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Multiple and Complex Exclusion

VOICES case study 09

*Names have been changed to protect identity


Emma has a long history of rough sleeping and none engagement with services. There has been prolific offending, mainly with antisocial behaviour in and around the town centre. Emma is known to take substances and drink heavily when not in prison. Alongside her addictions Emma does suffer with poor mental health and it is believed there is a diagnoses of schizophrenia/personality disorder. Whilst in prison Emma’s mental health is stabilized with medication and once released no follow up appointments are kept due to Emma rough sleeping.

There is evidence to suggest that Emma may be exploited by others. She has no benefits in place and she states this has been the case for the past twelve months. Even though she has no income Emma can fund her habit. Also, Emma has been known to stay with males who have their own property and pay nothing towards the costs.

Emma is known to be abusive to services who are trying to support her needs. A lot of aggression and threats appear to be directed at female professionals. This results in Emma being excluded from most services.

Unfortunately, the lifestyle Emma leads results in her not getting to correct mental health support. Emma will miss appointments due to rough sleeping and her reluctance not to engage with services. Emma often finds herself with prison sentences and associates with other known addicts.

Emma has stayed in Hostel environments in the past but has been asked to leave due to her aggressive behaviour.

When Emma is rough sleeping it is very difficult to locate and work with her as she tends to move locations. Emma is known to squat in abandoned buildings or with males who have their own property.

Emma is often released from prison to no fixed address because the prison resettlement team can’t find accommodation due to exclusions and risks.

There is an ongoing cycle off Emma coming out of prison to no fixed address, causing anti-social behaviour or public order offences and being recalled back to prison with short sentences.

Emma’s decision making is influenced by multiple contexts that may impact each other, or be more or less dominant, depending on the decision that needs to be made at a particular time. Her circumstances mean that there are a variety of potential influences that may shape how she makes sense of information and how she understands the options that are made available to her. This case would require linking a variety of overlapping contexts so that staff charged with decision-making operate in a more fluid and flexible way.


  • An offer of temporary accommodation to reduce immediate harm (preferably not a hostel) or immediate permanent housing via a ‘Housing First’ approach. (has now been accepted with housing first)
  • Referral/Engagement with the Early Intervention Team. Appoint a Mental Health worker to work Emma. Miss Emma’s preference is for a male worker.
  • Any assessment will need to be appropriate and proportionate about Emma’s circumstances and consideration given to any fluctuating needs.
  • Adult Social Care to conduct an assessment as per the requirements of s9 of the Care Act 2014
  • If Emma is placed in custody or admitted to hospital then it may be a critical time for agencies to intervene/engage prior to discharge/release.
  • Correct benefits in place

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