This essay aims to discuss the health problems and health service issues that are associated with homelessness. It also seeks to address the following subjects; defining what homelessness is, describing the starting point epidemiology for homeless people, identifying the existing healthiness in the homeless, and searching out recommendations that can help improve the health of the homeless in the UK.
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The state of Homelessness is currently considered a grave problem in Britain. Crisis (2005) states that homelessness is a problem faced by people who lack a place to live, which is supportive, affordable, decent and secure. A state caused according to DOH (2004), by a complex mix of structural problems that includes but is not limited to the availability of adequate housing and personal problems e.g. debt, poor health, relationship breakdown. However, there are many other factors that can increase the risk of homelessness which include sexual or physical abuse, alcohol and drug abuse, unemployment, mental health problems, lack of social support network and involvement in crime (Wright et al, 2006).
According to the World Health Organisation, health is “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”(WHO I946: 100).
Hewett et al (20I0) states that chronic homelessness marks a significant increase in the risk of ill-health and premature death. Hewett et al. (20I0) also mentions that the National Health Service has dismissed homelessness for far too long as simply an issue of housing and social care, but there is growing evidence that long-term homelessness is strongly also an issue of health.
A study by Seigler et al. (2008) shows that the lifespan of males in the UK generally varies from one area to the next. According to Seigler et al. (2008), people living in the South of England are much healthier that those who live in the northern part of England.[A1]
A study by Doran et al. (2004) shows that people who live in England are far healthy than those who live in other parts of the United Kingdom. [A2]Homelessness and increased mortality rates are linked as homeless people are more likely to die young (Crisis, 2002). Morrison et al. (2009) study of homeless patients including people living in hostels who were admitted into hospital in Glasgow with drug related problems found that they are seven times more likely to die over the next five years than housed patients with the same drug related reason(s) for admission.
The experience of being homelessness can have really detrimental effects on one’s mental and physical health, this is reflected by the fact that the average life expectancy of the homeless which is 47 years for men and 43 for women is about 30 years lower that the national average (Crisis, 2011).
Homeless Link is a national charity supporting people and organisations working directly with homeless people (Homeless Link 2010). [A3] Some other factors as such as physical incapacities, mental un-healthiness or addiction issues when present can directly or indirectly along with other factors lead to a person or persons becoming homeless. These factors can make it much harder for the homeless to seeks or accept help and support even when they are available which may not always be the case (Home link 2013).
Homeless people are among the most vulnerable and socially excluded people in our society and they find it difficult to access the help they need (Crisis, 2002). Wright et al. (2006) states that premature mortality is higher among homeless population than the general populace. Health is an enormous issue for the homeless, as poor health can lead to homelessness and being homeless can exacerbate and cause health problems (Crisis, 2002). Majority of people in this state of homelessness have multiple morbidity including mental health problems, drugs or alcohol dependences, and physical problems, e.g. breathing problems and tuberculosis. Homeless Link (2010) conducted an audit involving over 700 homeless people in England and the results showed that eight out of every ten participants had one or more physical health needs and seven out of ten have one or more mental health needs. Therefore, homeless people need tailored health promotion. Health problems can severely diminish their quality of life and limit their ability to access routes out of homelessness (Tackling Health Inequalities 2003). They have the same rights to health services and health promotion as the rest of the population, but health promotions targeted at the general population may not always be suitable or accessible to them, thus disadvantaging them further (Tackling Health Inequalities 2003).
UK policy documents on health promotion, such as Choosing Health: making healthy choices easier (DOH, 2004), recommend some key areas for work to promote healthy lives. These include health inequalities which is very important when working with homeless people. The Homeless are in particular need of health promotion as they may have greater mental health problems than the general population; they have greater physical and non-physical health problems, while they also have more difficulty in accessing health services than the general population (DOH, 2004). Hence, homeless people need more health promotion because of their increased complex physical and mental needs.
Homelessness and poor health goes hand in hand. This may be because they seemingly have to endure health inequalities that the general populace do not have to. This in conjunction with an array of complex needs they have which may result from having to sleep on the streets, in hostels and or squat in over crowed and inadequate accommodations has detrimental effect(s) on their general wellbeing which includes their mental and physical health (Crisis, 2009).
A survey by St Mungo (2005) showed that more than two third of homeless people living in hostels were suffering from physical health problems which included conditions such as bronchitis, pneumonia, trench foot, frostbites, wound infections; respiratory and cardiovascular conditions; cancer, renal damage, liver damage, and seizures.
