Ever SMD(5D)


Finally, we turn to the ‘Ever 5D’ definition, in Figures 4a-4b. As with the 3D classification, shifting to an ‘Ever SMD’ from a ‘Current SMD’ basis raises the numbers very considerably. Note, though, that this multiplier effect is greater for homelessness-only and the original 3D combinations, and for the DVA-only and its combinations, than it is for MH, which tends to dominate the totals in the 5D classification. The persistence of MH conditions, together with some limitations of the ability of our survey sources to measure past MH problems, contributes to this outcome.


Overall, the results suggest that the number of adults with one SMD(5D) disadvantage would be 3.1 times higher on the ‘ever’ basis than on the current basis; those with 2 disadvantages would be 3.7 times more numerous, while those with 3 or more disadvantages would be 10.4 times more in number giving a total of nearly 166,000 for Scotland.


Figure 4b brings home the point that, over the lifecourse, the chances of someone having experienced several of these disadvantages is quite high. In other words, SMD appears much more common on an ‘Ever’ basis. Not only are the sheer numbers much larger than in Figure 3b, but there are smaller proportions of ‘single disadvantage’ cases across all of the domains. This is what we would expect, given that people have a wider ‘window’ within which to experience second and further disadvantages. It is important to appreciate that these disadvantages ‘ever’ faced may not be simultaneous, although the Waugh et al (2018) study does suggest an association between the timing of homelessness and ‘peaks’ in relevant health services interaction, albeit within a ‘time window’ which is longer than one year.


As can be seen, even from the ‘Ever’ perspective in Figure 4b, offending remains the most-SMD


62


oriented of all the domains. DVA looks similar to homelessness and substance dependence in having a slight majority of cases who have experienced more than one of these disadvantages. Mental ill-health remains the least ‘overlapping’ of all five domains, with 66% of relevant cases still being ‘MH-only’, even in the ‘Ever’ analysis. Thus a clear majority of all people with MH issues do not face any of the other disadvantages that we are considering in this report.


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