Table 5 Quotes on suggestions for making care more accessible to homeless people who avoid care

Characteristics of homeless people

Tailored care

Q1

“Wouldn’t it be nice if the care system could offer more tailored solutions, saying ‘What would help you? And how can we work together so that here’s a place where you can get it. Get what would help you.’ Within reason, of course, but without saying it’s our way or the highway. Instead, you say there’s supervision but we’ll take a look at things with you to see what’s the best way of arranging it. So that it works for you.” (P1, street pastor)

Building relationships

Q2

“Suppose I’ve found you and you very often sit at a particular time on a certain bench in the part, ‘cos that’s where you are with your two bags. Well, then you’ve not got to start by saying, ‘Come along with me.’ No, I think you’ve first got to ask if you can sit there with them. And maybe you don’t say anything else to start with. Getting someone to come and do what you want is still a long way down the road at that point.” (P19, spiritual caregiver)

Setting limits, but no rejection

Q3

“We speak to people about their behaviour, we apply sanctions, but there’s one thing that we always make clear: you can always come back again. So it’s crucial that they know that the relationship will never be put under pressure. It can therefore mean that we ban people ten times, that they do something wrong ten times, but you can always come back again.” (P13, homeless outreach worker)

Humanity, dignity and equality

Q4

“It’s pretty awkward for them; they’re never normal. So, well, they need in some way or other to be able to give and get something back. And so that they’ve got lots of skills and things that they can use, even if they are care avoiders.” (P23, homeless outreach worker)

Characteristics of the system

Clear information, explanation and communication

Q5

“Just be honest about it, like ‘It’s not possible right now with these waiting lists, but we’ll see what steps we can take that will really help you.’ And being straight up: ‘I can make this or that agreement with you now that we’ll take a look, because you want something to do. Right, I can call them now and see if there’s a place and I’ll call you, make an agreement with you, such and such a place and time, that’s when you’ll get the details from me.’ Short timelines, clear communication and clear agreements.” (P27, formerly homeless person)

Change of policy and legislation regarding to available time

Q6

“My experience is that individual care providers are genuinely motivated, but that it’s often the structures of the institutions – imposed by legislation and regulations and driven by costs above all – that make it tricky. So it’s not the individual care providers, because they’re people who are really trying [to make the process less complex, more accessible, working from a relationship of trust, looking to see what the person themselves needs, communicating in understandable terms]. But, well, we need to set up the legislation and regulations and the funding so that it’s possible.” (P3, spiritual caregiver)

Quiet shelters

Q7

“All the crisis shelters are in groups: several people sleeping in the same room. And it’s difficult there, it’s sometimes difficult to tailor the care there to suit... there’s just too little money for it, actually. A crisis shelter like that, there are just two of them for sixty people, so there’s no chance for any one-on-one supervision or whatever.” (P21, homeless outreach worker)

Attitude and treatment by professionals

Q8

“We go to the station at five in the morning, at the times and moments that really suit them and not just during office hours. Care avoiders are often up and about at night, and they’ll sleep during the day, simply because sleeping in the daytime is safer. The other thing we do is start normal conversations with these people. So it’s not like ‘What do you need to get out of this situation’, but ‘How was your day? What are you going to do?’ And don’t think people won’t appreciate it, that it’s not part of the world they live in: it’s very much in their kind of world, because all day long they’ve got a caregiver or a cop or a guard hassling them, and never a normal person with a normal conversation.” (P15, homeless outreach worker)

Self-reflection of professionals

Q9

“The caregivers also have to take a bit of a critical look at themselves. Like, well, I can’t do this; it isn’t working; there’s no click. We’re not making contact. So keep hacking away at those knots, and you mustn’t see it as failure.” (P27, formerly homeless person)