Homelessness prevention by Medics Against Violence

Navigators in the Emergency Department

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The context

Research on health and homelessness in Scotland (2018) showed people’s interactions with health services increased in the period leading up to homelessness. This was especially true for presentations to the Emergency Departments (ED) due to injury, substance use or poor mental health. Hospital-based interventions, such as Navigator, which support individuals with multiple, complex needs who attend the ED, often as a direct result of violence, injury or substance use, could play a role in preventing violence/substance-related homelessness, as well as reducing re-attendance at the ED.

The intervention

Navigator was launched in the ED at Glasgow Royal Infirmary in 2015 and now serves nine hospitals in eight local authority areas. Funded by Scottish Government, NHS Trusts and ADPs, Navigator is managed and developed by the health-led charity, Medics Against Violence. Navigators are based in the unique environment of ED at its busiest times - including overnight and at weekends - to offer support to patients who have social, in addition to medical, needs. These include issues related to violence, including sexual violence, substance use, domestic abuse, poor emotional and mental wellbeing and homelessness. In many cases, people present with more than one issue, and their needs are complex.

Before Navigator, NHS staff treated the medical issue and discharged people - but often remained concerned about the circumstances they were returning to. ED staff lack the time and expertise to help patients address the complex social problems impacting on their lives. So many return to the ED repeatedly, seeing it as their place of last resort. Navigators aim to reduce that ‘revolving door’. They tap into the desire for change that often accompanies a person’s time in the ED - a ‘reachable moment’ - and turn it into action, with non-judgemental, motivational, holistic, emotional and practical follow-up support.

Many Navigators have relevant lived experience; some are specialists in substance use, domestic abuse or emotional wellbeing. They’ve got time to spend, and work hard to source the right support - understanding many people have tried things in the past that haven’t worked for them.

A Navigator’s work starts but doesn’t end in hospital. They’re well connected to local services and agencies, and have good understanding of the statutory systems people may be dealing with, such as housing, criminal justice or benefits. Navigators can people accompany to, or advocate for people with, these services, helping them make the right links. Then they work to empower people to navigate services themselves, staying involved for a handover period.

5-10% of Navigator patients (varies by hospital) have issues with ‘homelessness’ at presentation. Most of the rest have a mix of other issues which can lead to homelessness - like domestic abuse, substance use or issues with wellbeing. Where relevant, Navigators connect with private and social landlords, provide advice and assistance around finances and safety planning, and link in with domestic abuse services.  

The outcome

Navigator has provided support to over 5,000 people, up to April 2022. Rate of engagement is high, at around 70%. A study, focused on Glasgow, showed engagement with the service can reduce ED attendance. This fell by 24% in 12 months for those accepting Navigator support, whilst attendance rose by 15% in the same period for those who declined it. This suggests the additional layer of support started in hospital and continued in the community that Navigator provides can make a real difference to patient outcomes.

Intervening at a key moment and offering support where housing risk is an issue may also offer an opportunity to prevent homelessness - as well as many of the other social harms people experience.

Key insights

• having a service based within the hospital to which staff can refer appropriate adds an additional layer of care, as well as reducing pressure on NHS staff
• ‘being in the right place at the right time’ is a key element in Navigator’s success – opening up the possibility of change in different areas of a person’s life at a ‘reachable moment’
• interventions which address many aspects of complex lives may have less impact on reducing homelessness specifically - but their holistic approach engages with all the factors that contribute to and perpetuate it

Find out more…

Navigator, Medics Against Violence
info@mav.scot