local partnership practice,but these are often working around the system rather than being supported by it.

The central conclusion is that meaningful progress requires sustained, cross‑government commitment to prevention, better alignment between housing, health, justice and welfare systems, and a clearer understanding of how national policy choices shape local outcomes.

Rough sleeping and complex needs process evaluation

The rough sleeping and complex needs evaluation zooms in on services supporting people facing the most entrenched disadvantage. This process evaluation examined interventions funded through the Rough Sleeping Grant and Rough Sleeping Social Impact Bonds, focusing on people with co‑occurring mental health and substance misuse needs.

Using case studies across 12 areas, interviews with service users and staff, and cost analysis, the evaluation explored how different models worked in practice. It found that progress, including improved housing stability and engagement with services, was most likely where support was flexible, persistent and relationship‑based. Small caseloads, psychologically informed approaches and multi‑disciplinary working were all important.

However, delivery was often hampered by structural barriers beyond local control: gaps in mental health provision, restrictive criteria in mainstream services, workforce instability and the limitations of short‑term funding.

Rough Sleeping Initiative process evaluation

The Rough Sleeping Initiative (RSI) process evaluation complements earlier impact analysis by explaining how and why the initiative achieved results. While the impact evaluation estimated a significant reduction in rough sleeping in RSI areas, the process evaluation explored local delivery through surveys of all funded authorities and in‑depth qualitative case studies.

Local authorities consistently reported that RSI funding enabled them to expand outreach, create specialist roles, and strengthen partnerships with health and voluntary sector providers. Rapid mobilisation, local flexibility and visible political commitment were key strengths. Many areas highlighted the value of multi‑disciplinary teams and assertive outreach in engaging people who had been sleeping rough for long periods.

At the same time, the evaluation identified familiar challenges: recruitment difficulties, reliance on short funding cycles, and the risk of losing skilled staff when funding ends.

Next Steps Accommodation Programme evaluation (briefing paper)

The Next Steps Accommodation Programme (NSAP) evaluation focuses on what happened after the incredible emergency response of “Everyone In” during the Covid pandemic lockdowns. It draws on two waves of interviews with service users in 34 local authorities, around 12 and 18 months after they were placed in longer‑term accommodation.

The findings are cautiously positive. Many people reported improved stability, safety and wellbeing, and a reduced use of emergency services. Sustained accommodation outcomes were more likely where individuals received ongoing, tailored support alongside housing. However, the evaluation is clear about its limits: the absence of baseline data, attrition over time, and the likelihood that those still in contact with services are the “success cases”.

Crucially, it highlights risks to sustainability, particularly affordability pressures, isolation, and unmet support needs.

Capital Letters process evaluation

The Capital Letters process evaluation adds an important organisational and commercial dimension to the evidence base. Capital Letters was established in 2019 as a borough‑owned, non‑profit company to reduce homelessness and temporary accommodation use in London by collectively procuring private rented sector homes, reducing competition between boroughs and driving better value for money.

The evaluation, based on interviews with boroughs, board members, landlords and MHCLG officials, alongside document and performance data review, focuses on how the initiative was set up, governed and sustained. It finds that Capital Letters had early success in demonstrating the potential of scale, shared negotiation and coordinated landlord engagement. Boroughs valued the ambition to change market dynamics rather than simply manage them.

However, the evaluation also highlights significant challenges. Achieving financial self‑sufficiency while meeting social objectives proved extremely difficult, particularly in a highly pressured London housing market. Tensions emerged between commercial risk, borough expectations and the constraints of homelessness legislation. Governance and accountability arrangements were complex, and uneven borough engagement limited the company’s ability to operate at the scale originally envisaged. Ultimately, despite grant support, Capital Letters was unable to become financially sustainable and subsequently wound down operations in 2025.

What does this mean for local authorities?

Read together, these evaluations paint a coherent but challenging picture of what local government can do in homelessness and rough sleeping.

First, prevention and system change demand stability. The biggest barriers to progress lie beyond individual projects. Short funding cycles, fragmented policy levers and misaligned national incentives consistently undermine local efforts, even where practice is strong. Councils can innovate, but without longer‑term certainty the system pulls them back towards crisis response.

Second, relationships and capability are critical. Outreach teams, assertive support for people with complex needs, and sustained tenancy support all rely on skilled staff, trust and persistence. These are precisely the elements most at risk from time‑limited programmes and competitive commissioning.

Third, housing supply and affordability are constraints. The Rough Sleeping Initiative and Next Steps evaluations both underline that service innovation only works when there are viable move‑on options. Capital Letters reinforces this at a system level: even ambitious collective approaches struggle when the underlying market is stacked against local authorities.

Fourth, collaboration is necessary but tricky. Whether through multi‑disciplinary teams or borough‑owned companies, partnership working requires time, governance capacity and shared risk. The evidence suggests collaboration works best when it is supported by clear national frameworks, realistic financial models and space to mature, rather than when it is required to develop and achieve results rapidly.

Finally, these evaluations show the growing value of learning‑focused evaluation in local government. They do not offer simple answers or “magic bullet” models. Instead, they help councils articulate what they are already experiencing on the ground and provide credible evidence to challenge policies and funding arrangements that make homelessness harder, not easier, to resolve.

The learning is no longer about whether local authorities know what works. It is about whether the wider system will allow them to do it.

All in A Day’s Work: Mental Health Provision, Wellbeing and Scrutiny in Brent Council

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Cllr. Ketan Sheth

As Chair of the Community and Wellbeing Scrutiny Committee at Brent Council, Cllr. Sheth has a behind the scenes look at the workings of local government. Here he shares his experience in trying to improve Brent’s mental health provision and his views on what good local authority overview and scrutiny looks like. 