It could be easily assumed that it is only the experiences undergone when some is homeless that leads to their health (i.e. a homeless person`s health) being poorly, sometimes it is as a result of not having adequate access to the health services they require, as implied by a St. Mungo (2005) survey. The survey states that more than a third of hostel residents who needed medical and nursing action did not receive it. Backing this up is another finding by Crisis (2002) which found out that the homeless are 40 times less likely to be registered with a General Practitioner (GP) than the general populace, while 55% of them have had no contact within the last one year of the publication with a GP. Instead, emergency services such as the A&E are frequented but usually by this time the medical condition has become dire (St.Mungo`s 2008).
Mental illness serves both as a cause for people becoming homeless and an effect of homelessness. Crisis (2009), explains that mental health issues can lead to homelessness by among other things causing increased stress in an individual or individuals which, can in turn result in that individual becoming homeless. This is further buttressed by the fact that 30% of those accounted for by the homeless services in England have some form of mental health need (Crisis 2009) and that those in this state i.e. homelessness, have twice the level of common mental health issues when compared to the general public, with Psychosis 4-15 times more prevalent in the homeless population (Home link 2013; Crisis 2009).
Also, Drugs or/and alcohol problems can spiral an individual into the state of being homeless (Crisis 2009). Some people use drugs or alcohol as a coping mechanism, for e.g. to num the pain when they have family bereavement, but this can lead to depression or and mental illness. Crisis (2002) states that two third of the homeless say abuse of drug(s) or alcohol or both lead them to becoming homeless. This ties in with what was stated by Kemp et al. that there is 7 times more likelihood of drug users to become homeless than the general population.
It is common for those who have been traumatised by being homeless to take to alcohol and or drugs for solace as there is increased level of stress and mental illnesses of some sort which may come about as a result of being homeless. The cause effects of alcohol and or drugs cannot be ignored given its influence on homelessness. This is reflected in the fact that 31% of homelessness service in England had an alcohol problem, while 28% had a drug problem (Home Link 2013). Substance misuse problems are often linked to serious mental illness. This is reflected in the fact that around ten to twenty per cent of those in a homeless state have both a substance misuse and mental health problem (Crisis, 2009). The services for this group of people are poor as dependency services find it difficult to look after people with mental health issues (Crisis 2009).
The Government is determined to tackle homelessness more effectively and is taking forward a number of new approaches that was set up in the March 2002 report (More Than a Roof, 2003). The key principles that underpin these approaches will be to identify and tackle the causes of homelessness as well as preventing people from becoming homeless in the first place (More than a Roof 2003). The new Legislation by the government for tackling homelessness gave power to local council authorities to help homeless families and to create preventative schemes to homelessness (Homelessness Act 2002).
A pilot project which began on April 2011, “No Second Night Out” is focusing on a rapid response for those people who sleep rough in London for the first time (DOH 2011). About fifty people a week are seen sleeping rough for the first time in London (DOH, 2011). The mayor of London expressed then, that by the end of2012, no one will be living on the streets of London and no one arriving new to the street will sleep out for a second night (DOH 2011).
There is a lot of change going on at the moment with the extensive restructuring of the National Health Services, e.g. the funding cuts to local authorities. As a sector, it is failing homeless people on health issues and it needs to re-examine its methods of trying to support the homeless in tackling their health issues (Tackling Health Inequalities 2003).
There are a number of ways to improve the health of the homeless. One way would be to improve the health care provision available to the homeless. This should be aimed at making sure homeless people have equal access to the health care services they may need (Tackling Health Inequalities 2003). Another way is raising awareness within the homeless populace about services available to them. People who are homeless generally have a lot of needs some of which are a place to stay, food to eat among others, meaning there is a tendency for them to ignore matters regarding their health until it is in a really bad condition. But for health promotion to be effectively delivered and in turn successful, health professionals need to make this services as widely available as possible while being easy to use and access and also fun to use (Tackling Health Inequalities 2003). A third way is to encourage the Primary Health Trust to continually engage with the homeless, so they can keep developing new and improved ways to tackle the health and heath service issues of this population. In terms of health care for the homeless people, the flexibility in the provision of health services and different models of working [A4]help to overcome the barriers to accessing appropriate health care that many homeless people experience (Wright et al, 2006).
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Many NHS hospitals’ Trust have the homeless discharge project in place, whereby having partnership between The Passage, Connection St Martins and West London Mission; working together with Rough Sleepers Team and the Homeless health Teams. [A5] Their work is funded by the Department of Health. Their role is to visit the patients in hospitals; assess their needs; make a discharge plan with the hospital staff to meet accommodation and social needs as well as health; support the patient to attend follow-up appointments and link them in with a GP if they do not already have one (The Homeless hospital Project, DOH 2013).
