Introduction

This study focuses on the assessment of the mental capacity of people who are experiencing multiple exclusion homelessness (MEH), a term used to capture the overlapping of a range of experiences associated with profound social exclusion, including not just homelessness but also institutional care, substance misuse, and ‘street culture’ activities.

Factors such as poor mental health, addiction, and the effects of adverse childhood experiences in this population mean that capacity assessments under the Mental Capacity Act 2005 (MCA) can be particularly challenging. Earlier research conducted at this Unit, which focused on adult safeguarding approaches to self-neglect among this population, brought into question the standard of practitioner approaches to these assessments.

This research will explore and analyse health and social care practitioner approaches to mental capacity assessments with people experiencing multiple exclusion homelessness in England. Findings from mixed-methods research will inform the co-production of a revised and tested specialist assessment tool for this population.

Read further on the NIHR page for this project.

Stephen Martineau introduces the study on the Unit blog (October 2023).

Methods

A scoping review of evidence will be accompanied by expert interviews with national experts and a survey of practitioners.

In-depth fieldwork across three contrasting study sites in England will include interviews with two stakeholder groups: practitioners and those with lived experience.

The research team will work with national stakeholder representatives, expert practitioners and PPI advisors to review and update a specialist tool for capacity assessment in this field. We will conduct a pilot testing and evaluation of the tool.

Funding

NIHR Health and Social Care Delivery Research (HSDR) Programme: NIHR154668

Timescale

October 2023 - March 2026

Research team

The main researchers on this project are Jess Harris (Research Fellow, KCL, and first point of contact for any enquiries about the study) and Stephen Martineau (Research Fellow, KCL). 

• Kritika Samsi (co-PI) is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce (HSCWRU) at King’s College London (KCL).
• Michelle Cornes (co-PI) is Professor of Health and Social Policy Inequalities in the School for Health and Society at the University of Salford, Visiting Professor at HSCWRU, and Senior Fellow at the NIHR School for Social Care Research.
• Stan Burridge brings lived experience of homelessness, addiction, mental ill health and a number of institutional settings. He leads a user-led organisation bringing the voices of diverse lived experiences of homelessness to shaping research, policy and practice.
• Alex Ruck Keene KC (Hon) is a barrister specialising in mental capacity and mental health law, and Visiting Professor at KCL.
• Nathan Davies is Associate Professor of Ageing and Applied Health Research and Deputy Director for the NIHR Research Design Service at UCL.
• Bruno Ornelas is Rough Sleeping Adviser at the Department for Levelling Up, Housing and Communities, and a homelessness Safeguarding Adults Review author.
• Alex Bax is Chief Executive of the homeless health charity, Pathway; with Samantha Dorney-Smith, Nursing Fellow, Pathway.

Lived experience Advisory Group (PPIE)

PPIE is led by Stan Burridge.

Collaborators

• Enabling Assessment Service London (EASL) is a team of multi-disciplinary mental health professionals working with MEH who are commissioned by local authorities and third sector organisations.
• Elizabeth Furber is an experienced mental health social worker in the field of homelessness, Approved Mental Health Professional, and Practice Educator and trainer on MEH and mental capacity.
• Fiona Bateman is a Safeguarding Adults Board Independent Chair, a solicitor focusing on health and social care for excluded populations, and Safeguarding Adults Review author. 
• Edge Training & Consultancy Ltd are specialists in training health and social care practitioners in the MCA.

Related work

Project

Opening the "too difficult box": Strengthening adult safeguarding responses to homelessness and self-neglect (2019-23)

Safeguarding Adults Review analysis

Martineau, S. J., Cornes, M., Manthorpe, J., Ornelas, B., & Fuller, J. (2019). Safeguarding, homelessness and rough sleeping: An analysis of Safeguarding Adults Reviews. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London.

Related projects at the Unit (2022-2023)

• Evidencing the social work role within responses to multiple exclusion homelessness
• Examining mental capacity approaches to multiple exclusion homelessness
• Addressing multiple exclusion homelessness in social work education
• Just another form of exclusion? Carrying out research with people experiencing multiple exclusion homelessness

See also

The Unit conducted a project examining social care responses to self-neglect and hoarding among older people. As well as fieldwork, this study published two evidence reviews, one on self-neglect (2021) and one on hoarding (2022).