One in four people will experience mental ill health at some point in their lives – so it is likely all of us will directly or indirectly need support from the valuable services that support people to recover and to remain resilient.

Mental health – a once under-reported and some would say under-valued aspect of our health and wellbeing – has been making headlines recently and is a stated national priority. Earlier this year the Prime Minister announced plans to transform mental health services with a particular focus on children and young people. This was subsequently followed by an announcement last month by the Health Secretary of a plan to create 21,000 new posts, investing £1.3bn by 2020. Again, the commitment to mental health services for children and young people was affirmed.

This brings a welcome focus given children and young people’s mental health and wellbeing can ultimately shape their life chances and outcomes. So now we must think about how we – as a local authority overview and scrutiny committee – understand what is going on behind the headlines and – as elected councillors – continue to shine the spotlight locally.

Scrutiny work that adds a real value and makes a positive difference to local residents’ lives must remember a number of important factors: are elected councillors supported to carry out a meaningful review? Do they understand how to capture the service model? Do they understand how to draw out the challenges to effective delivery of that model? Do they have the tools and information they need to be responsive local decision makers?

In Brent, my Community and Wellbeing Scrutiny Committee recently went behind those headlines to better understand mental health provision for children and young people across Brent and to see how we might add value to the current service model. A Task and Finish Group on Child and Adolescent Mental Health Services (CAMHS) was set up to review this complex area, and their report makes for very interesting read.

The task group was put in place to gather evidence – qualitative evidence from face-to-face interviews and research, and quantitative data and this was done alongside NHS Brent CCG, local health providers, schools and further education representatives and community representatives. I want to highlight two things my committee learnt in undertaking this work.

Firstly, the involvement of young people in this research was vital. Let’s face it, elected councillors in a local authority tend to be far older than the demographic we were seeking to reach, so it was incredibly helpful to have the input and perspectives of young people. We appointed a former member of Brent Youth Parliament (now a student at King’s College London) and they brought an excellent viewpoint to the task group’s work and deliberations.

Secondly, it was essential we recognised and embraced the complexity of this area. CAMHS is a complex and challenging subject for overview and scrutiny members because it cuts across local government and health responsibilities. Whilst this is excellent news for integrated care, it means you must be able to grasp and work across a range of people and organisations. You must also recognise the child or young person and their family and carers are a vital part of this system and network of care, and understand their perspective as well.

Effective scrutiny can be a powerful vehicle for change if committee members can stand back and really understand what is happening across local government and health services. If we are honest, overview and scrutiny committees nationally have varying relationships with public sector colleagues; however, in Brent, my committee’s relationship with NHS Brent CCG and wider health services is a good one. We try to be constructive and fair in forming our recommendations, especially in areas where we think things could be done differently and outcomes could be improved.

We have now made our recommendations to the Brent Council Cabinet and NHS colleagues and will monitor progress as a result. In Brent we will ensure mental health for adults and children and young people remains on the agenda, irrespective of the headlines.

To read the CAMHS task group report, visit http://www.brent.gov.uk/scrutiny.

 

 

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Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. Ketan is a lawyer by profession and sits on a number of public bodies, including as the Lead Governor of Central and North West London NHS Foundation Trust.

When will they ever learn?

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Catherine Staite

The news of the death of Pete Seeger has reminded me again of his old song ‘Where have all the flowers gone?’ The line ‘oh when will they ever learn?’ has been running through my head since I saw an item on the local news about police officers and mental health professionals working together to prevent people with mental health problems ending up in police cells for want of the right support. ‘Good stuff!’ you might think.  Indeed it is  – but it is also profoundly depressing to hear such a venture being reported as ‘new’.

In 1993 I led a multi-agency, multi-disciplinary team, which diverted people with mental health problems and learning disabilities from custody.  The team included all the right skills and necessary statutory powers – a specialist social worker, two community psychiatric nurses, a senior probation officer and a police inspector.  We had the backing of all the chief officers and the team went wherever they were needed, the police station, the bridewell below the magistrates court and the remand and hospital wings of the local prison.

The approach was simple but effective. By bringing the right skills into the system at the right time, we were often able to help get the right decisions and find the right services. Within a year, the prison hospital wing was no longer full of prisoners with mental illness and learning disabilities. This was a time when the local mental hospital was being run down for closure, so it was no small feat. Of course, some of our clients were very disturbed and a small number were dangerous, or had committed very serious offences so they had to stay in prison or be moved to a secure hospital but at least we knew who they were and where they were.  We advocated for them. They were not dumped and forgotten.

We shared our learning and even wrote a book about our approach which was replicated and adapted all over the country. It was cheap and effective because it made better collective use of existing individual professional skills, capacity and powers and partner agencies’ budgets.  It was about reducing demand, reducing costs and reducing re-offending – but most of all it was about reducing risk and suffering.

‘What’s not to like?’ you might ask and you’d be right but, somehow or other, twenty years later, police officers and mental health nurses are re-embarking on the same journey. Is it because mental health services are still the “Cinderella’ – and their budgets have been cut even when the rest of the NHS has had increases in funding? Is it because we are still so ignorant and fearful about mental illness? Or is it because innovation is generated by enthusiasts on short-term funding so it doesn’t get mainstreamed or embedded? Perhaps it is all of the above.

Whatever the reason, our collective inability to use the available evidence to guide our thinking and to take shared professional and organizational responsibility for public policy challenges means we are doomed to keep making the same mistakes.

When will we ever learn?

Catherine Staite

Catherine Staite is the Director of INLOGOV. She provides consultancy and facilitation to local authorities and their partners, on a wide range of issues including on improving outcomes, efficiency, partnership working, strategic planning and organisational development, including integration of services and functions.