Martlets is working in collaboration with the Community Homeless Team in Brighton to improve palliative and end-of-life support for those who are homeless and vulnerably housed. It’s important to reduce the misinformation around how people end up living on the streets. People who are homeless and vulnerably housed have often had traumatic lives. They may have had to cope with mental health illness. Repeated trauma and abuse experienced in childhood can affect people life-long. Substance misuse can seem to be a way of coping but impacts on physical health. Working collaboratively to support this group of patients with often high degrees of complex needs who develop life-limiting illness is crucial.

People who are homeless and vulnerably housed experience barriers to accessing healthcare. They may experience stigma and discrimination or not feel able to prioritise their health. Sometimes they may not want to engage with their health at all. Frontline staff not trained in healthcare can find this stressful. Consequently, symptoms may not be recognised so are less well managed. If someone is approaching the end of their life at a relatively young age, it may be difficult to recognise.

Martlets received a grant for a year-long project. Working with Brighton’s Community Homeless Team a two-hour teaching session has been created and delivered to frontline staff working with this group which includes:

• ‘Red Flag’ signs of deteriorating health, particularly important where there is a lack of information on someone’s health.

• Being young and frail.

• Considerations in pain management including total pain in the context of complex needs of mental health issues, socially being without a secure home and emotionally being estranged from family and the sense of guilt that may exist as a result.

• Understanding what palliative care support can offer.

Research by Dr Caroline Schulman and St Mungo’s in London has shown that educational support for frontline staff can help improve palliative support for those who are homeless and vulnerably housed (Shulman, Hudson, Kennedy, et al., 2018).