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This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

The study of shame has a long tradition in intra- and inter-personal psychology. This paper aims to investigate whether consumers can experience brand shame after self-relevant consumption incidents. Specifically, this research proposes that consumers follow a complex shame-inducing process in the aftermath of unpleasant experiences involving their favorite brand. The moderating role of relational tie strength between consumers and their favorite brand existing prior to symbolic failures is examined.

A scenario-based, online survey (n = 660) among consumers who have recently experienced a self-relevant failure with their favorite brand was conducted. Confirmatory factor analysis ensured the reliability and validity of the measurement model. For testing the conceptual model, data was analyzed by means of a moderated mediation analysis. The proposed model was tested against, among others, common method bias and alternative models. The findings were cross-validated with a scenario-based online experiment (n = 1,616).

Results show that brand shame is a key mediator between customer dissatisfaction and brand anger when self-relevant, symbolic failures happen. Moreover, strong consumer-brand identification triggers brand-detrimental effects. It is shown to influence the connection between consumers’ inward- (i.e. brand shame) and resulting outward-directed (i.e. brand anger) negative emotions on brands, which lead to consumer vengeance.

To the best of the authors’ knowledge, this research is the first to introduce the concept of situational brand shame to the literature on favorite brands. Furthermore, it shows that consumer-brand identification moderates the direct and indirect (via brand shame) unfavorable effects of failure-induced dissatisfaction on brand anger. This research adds insights to the investigation of the “love-becomes-hate” effect arising after self-relevant failures involving consumers’ most preferred brand.

The current review aims to focus on how risk and protective factors for self-harm in secure mental health hospitals are captured in the literature.

Fifty-seven articles were included in a systematic review, drawn from an initial 1,119 articles, post duplicate removal. Databases included Psycinfo, Psycarticles, Psycnet, Web of Science and EBSCO host. A thematic analysis was used, which included a meta-ethnographic approach for considering qualitative papers.

There was a clear focus on risk factors, with eight identified (in order of occurrence): raised emotional reactivity and poor emotion regulation; poor mental health; traumatic experiences; personality disorder diagnosis and associated traits; increased use of outward aggression – dual harm; constraints of a secure environment and lack of control; previous self-harm and suicide attempts; and hopelessness. Protective factors featured less, resulting in only three themes emerging (in order of occurrence): positive social support and communication; positive coping skills; and hope/positive outlook.

This includes a proposal to move focus away from “risk” factors, to incorporate “needs”, in terms of individual and environmental factors. There is also a need for more attention to focus on developing high quality research in this area.

The research captures an area where a synthesis of research has not been comprehensively undertaken, particularly with regards to capturing protective as well as risk factors.