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A JSNA deep dive for Bracknell Forest
Multiple disadvantage or multiple complex needs commonly describes the experience of facing several interconnected and compounding needs linked to social exclusion. While definitions vary across programmes and policy frameworks, there is a shared recognition that these intersecting health and social support needs can reinforce each other and together, create barriers to health, wellbeing and social participation.
Lankelly Chase Foundation’s Hard Edges Report1, defined severe and multiple disadvantage (SMD) as some combination of homelessness, substance misuse, mental-ill health and offending behaviour. The Changing Futures programme includes those experiencing three or more of the following five: homelessness, substance misuse, mental health issues, domestic abuse, and contact with the criminal justice system.2 The programme provided funding for local systems to develop more joined-up responses.
People experiencing multiple disadvantage experience significant health inequalities. The average life expectancy of people experiencing homelessness is significantly shorter than the general population (43 years for women and 45 years for men).3 Evidence also suggests that they experience high rates of physical health conditions including cardiovascular disease (CVD), diabetes and chronic lung disease.4 Early onset of frailty is also found in people experiencing homelessness.5
Without appropriate and sustained support, these needs can be increasingly entrenched. This leads to significant system-wide consequences such as disproportionate use of emergency services, acute hospital care and the criminal justice system.1 Alongside the individual drivers of multiple disadvantage, this chapter identifies a number of systemic factors including eligibility thresholds, silo working, missed opportunities as a result of loss to follow up at key transition points that shape whether needs are identified and responded to effectively as opposed to escalation to crisis.
A locally agreed definition enables agencies to identify needs consistently, share data appropriately, and commission services coherently.
This JSNA provides a snapshot of the prevalence of people with SMD by triangulating data made available by key services supporting individuals experiencing or at risk homelessness and substance misuse teams.
Addressing multiple disadvantage has become an increasingly prominent focus of national policy over the past decade, recognising that traditional siloed service models are poorly equipped to meet the needs of people facing compounding and entrenched challenges.
Relevant local policies in Bracknell Forest include:
The scale of multiple disadvantage in England is significant, though estimates vary depending on the definition applied. The Lankelly Chase Foundation’s Hard Edges report estimates that around 160,000 people in England experience severe and multiple disadvantage (SMD) at any one time. This is defined as the co-occurrence of homelessness, substance misuse, mental ill-health, and offending. This figure is widely regarded as a conservative estimate, as it captures only those whose needs are visible to services, and excludes the substantial hidden population whose co-occurring needs have not been formally identified or recorded.
The following figures establish the scale of need across each of the four core domains of multiple disadvantage in Bracknell Forest. Where local data is available it is presented alongside regional and national comparators; where local data is absent or pending, national prevalence estimates are presented, and the evidence gap is noted.
The table below provides the details of statutory homelessness figures for Bracknell Forest compared with South-East and England.11
| measure | Bracknell Forest | South East | England |
|---|---|---|---|
| Threatened with homelessness (owed prevention duty) | 300 | 23,080 | 147,870 |
| Homeless (owed relief duty) | 129 | 20,950 | 182,540 |
The Council’s Homelessness and Rough Sleeping Strategy (2021-2026) provides important context for understanding the scale and nature of housing needs locally. The strategy highlights homeless applications rising from 573 households in 2019/20 to 735 in 2020/21.
Domestic abuse was the third highest cause of homelessness in Bracknell Forest, with cases more than doubling from 38 in 2019/20 to 83 in 2020/21.
