“A sticking plaster over a burst artery” An explanatory theory of moral distress: Frontline workers experience of supporting rough sleepers with a mental illness through austerity, welfare reform and the COVID-19 pandemic.

For a decade, prior to the COVID-19 pandemic, frontline homelessness workers in England have worked within national and local policies of welfare reform and austerity, within which there was a major cut to public spending. After the COVID-19 outbreak frontline workers began working within policies relating to the pandemic and homelessness. There is little empirical research on how these policies have impacted frontline workers who support rough sleepers with a mental illness as previous research focuses on people experiencing homelessness and/or mental illness during austerity and welfare reform, rather than the experience of the frontline homelessness worker. The purpose of this empirical research was to explore the experiences of homelessness frontline workers supporting rough sleepers with a mental illness post austerity, welfare reform and during the COVID-19 pandemic in the Midlands geographical area. Using a constructivist grounded theory approach, ten frontline workers, who worked within a variety of statutory and third sector organisations, took part in sixteen semi-structured interviews. The study offers an explanation of how working within welfare reform, austerity and COVID-19 has affected frontline workers who support rough sleepers with a mental illness. An explanatory theory of moral distress was co-constructed with the research participants. The frontline workers worked within disconnected systems across, housing, health, social care and the department of work and pensions, with the COVID-19 pandemic exacerbating this. They were frequently restricted in supporting their service users as they saw fit. This caused them to experience moral distress. The findings have significance going forward as due to the cost-of-living crisis, homelessness may increase, and planned cuts to public services will put additional pressure across housing, health, and social care services, which in turn will impact on homelessness organisations and frontline workers in the sector. If this does occur without any increase to funding to homelessness and mental health services, along with changes to policy and legislation, frontline workers will be under even higher risk of experiencing moral distress.