Based on a needs assessment, it is estimated that between 1300 and 1600 people in Bristol are experiencing three or more multiple disadvantage factors (homelessness, mental ill health, substance misuse, domestic abuse and interactions with the criminal justice system) in their lives currently while the number of people facing two factors is estimated to be 3750.

Of this number, we estimated that 200 (c.15%) have higher levels of acuity, and need a new approach to how services are delivered. These people face many barriers when accessing services and are often stuck in a revolving door. This comes at a cost, both in human terms, and in terms of costs to the system.

Based on the evidence, we need to adopt new ways of working with joined-up, person-centred support and early intervention as the main focus.

The strategy sets out five objectives we would like Bristol to achieve:

• Objective 1: embed service and system improvements for people experiencing three or more MD needs, including a new approach for those with the highest levels of acuity, to transform the support they receive, reduce inequalities, and improve people’s lives.

• Objective 2: intervene earlier at all stages of the life course, taking a trauma-informed approach, to reduce the incidence, duration and impact of MD.

• Objective 3: Strengthen and embed co-production with people with lived experience of MD, so that their diverse voices and expertise continue to influence positive change.

• Objective 4: Improve data on MD, so we have a ‘whole system view’ of people’s diverse and intersecting needs and strengths, to drive earlier intervention, influence policy, and deliver truly person-centred support.

• Objective 5: Continue to work in partnership, building our collective skills, capacity, leadership, and resilience, to achieve cultural and system change.