The number of houses in multiple occupation (HMOs) in the UK has increased significantly in recent years, with the sector disproportionately housing vulnerable tenants. Government responses to the growth in HMOs has focused increasingly on landlord enforcement and planning controls, with limited attention on the needs of vulnerable residents. Drawing on new research with HMO tenants with multiple and complex needs (MCN), attendance at HMO working groups and consultations with stakeholders, this article argues that, whilst landlord enforcement and regulation are necessary, it is important to balance this approach with appropriate support for tenants with MCN. Whilst living in an HMO can exacerbate personal challenges, the research shows that positive outcomes are possible when tenants with MCN are supported to address their needs. At a time when the number of HMOs is continuing to increase, it is important to explore the significant role of support provided to tenants with MCN.