When you work in homelessness services, the link between homelessness and poor mental health is obvious. But when trying to find appropriate mental health support, it can feel as though the wider world is behind on understanding this connection.
We have written this blog for World Health Day to draw out the reasons why housing security and mental health are so connected, and to discuss what role the health system can play in ending homelessness for all. It uses information from our recent submission to the Community Mental Health inquiry which you can read here.
Many of our stats are drawn from research by our friends at Groundswell, and from our Homeless Health Needs Audit data. Curious about running a health needs audit in your area? Click here to find out more.
Homelessness and mental health
Poor mental health is both a cause and a consequence of homelessness. Evidence from our Unhealthy State of Homelessness report shows that untreated mental health conditions are both a precursor and a cause of homelessness. Between 2014-2021, the proportion of people experiencing homelessness with a diagnosed mental health condition rose from 42% to 82%.
And pressure is rising. Structural factors like poor quality housing, poverty and welfare insufficiency all have a negative impact on mental health. As these remain unchanged or worsen, and as the number of people experiencing homelessness continues to rise, services like ours pick up more responsibility as the health system falls short.
Why can’t people access mental health care?
The barriers that people experiencing homelessness face when trying to access mental health support include:
- Long waiting lists
- Poor previous experience of services
- Stigma from clinicians, including mental health specialists
- High thresholds for care and a focus on crisis responses at the expense of early intervention
- Inflexibility on appointment times and stringent rules around non-attendance
- Services turning people away if they also use drugs or alcohol
- Narrow support thresholds with people deemed to be either too well, or too unwell, for mental health provisions
Even getting through the front door of a mental health service can be a significant challenge. Our Annual Review data shows that an overwhelming 90% of our members face challenges accessing mental health support for their service users. While our services clearly understand the interconnected nature of mental health, trauma and substance use, specialists in other fields often have little insight into how homelessness services work and may incorrectly assume they can provide higher level support than what we are often designed for.
But people need places to live, and so the homelessness sector can often be one of the few avenues of support people have available to them. This can mean people with significant and disruptive needs being accommodated in settings designed – and funded – to deliver low-level support. As well as meaning acute mental health needs going untreated, this can be incredibly disruptive for other residents and unsafe for staff.
What works?
Despite the negative outlook of the system at current, there are examples of good practice spread across the country that we can look to for change. There areNICE Guidelines on delivering accessible integrated care for people experiencing homelessness, which provide a fantastic blueprint for any service looking to improve its ways of working.
Some of the most successful services in supporting mental ill-health and preventing and ending homelessness are those which work flexibly across sectors to deliver holistic support. Safeguarding Adults Boards can be key facilitators in this space, supporting services to join up and provide the wraparound care that we know works.
For people experiencing homelessness, evidence shows that a ‘one stop shop’ approach works well, delivered within the community. These were felt to hold capacity for flexible, holistic support outside of clinical settings, with space to support with multiple determinants of health.
Specialist programmes of support can also be incredibly beneficial in reducing mental ill-health. Dual diagnosis services, which support people with both substance use and mental health needs, are in short supply but can be transformative when they are available. And the lifechanging support of Housing First is available to far too few of the people who would benefit from it, despite consistently transforming people’s mental health alongside their sense of home, agency and self worth.
What steps can I take for our service users?
While the current system can be incredibly frustrating, there are steps that any service can take to improve their approach to mental health support. We have produced a trauma-informed toolkit for services working with people experiencing homelessness, the learning of which can be adapted across lots of different settings.
And you will find a suite of resources and training courses on mental health and homelessness here.
Do get in touch if you have other questions around mental health and homelessness.