It is well known that rough sleeping and homelessness [A6]have significant and negative consequences for an individual’s health. Many studies have found that homelessness affects both the physical and mental status of an individual (Crisis 2009). However, despite the increased morbidity among the homeless, they still miss out on the health care they need. As a result, their health problems are left untreated and their health deteriorates. When homeless people do access health services, they are likely to do so in an unplanned way, e.g. through A&E and can be in a state of poor health before them do (North West London NHS 2013). This results in longer stays in hospital and multiple readmissions which has clear cost implications for the National Health Services (North West London NHS 2013).
The five main recommended ways to improve the health of the homeless population are: improve how accessible primary health care is to the homeless; improve the quality and efficacy of health care of homeless families in temporal housings; improve the discharge policies of the A&E and other hospital units in regards to discharging the homeless; improve treatment for the holes populace with issues of substance misuse; and improve mental health care for the homeless (Groundswell, 2012).
The best means of improving how accessible primary health care is to the homeless remains controversial. ‘Our Healthier Nation’ (DOH, 1998) states that “in a fair society there must be fair access to top quality health services”. Homeless people are among the most deprived members of our society and commonly experience difficulty in gaining access to health care (Connelly et al. 1994).
To improve health care for homeless families in temporary accommodation, a notification system should be put in place which allows the tracking of homeless families that resides in in temporary housing, while making sure that effective health checks and referrals from the social, health and housing services are available.
In order to improve the discharge policies of the A&E and other hospital units in regards to discharging the homeless, there is need for appropriate practices that cover how the homeless receive appropriate support services when leaving A&E. Homeless people are four times more likely than the general public to tum to A&E if they cannot access a GP (Wake 1992). One study suggests the homeless are 40 times less likely to be registered with a GP than the general population (Crisis, 2002). A homeless person, when as an inpatient in hospital, may be the ideal opportunity for a healthcare professional to undertake investigations into previous medical history, finding old notes, addressing their physical health needs, which should include how well they are doing nutritionally and checking to see if they have any chronic illness, especially in situations where the patient (seems to) avoid engagement with primary care (Jones 2008).
‘The Adviso1y Council on the Misuse of Drugs’ (1998) classifies drug abuse as having a vital role in homelessness. Research shows that two thirds of individuals report increasing problems with substance misuse after becoming homeless (Homeless Link’s SNAP 2012). Given that homelessness can significantly reduce the chances of drug users accessing treatment services or them staying on a treatment programme (DOH 2002), the following action to improve substance misuse treatment for the homeless should be implemented; building screening and referral procedures for substance abuse and providing an organised after care provision to allow drug users to maintain their housing (DOH 2002).
Access to mental health services for homeless people can be improved through improving staff awareness and delivering services differently whereby non-clinical settings are available as well as effective teamwork between partner agencies (St Mungo’s 2012). The Government’s mental health strategy identifies addressing the mental health needs of homeless people as a priority for action (St Mungo’s 2012).
“Health promotion is the process of enabling people to increase control over the determinants of health to improve their health” (WHO, 1986). The World Health Organisation (1986) stated that in order to promote health, attention should be paid to improving access to health, developing environments that are conducive to good health, strengthening social and support networks and promoting positive health behaviour by increasing knowledge and information.
Available and easy to use resources can help promote the health of homeless people. Some practical examples for health promotion that could benefit the homeless include: setting up of a all-inclusive one-stop day facility consisting of a group of key health practitioners, hot meals, wet rooms, and laundry facilities, smoking cessation health centre, routes to finding employment, training and GUM clinics (Yeomans 2000).
Health information for homeless people should be simple and easy to understand. Health information leaflets should be small, with little information and should include pictures or diagrams.
Nurses have a key leadership role to play in the commissioning of health care for homeless people as they know their client group. They should know the health needs of their client group, both physical and mental, as well as know the gaps in service provision and models of good practice. Working with homeless people to improve their health, gives health professionals the prospect of improving healthcare systems for the benefit of all.
[A1]I do not really see how this is necessary, so I suggest removing it or adding more fact as to how it relates to the homeless.
[A2]I do not really see how this is necessary, so I suggest removing it or adding more fact as to how it relates to the homeless.
[A3]I do not think it`s necessary.
[A4]Sorry but don’t really get what you were trying to write
[A5]Can’t figure out what you are trying to say here
[A6]Isn’t rough sleeping a type of homelessness?
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