Frontline homelessness workers are experiencing psychological distress, grief, heightened stress and burnout as they support growing numbers of people in increasingly complex circumstances, new research has found.

A systematic review led by the University of Stirling found repeated exposure to the deaths of people using homelessness services can have a significant and lasting impact on staff.

Researchers say more structured, evidence-based support is needed to protect workers’ wellbeing and reduce the risk of burnout and people leaving the sector.

The study, funded and commissioned by The Salvation Army, examined existing research into the experiences of staff working with people facing homelessness, chronic ill health, substance use and an increased risk of premature death or fatal overdose.

Researchers from the University of Stirling-based Salvation Army Centre for Addiction Services and Research analysed six previous studies involving around 400 participants.

Workers reported relying on formal and informal support from their organisations, alongside their own coping strategies such as setting boundaries. However, the review identified a lack of formal interventions specifically designed to address the psychological impact of repeated exposure to client deaths.

Jessica Greenhalgh, Research Assistant at the University of Stirling and lead author of the review, said the relationship between workers and the people they support made their experiences distinct from those of many other frontline professions.

“These workers are in a different position to emergency workers, as the people they support are usually known to them, from repeated interactions,” she said.

“It is imperative that structured, evidence-based support is provided to these staff, to avoid the risk of stress, burnout and staff leaving their jobs – especially at a time when homelessness is such a mounting public and political concern.”

The Salvation Army said the findings reinforced the importance of considering the wellbeing of staff as part of a wider harm reduction approach.

Lee Ball, its Director of Addictions, said: “When someone dies, it hurts. That’s the simple truth. What this review does so well is give voice to the grief, stress and emotional weight that can come with frontline work.

“Our staff are our most valuable asset. If we want compassionate, relationship-based support for people experiencing homelessness, poor mental health, substance use and sometimes trauma, we must be just as committed to caring for the people who provide it.”

The findings come amid renewed political focus on homelessness.

Prime Minister Andy Burnham made ending rough sleeping one of his first priorities after entering Downing Street on 20 July, initially announcing an additional £340m for a national drive to tackle the issue. The government has since increased the overall package to £442m, with a goal of offering everyone sleeping rough a route off the streets this winter.

The pressures on services remain significant. The latest cross-UK analysis from the Office for National Statistics showed households assessed as homeless and owed settled accommodation had reached their highest levels in at least six years in England, Scotland and Wales.

It also recorded historically high numbers of households living in temporary accommodation, including around 117,400 in England, 16,300 in Scotland and 6,400 in Wales at the end of March 2024.

The review argues that, alongside tackling homelessness itself, organisations need to recognise the emotional impact of delivering frontline services and ensure staff have appropriate support to deal with grief, trauma and repeated exposure to death.

The paper has been published in the Journal of Social Distress and Homelessness.