Homeless Brum

Solutions Based Reporting to Tackle Homelessness In The City

Homelessness and mental health: A problem with very few solutions

People who are homeless experience some of the most severe mental health problems and report much poorer health than the general population. Many have co-occurring mental ill health and substance misuse needs, physical health needs, and have experienced significant trauma in their lives.

While the causes of this problem have been clearly outlined by the authorities, the solutions are still not clear.

How does mental health impact homelessness?

According to Public Health England, half of the people sleeping rough have mental health needs. Evidence has also shown that, compared with the general population, common mental health conditions such as depression, anxiety and panic disorder are over twice as high among people who experience homelessness.

Although mental health is not identified as a trigger causing homelessness, being in a poor mental health state contribute to job loss or relationship breakdown, which in turn can result in homelessness.

PHE also lists the poor health outcomes that homeless people experience are related to exposure to poor living conditions, difficulty in maintaining hygiene, poor diet, high levels of stress and drug and alcohol dependence.

“Substance dependence can also be both a cause and consequence of homelessness with 41% of people sleeping rough having substance issues. Those who are dependent on drugs or alcohol may struggle to retain accommodation due to financial difficulties, problems with behaviour or family relationship breakdown,” a PHE blog post said.

In the latest annual review of single homelessness support in England, the charity Homeless Link had found out mental support as the most common need among households with homelessness duties.

“Of the 68,170 households which is owed a homelessness duty, 30,670 were identified as having support needs. The most common support need was mental health, which was reported by 14,950 households.”

Homeless Link 2019 annual report on single homelessness.

The report also recognised mental health as the most common support need of those accessing day centres and accommodation services out of single homeless people.

What issues does the homeless face with mental health?

Inability to access primary care and poor housing standards are the main issues when dealing with mental health and homelessness. Not having a permanent place to stay limits access to GP clinics which is the primary concern in accessing mental health services.

In a report published by Shelter focusing on ‘The impact of housing problems on mental health’, the charity had identified housing to be the main cause of mental health conditions while the most commonly cited conditions were anxiety and depression.

“1 in 5 English adults said a housing issue had negatively impacted upon their mental health in the last 5 years. 3 in 10 of those who have had a housing problem or worry in the last five years, not only said that it had had a negative mental impact, but that they had no issue with their mental health previously.”

The impact of housing problems on mental health published by Shelter in 2017.
Ken Cheung

Ken Cheung, an assistant psychologist at central and north west London NHS foundation trust said the poor standards of housing has a negative impact on peoples lives which leads to depression and homelessness.

“When people start living in unsafe housing and poor living situations, they are most likely to experience negative experiences like abuse and offensive language from people along with judgement and police intimidation at times. These experiences can trigger emotion like feeling low, anxious, low self esteem, and worthlessness which ultimately leads to depression,” Ken said.

Is there a government response to this issue?

Speaking to Homeless Brum, Cabinet member for homes and neighbourhoods, Cllr Sharon Thompson said the council is looking at mental health among the homeless through a collective approach outlined in the rough sleeping strategy.

“This approach also includes mental health and wellbeing. We are working more closely with Change Grow Live, the commissioned body to drug and alcohol addiction in the city.

“We are also doing a lot of work with GPs to treat the homeless even though they are not registered with a service.

“Bereavement is also a big focus of the council when it comes to the homeless community. So if someone passes away connected to someone homeless, we are making sure there is a good service to give support to them and their mental health is also considered in that,” Sharon said.   

According to the government rough sleeping strategy which was implemented in 2018, up to £2 million in health funding has been provided to enable access to health and support services for people who are sleeping rough. The government have also asked NHS England to spend up to £30 million on health services for people who sleep rough.

In 2019, the NHS announced a long term plan to provide specialist mental healthcare support for rough sleepers in the next 5 years worth of £30 million as part of the NHS Long Term Plan.

In 2020, the Birmingham and Solihull Clinical Commissioning Group (CCG) were given a £2.5m boost for rough sleeper mental health support. The project oversees a specialist rough sleepers mental support team working on the streets and providing assessment and treatment for men and women over the age of 16 years old sleeping rough in the city.

What are the possible solutions?

According to Ken, the IAPT service provided freely by the NHS might be a good solution to get mental health support. IAPT, short for Improving Access to Psychology Therapies was founded in 2008 and specialises in helping people who suffer from anxiety and depression.

“This is a good service because it not only provides patients support, it also works as a signposting service where the patients will be referred to advanced mental health support services if needed. Anyone registered with the NHS can access the service though a GP or can self refer themselves to this service,” Ken said

Although these services require registering with a GP, many charities offer mental health services for the homeless with no registrations required.

The Birmingham and Solihull mental health foundation trust offers services of assessment and treatment of mental health problems, management of complex psychological and social needs, risk assessment, community nursing support and physical health monitoring. The trust can be contacted through here.

The community mental health team of the charity ‘homeless link’ offers mental health and social needs assessments, accommodation, financial, and resettlement needs assessments to people with complex mental health issues.

Alternatively the ‘Samaritans‘ can be contacted by calling 116123.

Learn more about Birmingham charities which helps the homeless from here.


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