The most recent data suggest a steady increase in the rate of households living in temporary accommodation nationally though this has remained stable in Bracknell Forest.11
| period | Bracknell Forest | South East | England |
|---|---|---|---|
| 2023/24 Q4 | 2.96 | 5.34 | 4.85 |
| 2024/25 Q1 | 2.94 | 5.64 | 5.08 |
| 2024/25 Q2 | 3.07 | 5.78 | 5.20 |
| 2024/25 Q3 | 3.13 | 5.74 | 5.28 |
| 2024/25 Q4 | 3.19 | 6.03 | 5.37 |
| 2025/26 Q1 | 2.86 | 5.62 | 5.38 |
| 2025/26 Q2 | 3.03 | 6.59 | 5.51 |
| 2025/26 Q3 | 2.92 | 5.94 | 5.49 |
Roughsleeping snapshot data shows that the number of people experiencing rough sleeping in Bracknell Forest has decreased significantly following Covid-19 and the ‘Everyone In’ scheme.12
| month | England | South East | Bracknell Forest |
|---|---|---|---|
| 2020-10-01 | 8.3 | 8.5 | 4.9 |
| 2020-11-01 | 9.5 | 9.8 | 4.1 |
| 2020-12-01 | 8.4 | 8.5 | 1.6 |
| 2021-01-01 | 7.8 | 6.9 | 4.8 |
| 2021-02-01 | 7.0 | 6.3 | 7.2 |
| 2021-03-01 | 7.0 | 5.5 | 7.2 |
| 2021-04-01 | 6.9 | 5.6 | 1.6 |
| 2021-05-01 | 7.5 | 6.3 | 0.8 |
| 2021-06-01 | 8.4 | 7.9 | 3.2 |
| 2021-07-01 | 8.7 | 8.2 | 2.4 |
| 2021-08-01 | 8.9 | 8.0 | 3.2 |
| 2021-09-01 | 9.3 | 9.1 | 4.8 |
| 2021-10-01 | 9.2 | 9.0 | 5.6 |
| 2021-11-01 | 9.8 | 9.9 | 5.6 |
| 2021-12-01 | 8.2 | 8.6 | 5.6 |
| 2022-01-01 | 7.2 | 6.9 | 7.1 |
| 2022-02-01 | 7.0 | 7.2 | 3.9 |
| 2022-03-01 | 8.1 | 8.0 | 3.9 |
| 2022-04-01 | 8.1 | 8.8 | 5.5 |
| 2022-05-01 | 9.2 | 9.9 | 4.7 |
| 2022-06-01 | 9.7 | 10.7 | 3.1 |
| 2022-07-01 | 11.1 | 12.1 | 2.4 |
| 2022-08-01 | 11.7 | 12.7 | 3.1 |
| 2022-09-01 | 11.6 | 13.0 | 3.1 |
| 2022-10-01 | 11.2 | 12.3 | 2.4 |
| 2022-11-01 | 11.8 | 12.1 | 3.1 |
| 2022-12-01 | 10.5 | 10.2 | 5.5 |
| 2023-01-01 | 9.6 | 10.0 | 2.3 |
| 2023-02-01 | 9.2 | 10.2 | 3.9 |
| 2023-03-01 | 10.9 | 11.2 | 2.3 |
| 2023-04-01 | 9.7 | 9.3 | 3.9 |
| 2023-05-01 | 11.4 | 11.2 | 4.6 |
| 2023-06-01 | 12.5 | 12.7 | 10.1 |
| 2023-07-01 | 12.8 | 13.3 | 5.4 |
| 2023-08-01 | 13.7 | 13.9 | 10.1 |
| 2023-09-01 | 14.6 | 14.3 | 10.1 |
| 2023-10-01 | 14.6 | 13.8 | 7.7 |
| 2023-11-01 | 15.0 | 13.9 | 5.4 |
| 2023-12-01 | 12.2 | 11.4 | 1.5 |
| 2024-01-01 | 12.7 | 11.6 | 6.1 |
| 2024-02-01 | 12.0 | 12.0 | 8.4 |
| 2024-03-01 | 12.6 | 11.7 | 7.6 |
| 2024-04-01 | 13.6 | 13.3 | 10.7 |
| 2024-05-01 | 14.0 | 13.5 | 9.2 |
| 2024-06-01 | 14.2 | 14.2 | 6.9 |
| 2024-07-01 | 15.9 | 15.7 | 10.7 |
| 2024-08-01 | 15.4 | 14.9 | 9.2 |
| 2024-09-01 | 15.3 | 15.0 | 9.2 |
| 2024-10-01 | 15.2 | 14.7 | 10.7 |
| 2024-11-01 | 15.8 | 14.9 | 5.4 |
| 2024-12-01 | 12.8 | 11.4 | 7.6 |
| 2025-01-01 | 13.1 | 11.5 | 3.8 |
| 2025-02-01 | 12.0 | 10.3 | 6.9 |
| 2025-03-01 | 13.2 | 11.2 | 6.9 |
| 2025-04-01 | 13.6 | 12.0 | 11.5 |
| 2025-05-01 | 14.7 | 13.5 | 13.8 |
| 2025-06-01 | 14.9 | 14.2 | 7.6 |
| 2025-07-01 | 16.3 | 16.2 | 6.9 |
| 2025-08-01 | 15.6 | 15.6 | 4.6 |
| 2025-09-01 | 15.9 | 15.5 | 6.1 |
| 2025-10-01 | 15.6 | 14.8 | 9.2 |
| 2025-11-01 | 15.7 | 14.7 | 5.4 |
| 2025-12-01 | 13.6 | 13.0 | 6.1 |
| 2026-01-01 | 13.3 | 11.9 | 7.6 |
| 2026-02-01 | 12.4 | 11.2 | 7.6 |
| 2026-03-01 | 12.9 | 11.4 | 6.1 |
