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ARE THERE MISSED OPPORTUNITIES WITHIN HEALTH AND SOCIAL CARE PRACTICE THAT COULD PREVENT HOMELESSNESS?Ruth Elias Jones
AIM
To identify the precipitating factors to becoming homeless and in particular missed contact opportunities by health and social care practitioners and members of the voluntary sector.
RESEARCH QUESTIONS
How and with whom (members of the public services) do homeless people have contact with prior to becoming homeless?
Which members of the public sector would homeless people most likely seek help and support from prior to becoming homeless?
How might people access better support to prevent homelessness?
Is there a common list of factors which should alert public sector workers to protect individuals from homelessness?
What are the messages for the caring professions?
BACKGROUND
Homelessness is increasing Strongly associated with poor physical and
mental health Little access to healthcare and other services
Stigma and staff attitudes Mistrust of professionals and institutions Experiences of bad treatment and being let down
RISK FACTORSSocial factors Family background
and childhoodHealth factors Institutional
backgroundSocial isolation
Unemployment
Poverty
Debt and mortgage/ rent arrears
Eastern and Central European migrants
Asylum seekers
Physical, sexual or mental abuse or neglect
Parents with drug or alcohol problems
Family history of homelessness
Involvement in crime at an early age
Exclusion from school and lack of qualifications
Family breakdown
Poor physical health
Mental illness
Addiction and substance abuse
HM forces
Care
Prison
Hospital/psychiatric care
CHILDHOOD RISK FACTORSExperiences in childhood (under 16 years old)
Truanted from school a lot
Didn’t get along with parent(s)/step-parent/carer(s)
Suspended, excluded or expelled from school at least once
Ran away from home and stayed away for at least one night
Violence between parents/carers
Parent(s)/step-parent/carer(s) had a drug or alcohol problem
Badly bullied by other children
Physically abused at home
Brought up in workless household
Family was homeless
Spent time in local authority care
Sexually abused
There was sometimes not enough to eat at home
Neglected
Parent(s)/step-parent/carer(s) had a mental health problem
METHODS
Ethical permission granted Recruitment from Action Homeless hostels
Male Currently homeless Resident of an Action Homeless property Willing and able to be interviewed – no physical
or mental barriers to interview Conduction of semi structured interviews Transcription into MS Word Thematic analysis using NVivo
DESCRIPTION OF THE SAMPLE
12 interviews included Aged 20-55 Homeless for between 3 months and 33
years
2
1
2
3
2
1
1
Participants' basic level of qualification
UniversityA LevelsHigh level vocational train-ingLow level vocational train-ingMaths or English below en-try level 3Maths or English below en-try level 2Illiterate
CAUSES OF HOMELESSNESS
Long term Medium term Short termLON
G TERM
Abuse
MEDIUM
TERMMenta
l illnessAddict
ion
SHORT
TERMRelationshi
p breakdown
ABUSE
“I was taking drugs from the age of nine years old, I was drinking at the age of 10.
And obviously depressed and had mental issues and my past issues [his abuse], I just couldn't cope with, so I took anything and anything to numb it
out”
ABUSE
“I was like being seriously hurt and that, when I was younger… That’s why I wasn’t seeing it as bad… I was thinking this is nothing compared to what’s happened, it’s nothing… I didn’t feel I was being threatened or it
was abuse of any type…
The way I was seeing it was the way I was raised up, well I’ve done something naughty,
I needed to be punished”
MEDICAL MISMANAGEMENT
“I had a really severe panic attack… The doctors put me on Valium and then in the evenings I used to have 2 or 3 pints, just to steady me nerves. In a sense, that’s, I think, where it began… I became self-medicating with alcohol”
“Well I wasn't sleeping properly so they gave me sleeping tablets and depression, they said you're depressed, that's why you’re gambling…”
“But doctors weren’t really especially interested… Some of them are very averse to helping people who have drug or alcohol issues. Some are sympathetic but there are quite a few who really just think you’re a waste of time.”
NOT ADDRESSING UNDERLYING SOCIAL PROBLEMS
“No you’re medically fit, you, there’s nothing wrong with your bloods, you can go”
“But there were nothing from the GP to point me in the right direction for the advice and the help that I needed… I told him exactly how I felt, what was going on in my life and it was just ‘well its just a quick appointment, yeah I’ll give you these 20mg tablets that’s not really going to do anything’”
LACK OF FOLLOW UP AND ONGOING SUPPORT
“If they had continued my support on my release then maybe things would’ve been different”
“We didn't hear any like ongoing support, we didn't get any phone calls… they thought everything was all right, you know what I mean, but then about 6, 7 months later my sister has been kicked out”
NOT RECOGNISING RISK FACTORS
“I was a bit of a tearaway… rebellious, angry, I didn't really care about anything… that's why I’ve ended up in and out of prison all my life”
“I feel that when I was a kid my needs weren't addressed properly because you know, I'd been expelled from two different schools”
MESSAGES FOR THE CARING PROFESSIONS
Greater awareness of homelessness and its causes
Education and training on the risk factors Training and information about local
resources to enable signposting Improved communication within and
between professions Proactive stance to preventing homelessness
MESSAGES FOR THE CARING PROFESSIONS
We may be the only contact a person has with services
We all have a role in identifying those at risk of homelessness
It is our responsibility to work together
Preventing homelessness may be as simple as doing our jobs correctly
“For many people, becoming homeless is not the beginning of their problems; it comes at the end
of a long line of crises, a long line of interactions with public and voluntary sector services, a long line of missed opportunities.
We must change that.”
The Rt Hon Grant Shapps MP, Minister for Housing, 2012