Vulnerable groups

Overview

The JSNA shows that vulnerable groups experience overlapping health, housing, financial, social, and service-access needs. Mental ill health, substance misuse, physical illness, homelessness, trauma, and caring responsibilities often coexist. These interactions create barriers to stability and recovery. Standard service pathways may not accommodate complex circumstances. Recent evidence supports coordinated, preventative, flexible, and locally tailored responses rather than fragmented management of single conditions.

Adults with multiple disadvantages experience particularly concentrated need. Thousands face homelessness, mental health problems, substance misuse, and physical illness. These overlapping conditions create substantial barriers to service access. Needs differ by age, sex, and geography.

Unpaid carers make a major contribution to health and care provision. At the time of the 2021 Census a total of 135,895 people in Kent identified as an unpaid carer. Almost one-third provide at least 50 hours of care weekly. Many experience stress, isolation, poor sleep, financial hardship, and poorer physical or mental health. Carers remain under-identified within service records. Support is frequently reactive, fragmented, and difficult to navigate. Young carers face additional educational, social, and developmental consequences.

Domestic abuse affects an estimated 61,500 Kent adults annually. Police records capture a smaller number, indicating under-reporting. Women form the larger share of estimated victims, although recorded victims include a substantial male minority. Domestic abuse intersects with housing, homelessness, mental health, substance misuse, safeguarding, and children’s services. About one fifth of referrals to refuges are rejected because of complex support needs related to drugs/alcohol or mental health. Short-term community funding creates additional sustainability risks.

Gypsy, Roma and Traveller communities experience poor health across the life course. Reported concerns include childhood illness, non-communicable disease, smoking, obesity, mental health, and older-age musculoskeletal needs. Discrimination, mistrust, low health literacy, language barriers, and cultural taboos reduce service access. Preventive and screening uptake is low. Routine data does not consistently identify these communities. Their needs consequently remain under-recognised within planning, monitoring, and health equity work.

Tuberculosis incidence is low overall, but case complexity is high. Incidence is higher in Gravesham, Dartford, Medway, and Ashford. There tend to be higher case numbers in more deprived areas. Social risks include drug misuse, homelessness, imprisonment, and alcohol misuse. Many affected people have multiple social risk factors. Enhanced case management is substantially more common than regional and national comparisons. This creates considerable workload for specialist tuberculosis nurses.

Armed Forces Veterans, community offenders, and rough sleepers experience distinct but overlapping barriers. Veterans face ageing-related need, physical conditions, transition pressures, stigma, housing difficulties, and low identification within healthcare records. Community offenders experience poor mental health, substance misuse, smoking, learning disability, unemployment, and housing instability. Many lack General Practitioner registration. Rough sleepers experience complex physical illness, mental health problems, substance misuse, communicable disease, and poor acute healthcare access.

Key issues and themes

• Multiple disadvantage combines homelessness, mental illness, physical illness, and substance misuse. Health Needs Assessment of Adults with Multiple Disadvantages advocates for coordinated multi-agency responses.
• Unpaid carers are under-identified and feel under-supported but make substantial system contributions. Unpaid Carers Health Needs Assessment prioritises prevention, respite, practical support, and supportive transitions.
• Domestic abuse interacts with homelessness, mental health, substance misuse, safeguarding, and child wellbeing. Kent Domestic Abuse Needs Assessment identifies under-reporting and service sustainability risks.
• Gypsy, Roma and Traveller communities experience poor health, discrimination, low screening uptake, and data invisibility. Kent Gypsy, Roma and Traveller Populations JSNA identifies barriers across the life course.
• Tuberculosis cases have high clinical and social complexity but low overall incidence. Tuberculosis in Kent and Medway Health Needs Assessment identifies substantial enhanced case-management requirements.
• Veterans have needs related to ageing, musculoskeletal, hearing, respiratory, housing, financial, and transition out of the Armed Forces. Armed Forces and Veteran Community Needs Assessment highlights major identification and data gaps.
• Rough sleepers experience mental illness, substance misuse, long-term conditions, communicable diseases, and healthcare access barriers. Rough Sleepers Needs Assessment supports stronger service coordination and outreach.
• Community offenders experience poor health and severe service disengagement. Kent Probation Community Offenders Health Needs Assessment documents high mental health, substance misuse, smoking, and registration needs.

Supporting reports

• Unpaid Carers Health Needs Assessment (2026) – Report
• Health Needs Assessment of Adults with Multiple Disadvantages (2026) – Report
• Tuberculosis in Kent and Medway Health Needs Assessment (2025) – Report
• Armed Forces and Veteran Community Needs Assessment (2024) – Report
• Kent Domestic Abuse Needs Assessment (2024) – Report
• Kent Gypsy, Roma and Traveller Populations JSNA (2023) – Report
• Rough Sleepers Needs Assessment (2022) – Report
• Personality Disorder Needs Assessment (2016) – Report
• Perinatal Mental Health Needs Assessment (2016) – Report
• Kent Probation Community Offenders Health Needs Assessment (2014) – Report