Nationally, it is estimated that around one in four adults will experience a mental health problem in any given year. Common mental health disorders (including depression and anxiety) affecting approximately 17% of the adult population in 2007 have increased to 22% in 2023/24.13 Fingertips provides indicators relating to local prevalence of mental health needs:
| period | Bracknell Forest | South East | England |
|---|---|---|---|
| 2017/18 | 3,770 | 4,741 | 5,948 |
| 2018/19 | 4,323 | 5,183 | 6,672 |
| 2019/20 | 4,971 | 5,590 | 6,881 |
| 2020/21 | 5,086 | 5,652 | 6,827 |
| 2021/22 | 6,195 | 6,283 | 7,942 |
| 2022/23 | 6,461 | 6,242 | 8,117 |
Nationally, it is estimated that there are approximately 311,000 opiate and/or crack cocaine users15 and around 608,000 with alcohol dependence in England16. In the South East, the estimated rates are 6.3 per 1000 population and 11.6 per 1000 population respectively.
The Drug and Alcohol Health Needs Assessment found the estimated unmet alcohol treatment need in Bracknell Forest in 2023/24 was 75.1%. For drug dependency, the rate of unmet need was 67% which was notably higher than the England average of 54%. These suggest that the population experiencing the most entrenched substance use needs is largely not visible to treatment services but are likely presenting in other parts of the system such as housing, social care and acute healthcare in crisis.
Hospital admission rates for alcohol-specific conditions in Bracknell Forest stand at 393 per 100,000 population in 2023-24, compared with 521 per 100,000 in the South East region and 612 per 100,000 in population in England.
Deaths from drug use in Bracknell Forest in 2022-24 is 4.0 per 100,000 compared with 4.5 and 5.8 per 100,000 population in South East and England respectively.
Police data from 2025/26 indicates a crime rate of 55.83 per 1,000 population in Bracknell Forest compared to 70.82 per 1,000 in South East.17 Figure 5 below shows the time series of the reoffending levels in Bracknell Forest compared to South East and England.
| period | Bracknell Forest | South East | England |
|---|---|---|---|
| 2016/17 | 19.9 | 27.6 | 29.2 |
| 2017/18 | 20.3 | 27.6 | 29.1 |
| 2018/19 | 18.5 | 24.9 | 27.9 |
| 2019/20 | 16.8 | 22.2 | 25.4 |
| 2020/21 | 17.2 | 21.6 | 24.1 |
| 2021/22 | 21.9 | 22.8 | 25.0 |
| 2022/23 | 21.4 | 23.8 | 26.2 |
| 2023/24 | 23.5 | 25.6 | 28.1 |
Local data on the profile and volume of adults in contact with the criminal justice system with co-occurring needs is currently limited, and is identified as a priority evidence gap for this chapter (see recommendations).
Dashboard — link to come A Power BI dashboard covering multiple disadvantage will be published alongside this chapter. The link will be added here once it is live.
National research consistently demonstrates that these domains rarely occur in isolation.
The Homeless Link Health Needs Audit provides one of the most comprehensive pictures of co-occurring need among a population experiencing homelessness:
The Gender Matters report18 highlights that the most common combination of domains of disadvantage in women are being a victim of violence/abuse and poor mental health and poor mental health and substance use in men.
This section provides an overview of what we know about co-occurring needs in our population.
