Homelessness has a devastating impact on people’s health and wellbeing, and understanding this is key to ensuring people are able to access the services and support they need, and to preventing people from becoming homeless in the first place.
Since 2009 Homeless Link has supported local areas to undertake Homeless Health Needs Audits (HHNA) to understand the health needs of people experiencing homelessness in their communities. The HHNA is a survey and methodology developed by Homeless Link with support from the NHS, local authorities, and our members. In 2014 we published the first Unhealthy State of Homelessness report setting out the findings from 19 HHNAs undertaken between 2012 and 2014. Today we’re publishing an updated report: The Unhealthy State of Homelessness 2022.
Presenting data captured from 31 audits carried out between 2015 and 2021, the research sets out not only the updated health needs of people experiencing homelessness but also how these have changed over time.
The report reveals a stark narrative of health inequalities. Across both physical and mental health, as well as access to necessary support, people experiencing homelessness report poorer diagnoses and greater barriers to healthcare than the general population.
And this is getting worse over time. In the data collected between 2018-2021, 78% of respondents reported a physical health condition, compared to 73% in the original cohort (2012-2014). For those reporting a mental health diagnosis the change has become even more significant, increasing from 45% of respondents in 2012-14 to 82% in 2018-2021.
The research also highlights that experiences of homelessness are both a cause and a result of poor physical and mental health. Over half of respondents reported being diagnosed with a physical health condition after they became homeless, speaking to the negative impacts of experiences of homelessness. Chronic health conditions such as joint aches and problems with muscles and bones are the most commonly reported, and a consequence of rough sleeping and homelessness. In this context we cannot ignore homelessness as a health issue and it must be considered as we would any other public health concern.
Mental health conditions are much more likely to have predated experiences of homelessness, with nearly three in four respondents having had a pre-existing mental health condition. Homelessness exacerbates mental health needs, but if it is not the primary cause then the importance of preventative healthcare – for tackling underlying support needs and helping to end homelessness – is apparent.
The consequences of untreated health issues are significant. The report sets out high levels of self-medication, over reliance on emergency services, and increased risks of self-harm and attempted suicide. This all adds to the complexity of trauma caused by experiences of homelessness and exacerbated by insufficient appropriate services to meet people’s health needs.
Throughout the Unhealthy State of Homelessness 2022 it is evident that poor experiences and outcomes are universal across the health care system. From dentistry to smoking cessation, hospital discharge to accessing routine secondary health care services, people experiencing homelessness are not getting the healthcare support they need.
National and local governments must work to understand why health inequalities for people experiencing homelessness are increasing and why services remain unable to meet their needs. This learning must be used to make systemic changes to ensure that people are provided with the support that they need to recover and remain well, rather than be left in circumstances known to worsen their health.
Experiencing homelessness should not mean that someone is unable to access healthcare, nor should it mean we accept poorer health outcomes and growing health inequalities. Homelessness is a health issue and we must respond accordingly.
Find out more about the Homeless Health Needs Audit and how to start one in your local area here.