Table 4 Quotes on system-related characteristics that hamper accessible or appropriate care

System is complicated

Q7

“It’s complicated finding the right organization as well. There are several options for your dole money or day care, for instance. Then there are the people from different situations, or from prison, where the probation service gets involved. Or there are people with addictions, where the addiction care service gets involved. Or the housing corporation – evictions or whatever – where a district team will sometimes have had a role too. And then you’ve got to find your way. So where do you start?” (P20, homeless outreach worker)

Conditions and requirements of organizations

Q8

“They’ve already said to start with that you should kick the drugs and then maybe we can help you with the mental problems. People can’t comply with those conditions – what’s going to replace them? They aren’t going to stop using because they’re suffering from sweaty feet. They’re going to keep using because they’re got an issue that they have to resolve, i.e. coping with daily life and the problem of what’s going on in their heads.” (P15, homeless outreach worker)

System is inappropriate

Q9

“Maybe it’s the level of education of the personal supervisors as well – that they’re simply not qualified enough to be able to deal with the entire spectrum of both mental and physical complaints. Ordinary staff, supervisors, they’re sitting there looking at a lump and wondering whether it means that a doctor is needed or not. They’re not really the people who should be dealing with those issues.” (P25, spiritual caregiver)

Time pressure of professionals

Q10

“The caregivers would also want to do more, but there simply isn’t the time. They only come along to tackle the issues of the moment and dole out medication. The homeless see perfectly well that they’re short of time too. They complain hugely about it, that the caregivers are often not really available.” (P25, spiritual caregiver)

Attitudes of professionals

Q11

“Many homeless people’s experience is that if they go anywhere – to a doctor or hospital or dentist – they get treated with a degree of suspicion.” (P4)

Noisy and busy shelters

Q12

“Some people actually find sleeping on the streets quite peaceful, because they think the care places are much too unsettled and too busy and too many other people snoring and far too much stuff that they don’t want.” (P8, spiritual caregiver)

Patronizing and lacking participation

Q13

“And one of these caregivers will then think, ‘I’m going to take you by the hand like a little kid and tell you how you have to do it.’ And if you do that to a fifty-year-old bloke who may have fought in a war or whatever, you’ll soon lose their respect. You mustn’t lay down the law for people. You can give them advice, though.” (P21, homeless outreach worker)