The domains are presented separately for clarity and to assist commissioners and practitioners in navigating to areas most relevant to their own service context. Each subsection includes, where evidence allows, an account of how that domain intersects with others and the local consequences of these interactions appear to be. When reading, it is essential to acknowledge them as deeply interconnected. Substance use shapes and is shaped by mental health. Likewise, housing instability drives and is driven by addiction or offending, contact with criminal justice can deepen poor mental health.
Stakeholders from different services often highlight that systems are often designed around single presenting needs and as a result, fail to respond effectively leading to entrenched and cyclical patterns of disadvantage.
Drug and alcohol dependency are significant drivers of multiple disadvantage locally. The relationship between substance use and other forms of disadvantage including homelessness, mental-ill health, and offending is well established nationally.
Using available NDTMS data on new presentations, indicators which suggest multiple disadvantage include:
People experiencing multiple disadvantage often have poorer sexual and reproductive health outcomes than the wider population. Substance use, homelessness, poor mental health and experiences of exploitation or domestic abuse can increase vulnerability to sexually transmitted infections (STIs), blood-borne viruses (BBVs), unplanned pregnancy and poor access to preventative healthcare.
Smoking prevalence is substantially higher among people experiencing multiple disadvantage than in the general population and contributes significantly to preventable illness, disability and premature mortality
The relationship between housing instability and other forms of disadvantage including substance use, mental ill-health, domestic abuse, offending and poverty is bidirectional. Insecure housing worsens health and social outcomes while poor health and social circumstances impact on their ability to secure and maintain accommodation.
Professionals highlighted that homelessness is a symptom of cumulative disadvantage rooted from unaddressed needs such as trauma and mental health problems.
Insights from the housing needs register (4 years combined 2022 to 2025) show that:
The intersection of substance use and mental health is an area of particular local concern. Research indicates that around 70% of people in community drug treatment and 86% of those in alcohol treatment experience co-occurring mental health problems. Death by suicide is also common, with a history of alcohol or drug use recorded in 54% of all suicides among people with mental health problems.19
In 2024, 70% of those entering Bracknell Forest’s drug and alcohol treatment service were identified as having a mental health problem, and 77% of these were receiving some mental health treatment. The Drug and Alcohol Health Needs Assessment notes this is an improvement on previous years which needs to be sustained. The needs assessment also highlights that continuity of care and effective joint working between services remain essential to maintaining this. In recognising this need, a dual diagnosis worker, jointly funded by DAAT and CMHT and joint protocol/pathway have recently been made available.
Evidence gap The local evidence base on the prevalence of mental health need within the broader multiple disadvantage population remains limited, with available figures largely drawn from drug and alcohol treatment data and therefore likely to underestimate true co-occurring need. In future, systematic analysis of service-level data held across mental health, primary care, housing, and drug and alcohol services and, where information governance allows, linkage between these datasets is recommended to build a fuller local picture.
Research consistently shows that people in contact with the criminal justice system (CJS) have disproportionately high rates of drug and alcohol dependency, mental ill-health, housing instability and experience of trauma.
An independent review of drugs in 2021 by Dame Carol Black estimated that people with serious drug addiction occupy 1 in 3 prison places.20 For offenders serving custodial sentences of less than 12 months, it was identified that in 2023, around 60% had a drug misuse need, 39% had an alcohol misuse need, and 70% have a significant level or some level of psychological problems.21 Release from custody is a period of vulnerability and without stable housing, continuity of care and connection to community support, the risk of returning to offending, homelessness and substance use if elevated.
In 2024/25, only 34.2% of adults across West Berkshire, Wokingham and Bracknell Forest with substance misuse treatment need to successfully engage in community based structured treatment following release from prison which is significantly below the England average.
Locally, the picture of adult offending and its intersection with multiple disadvantage is an area where the evidence base requires strengthening. The Bracknell Forest Youth Justice Plan 2024-2027 provides useful recent intelligence on the youth justice population, noting that there was no reoffending among the 2022-23 cohort of 21 children. The plan anticipated an increase in reoffending in 2024 following an increase in the proportion of Children Looked After (CLA) in the cohort. An independent review ‘In Care, Out of Trouble’, found CLA are significantly over-represented in the criminal justice system and in custody, highlighting the need for a focused and coordinated effort to reduce the risk of entering the CJS and reoffending.22
The Bracknell Forest Community Safety Partnership (CSP) Plan 2025–2028 identifies serious violence, domestic abuse, antisocial behaviour, and hate crime as strategic priorities. The CSP’s Serious Adult Violence and Exploitation (SAVE) group manages and supports habitual knife carriers, safeguards adults at risk of serious violence and exploitation, and tackles problematic hotspot locations, representing an important operational interface with the multiple disadvantage population. The CSP also oversees Multi-Agency Public Protection Arrangements (MAPPA) for the management of the highest-risk offenders, and the Multi-Agency Risk Assessment Conference (MARAC) for high-risk domestic abuse cases.
