Homelessness is often more than a lack of housing and can overlap with other issues, such as  substance use, offending, and poor mental health. This is sometimes known as ‘severe and multiple disadvantage’ (SMD). Understanding the scale of SMD and the extent of overlap between issues can help when planning services to help people with complex needs.

Several studies of SMD exist in Great Britain. Of primary interest has been the overlap of homelessness, offending, and substance misuse (SMD3). Some studies of SMD have also included mental health and domestic violence (SMD5). An estimated 58,000 people interacted with substance use, criminal justice and homelessness systems in England in 2010/111. In Scotland, research has estimated that 5,700 people experienced the same three disadvantages in 20152. No such estimates of SMD in Wales exist, and this is where our analysis comes in.

Using data linkage, we have been able to estimate the overlap of homelessness and substance misuse in the City and County of Swansea. We combined the Substance Misuse Data Set Wales and data from the City and County of Swansea housing team. Our analysis looked at unique people accessing services between April 2014 and March 2016.

We suggest that having housing support formally embedded in substance misuse services may benefit people’s recovery.

We found that 5,420 people had accessed either the housing team or substance misuse service. Of these, 7%, or 400 people, were interacting with both service types. Examining the overlap of access to substance misuse services and the housing team highlights two things of relevance to service planning. One in 10 people accessing the housing team had also accessed a substance misuse service, yet roughly one in five people accessing a substance misuse service were also accessing the housing team. We therefore suggest that having housing support formally embedded in substance misuse services may benefit people’s recovery.

Future analysis will include attendance at hospitals and General Practitioners for substance misuse related issues. South Wales Police data and General Practice data will also be linked. These extra data sources will improve estimates of substance misuse and help explore other dimensions of SMD, including offending, domestic violence, and mental health issues.

You can find out more about this work on the project page.


[1] Bramley, G. and Fitzpatrick, S. (2015) Hard Edges: Mapping severe and multiple disadvantage, England. London: Lankelly Chase Foundation

[2] Bramley, G. et al. (2019) Hard Edges Scotland. London: Lankelly Chase Foundation