Week 10 RF-Homelessness Flashcards
What is the legal definition of homelessness?
“a household has no home in the UK or anywhere else in the world available and reasonable to occupy”
This includes:
* Rooflessness
* Houselessness (e.g. temporary accommodation)
* Living in insecure housing (e.g. sofa surfing, eviction, domestic violence)
* Living in inadequate housing (e.g. unfit housing, extreme overcrowding)
* Places not designed for human habitation (e.g. car parks, sheds)
What are some statistics relating to homeless people?
Liverpool City Region Housing First
* Rough/sleeping or in TA with “complex needs
- 95% have mental health needs (196 of all individuals supported)
- 33% have a physical disability (69 of all individuals supported)
- 96% have a substance or alcohol dependency (199 of all individuals supported)
- 86% are ex-offenders (179 of all individuals supported).
What is meant by trauma and social location?
-Race/Social conditions/Local Context
-Generational embodiment/Historical Trauma
Both of these factors are factors that are fixed on a person and puts them more at risk for homelessness
What are the pairs of ACEs? (Ellis et al., 2022)
- Adverse Childhood Experiences e.g., emotional and sexual abuse, maternal depression, divorce, DV etc.,
- Adverse Community Environments e.g., Poverty, Poor housing quality & affordability, Community disruption etc.,
-Could be in loving families, BUT then experience adverse community environments which will still have an impact.
What was found in the Adverse Childhood Experiences Study?
- One or more ACE: Homeless population: 87%; General population: 38-39%
- Four or more ACE’s: Homeless population 53.9%; General population 3‐5%
A male child with an ACE score of 6, compared to a male child with an ACE score of 0, has a:
* A 250% increase in likelihood of smoking
* And a 500% increase in adult alcoholism
* 46-fold (4,600%) increase in the likelihood of becoming an injecting drug user sometime later in life.
-Those who experience ACE, are more at risk of developing “health-risk behaviours” such as smoking, drinking etc.,
How are Adverse Childhood Experiences a “Health Risk Behaviour”?
- Adverse childhood experiences are the main determinant of health and wellbeing of the nation (Felitti, 2004)
- Correlation between compound trauma and increased levels of disease in cardiovascular, immune, respiratory, gastrointestinal, genitourinary and musculoskeletal conditions remained
after screening for high-risk behaviours (D’Andrea et al 2011). - Compound trauma leads to physical illness through chronic hyper‐stress reactions… not just “high risk” behaviours…
What are the statistics seen with Social Adversity?
Persistent poverty in first seven years – cognitive development scores on average 20% below children who have never experienced poverty
Non-decent housing:
* 15% of homes in England were classed as non-decent in 2020
* 10 x more likely to contract meningitis (overcrowding)
* 25% higher risk of ill health and disability
Unhealthy State of Homelessness 2022: What were the Findings from the Homeless Health Needs Audit?
- 63% reported long-term illness, disability or infirmity (22% in gen pop)
- 80% with a physical health problem have more than one condition
- 29% have between 5-10 diagnoses
- 82% reported mental health diagnosis
- 72% reported experiencing depression (national rate 10% pre-pandemic)
- 45% self-medicate with drugs or alcohol to help them cope with their mental health
- 54% had used drugs in the last 12 months
- 76% smoke cigarettes, cigars or a pipe (national figure of 13.8%) (lack of exposure to public health messages due to exclusion therefore unawareness of true dangers).
- 33% typically eat one meal a day (experiences of preventable illnesses due to vitamin deficiencies)
- 66% ate one or fewer portions of fruit or veg per day
- 37% of females had had a breast screening within relevant time period (61.8% of gen pop)
Burden of stigmatisation: How are homeless people systemically excluded?
- Bureaucratic procedures, rigid service access, discrimination and stigma serve to exclude people from statutory services (Omerov et al. 2020) (e.g., drug use means immediately rejected for mental health support) (misjudged as social support, missed appointments due to lack of communication, lack of transport etc., THEREFORE dismissed from further services)
- MCA (mental capacity act) misappropriated by professionals and used as justification for not providing support (Armstrong et al., 2021; Martineau & Manthorpe, 2020) (e.g., they had the mental capacity to choose drugs therefore they could have taken a responsible path=professional uses this judgement to not provide support).
- Fragmented health and social services, unrealistic goals, pressure on staff, lack of support from statutory agencies (Armstrong et al., 2021; Moriarty and Manthorpe, 2014).
-Less than 20% of people suffering from a mental health problem are happy with the level of support they are receiving.
“Always at the bottom of the pile”: What was found in the Homeless and Inclusion Health Barometer 2024? (Jackson et al., 2024)
-NHS pressures are creating barriers to care for people in inclusion health groups
-Stigma and discrimination can exacerbate these barriers
-People in inclusion health groups have poor experiences across all major aspects of care
-Many current practices present a threat to the safety of people from inclusion health groups
-Housing is a foundation of health (keeps people safe from weather for example)
-People in inclusion health groups experience the worst health outcomes in society – and they are getting worse
-Invisible in the data, invisible to decision-makers
What is Social Exclusion? (Levitas et al., 2007)
“Social exclusion is a complex and multi‐dimensional process. It involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities available to the majority of people in society, whether in economic, social, cultural or political arenas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole.”
What is a ‘good enough’ life? What was found when Examining the support seeking experiences of people who have experienced homelessness and used drugs or alcohol? (Campbell et al., 2021)
- “being smashed by the streets: being gradually word down and trying to survive this process”
- Being “kicked out” of different places – multiple times
- Consistent rejection and disappointment led to hopelessness
- Difficult to stay part of old friendship circles – but loneliness when moving into accommodation by themselves
- Participants felt rejected – by individuals, agencies and society (via cultural narratives)
-Hostile architecture
What are the Social relationships, stigma, and wellbeing through experiences of homelessness in the United Kingdom?
-Stigma exacerbates sense of failure
-Exposure to stigma negatively affects self-esteem and mental health, causing people to withdraw from social interactions
-Concealment of homelessness results in reduced sense of belonging, potentially resulting in less support to buffer against stress of street homelessness
-Affiliation tended to come easily within the homeless community, maybe a buffer to some detrimental effects of social isolation
What is the Impact of Social Isolation?
- Social isolation has a greater effect size on mortality rates than either smoking or high alcohol consumption (Holt-Lunstad et al 2010)
- Activates the same neurological processes as physical pain and arouses the same stress, fear and shame responses as physical trauma (Eisenberger et al 2003; Kross et al 2011)
What would be some ways to deal with homelessness? (From a clinical psychologist’s point of view)
- Formulation ‐ making sense of what’s going on for someone utilising psychological theory
- Consultation – using the formulation to provide advice on ways of working to teams around the person (usually about building relationships)
- Therapeutic work – providing therapy to individuals experiencing homelessness
- Multi‐disciplinary liaison and advocacy – advocating and negotiating access to services, reducing barriers and building understanding/compassion
