A £262 million government programme expanded rough sleeper substance treatment to nearly 20,000 people across England last year. New findings reveal both what worked and what still needs to change.

The evaluation covers the Rough Sleeping Drug and Alcohol Treatment Grant (RSDATG), published this month by Ipsos, Groundswell, and Dr Stephen Green of Sheffield Hallam University. The Office for Health Improvement and Disparities (OHID) and the Ministry of Housing, Communities and Local Government (MHCLG) commissioned the review.

What the Rough Sleeper Substance Treatment Grant Set Out to Do

Between 2021 and 2025, the government invested up to £262 million across 83 local authorities in England. These areas carried the highest need. The goal was clear: strengthen rough sleeper substance treatment for people at serious risk, and cut drug and alcohol related deaths among this group.

Substance misuse is both a cause and a consequence of homelessness. People without stable housing face far greater barriers to treatment. Existing services have not always been designed with their complex needs in mind. The grant gave local areas the flexibility to build on existing provision and fill the gaps.

The Numbers Behind the Results

In 2024/25 alone, RSDATG funded services supported 19,614 people. Around 31% were sleeping rough at the time. A further 69% were at risk of doing so. That shift towards prevention is one of the programme’s most important achievements.

Of those engaged, 85% entered treatment. Roughly half had no prior treatment contact before reaching RSDATG funded services. For many, this was their first real point of access to support.

Over the year to June 2025, 1,273 people completed treatment. A further 2,611 people substantially reduced or stopped problematic substance use. For each person behind those figures, the change is significant.

How Homelessness and Addiction Support Reached the Hardest to Reach

Effective substance misuse support here was rarely about a single intervention. It came down to a joined up, human approach.

Services went to where people were rather than expecting them at fixed appointments. Small caseloads, assertive outreach, flexible drop ins, and rapid scripting brought support directly to people. Many had previously fallen through the cracks of mainstream provision.

Services also built consistent relationships and used trauma informed practice. Workers helped people with physical and mental health needs, ID documents, GP registration, and housing access. That practical wraparound support kept people engaged.

Multi disciplinary teams (MDTs), co location of workers from different agencies, and better data sharing connected drug and alcohol treatment services more effectively with housing, health, and criminal justice.

Harm Reduction and Saving Lives

Despite rising risks from synthetic opioids, areas consistently reported that the RSDATG slowed increases in drug related deaths. Outreach workers, rapid scripting, Naloxone distribution, and safer use messaging all contributed.

For people in chaotic circumstances, staying alive and connected to services is meaningful progress in itself. Recovery is a long road. Getting someone stable enough to take the first steps matters.

Where the System Still Falls Short

The evaluation is frank about the barriers that held the programme back.

Mental health was the most significant unmet need. Services reported turning people away despite many areas funding dual diagnosis workers to bridge the gap. The disconnect between mental health and substance misuse services is a serious structural failure that commissioners must address.

Housing proved equally stubborn. Shortages of abstinence supported and women only accommodation limited progress on housing outcomes. Without a safe place to move on to, people who made real gains in treatment struggled to hold onto them.

Spending also focused heavily on community based treatment and wraparound support over detox and rehab. Access to detox and rehab did grow over time, but building those pathways took longer than expected.

A Programme Worth Sustaining

The evaluators are honest: the benefit cost ratio is lower than first projected. The cohort had complex needs and required intensive ongoing support. Treatment completion rates stayed relatively low. But that is not the whole story.

This programme reached people who had cycled through crisis for years without sustained help. Bringing a higher need cohort into rough sleeper substance treatment, strengthening local systems, and building workforce capacity is genuine progress. The moral and public health case for continued investment is strong.

The evaluation calls for future funding to maintain outreach led, trauma informed teams, embed MDTs and data sharing, invest in move on housing, and reinforce NICE guidance on co occurring conditions. The flexibility that let areas tailor services to local need was a key factor in what worked. Future programmes should preserve it.

For commissioners and local authorities, the lesson is simple. Early intervention, persistent outreach, and joined up homelessness and addiction support are not optional extras. They prevent crises from becoming catastrophes.

Source: dbrecoveryresources