‘They already operated like it was a crisis, because it always has been a crisis’: a qualitative exploration of the response of one homeless service in Scotland to the COVID-19 pandemic

Abstract

Background The COVID-19 pandemic has necessitated unprecedented changes in the way that services are delivered to individuals experiencing homelessness and problem substance use. Protecting those at high risk of infection/transmission, whilst addressing the multiple health and social needs of this group, is of utmost importance. The aim of this novel qualitative study was to document how one service in Scotland, the Wellbeing Centre run by The Salvation Army, adapted in response. Methods Care was taken to identify methods that did not create additional stress at this pressured time. Semi-structured interviews were conducted with Centre clients (n = 10, in-person and telephone) and staff (n = 5, telephone), and external professionals (n = 5, telephone), during April–August 2020. These were audio-recorded, fully transcribed, and analysed using Framework. Service documents were used to enhance contextual understanding. Analysis was informed by theories of psychologically informed environments and enabling environments. Results The start of the pandemic was a time of confusion, disruption, and isolation. Centre staff rapidly adapted methods of engagement to provide a range of comprehensive physical and emotional supports, to both existing and new clients, through telephone and online communication and, eventually, socially distanced in-person support. This involved balancing the risks of COVID-19 infection/transmission with the benefits of continuity of support to those highly vulnerable to a range of harms. Whilst the pandemic created many challenges, it also facilitated removal of barriers, particularly concerning provision of harm reduction services which had previously been severely constrained. Clients described the Centre as a ‘lifeline’, providing stability and safety during a period of profound disruption when other services closed their doors. Strong leadership, intensive team working, support/training for staff, a focus on relationships, and active use of client feedback, enabled responsive adaptation to fast-changing demands and the creation of a ‘culture of care’. Conclusion This study provides a unique insight into the pandemic by analysing the response of one homeless service during the height of the pandemic. We present a range of implications that have international relevance for those designing policies, and adapting front-line services, to proactively respond to COVID-19 and the continued public health crises of homelessness and drug-related deaths.

“You know, we can change the services to suit the circumstances of what is happening in the world”: a rapid case study of the COVID-19 response across city centre homelessness and health services in Edinburgh, Scotland

“…Participants with lived/living experience discussed facing a raft of substantial existing challenges in their lives relating to mental health, losing care of children, isolation from family, social exclusion, substance use, disengagement from mainstream services, and imprisonment, amongst others. As described in our related paper [ 85 ], the lockdown period in general, but particularly the very early lockdown period, was characterised by feelings of confusion, anger, loss, and fear, which further exacerbated the social isolation that many experienced prior to the pandemic.…”

“…Data are organised into three overriding themes: the impact of COVID-19 on people who were experiencing homelessness and problems with substances, in particular the mental health implications and use of drugs and alcohol; the challenges of organisational and city responses to these needs; and opportunities presented by the pandemic. While our linked paper [ 85 ] presents data focused on the Centre’s organisational response to the pandemic, this current paper takes a wider perspective by providing insights into how the pandemic impacted individuals with multiple and complex needs, and the city centre’s response to COVID-19 more broadly. The three overriding themes are now presented below.…”

“…The methods are described in more detail in our linked paper [ 85 ] and are therefore briefly summarised below.…”

“…Framework is suited to policy- and practice-relevant research by providing a structured and transparent approach. More detail regarding data analysis of the transcripts and documents can be found in our linked paper [ 85 ]. Additional file 2 provides a glossary of terms used in the study and Additional file 3 includes a list of abbreviations used.…”

“…The Centre has a strong harm reduction ethos and provides a café, shower facilities, and various groups and social activities. The provision of harm reduction services changed in a range of ways in response to the pandemic, as detailed in our linked paper [ 85 ] where our team described the impact of the pandemic on those using the Centre and, most specifically, how the Centre adapted to the needs of their clients. In this current paper, we present our results from participant data concerned with wider issues including the mental health and substance use impacts of the pandemic and lockdown restrictions, and how individuals and organisations worked together across the sector/city centre to reduce risk of harms for those experiencing both homelessness and problems with substances.…”