The CSP’s 2024 domestic abuse needs assessment found over 2,500 reports of domestic abuse to police in Bracknell Forest in the preceding year, described as one of the highest types of crime recorded in the borough. Domestic abuse sits at the intersection of multiple disadvantage in complex ways as both a cause and consequence of housing instability, mental ill-health, and/or substance use and the scale of this locally is a significant concern.
Evidence gap It should be noted that the prevalence of co-occurring needs among those in contact with the criminal justice system, and the effectiveness of transition support at the point of release from custody is currently limited within this JSNA chapter. This is a recognised evidence gap. Engagement with the Community Safety Partnership, Thames Valley Police, the Probation Service, and the Reconnect Care After Custody service is recommended to develop a fuller local picture.
Alongside individual and social drivers described above, there are a number of reported challenges highlighted in the stakeholder engagement that shape the experience of people experiencing multiple disadvantage in Bracknell Forest:
Lankelly Chase Foundation (2015) Hard Edges: Mapping severe and multiple disadvantage. Available at: online↩︎
Ministry of Housing, Communities and Local Government (2020) Changing Futures: changing systems to support adults experiencing multiple disadvantage: Prospectus for local Expressions of Interest (EoIs). Available at: online↩︎
ONS (2022) Dataset: Deaths of homeless people in England and Wales. Available at: online↩︎
Atsunori N et al (2020) Prevalence, incidence, and outcomes across cardiovascular diseases in homeless individuals using national linked electronic health records, European Heart Journal, Volume 41, Issue 41, 1 November 2020, Pages 4011–4020↩︎
Cronin T et al (2025) Prevalence and risk factors of frailty in people experiencing homelessness: A systematic review and meta-analysis. J Frailty Aging. 2025 Apr;14(2):100029.↩︎
HM Government (2021) From harm to hope: A 10-year drugs plan to cut crime and save lives. Available at: online↩︎
DLUHC (2022) Ending Rough Sleeping for Good. Available at: online↩︎
NICE (2022) NG214: Integrated health and social care for people experiencing homelessness. Available at: online↩︎
HM Government (2022) Levelling Up the United Kingdom White Paper. Available at: online↩︎
Statutory homelessness in England: financial year 2024-25. Statutory homelessness detailed local authority data. Available at: online↩︎
Roughsleeping Snapshot in England: autumn 2025 - tables. Available at: online↩︎
BMA (2026) Mental health pressures in England. Available at: online↩︎
Office for Health Improvement and Disparities (2026) Public health profiles: Adult mental health and wellbeing↩︎
Office for Health Improvement and Disparities (2025) Estimates of opiate and crack use in England 2022 to 2023. Available at: online↩︎
Office for Health Improvement and Disparities (2024) Alcohol dependence prevalence in England. Available at: online↩︎
https://bracknell-forest.berkshireobservatory.co.uk/crime-and-community-safety/map/↩︎
Bramley G, Sosenko F and Johnsen S. Gender Matters. Gendered patterns of severe and multiple disadvantage in England. Lankelly Chase, I-Sphere, and Heriot Watt University. 2020↩︎
Public Health England (2017) Better care for people with co-occurring mental health and alcohol/drug use conditions: A guide for commissioners and service providers↩︎
Home Office and DHSC (2021) Independent review of drugs: phase two report. Available at: online↩︎
House of Commons written question 14892, 27 February 2024.↩︎
Prison Reform Trust (2016) In Care, Out of Trouble: How the life chances of children in care can be transformed by protecting them from unnecessary involvement in the criminal justice system↩︎
Acronyms This page uses abbreviations that may not be familiar. Every acronym used across the JSNA deep dives, the population profile and the deprivation profile is listed and explained, with a search box, on the JSNA acronyms page.