Harm reduction in homelessness services: evaluating Simon Community Scotland’s Safer Spaces approach: Follow-on fund

Scotland has one of the highest substance-related death rates in Europe. Drug deaths are recognised as a main contributor to Scotland’s falling life expectancy, and substance-related deaths are far more common in Scotland now than they were two decades ago. Those with experiences of homelessness are at a much higher risk of negative outcomes from substance use than the general population. In this context, understanding how to support those experiencing homelessness who use drugs could potentially save lives.
There is a growing body of evidence on the effectiveness of harm reduction (HR) approaches to reduce negative outcomes associated with drug use. HR refers to policies and programmes focused on the prevention of drug-related harm rather than the prevention of drug use. These approaches have been trialled in various settings internationally.
However, while the use of HR in general has a strong evidence base, HR approaches in homelessness services have been studied less. This is a significant evidence gap, particularly in Scotland, where substance use related harms and deaths reflect disparities in health and social outcomes. The potential policy impacts of evaluating HR approaches for homelessness services in Scotland are considerable.
Simon Community Scotland (SCS) are a homelessness organisation in Scotland who have recently started using the Safer Services approach in their emergency and supported accommodation for women. Women’s drug deaths in Scotland have increased at a greater rate than men’s recently (Tweed et al., 2018), and although often not visible in the homelessness population, the risks of the double jeopardy of drug use and homelessness are heightened for women (Reeve, 2018; Neale, 2001).  SCS’s objective is to reduce drug related harms and deaths and to ‘promote safety and wellness over any requirement to stop or not use drugs’. They report seeing early indicators of the benefits of this approach.
During the first stage of the Evaluation...