Health and Dependencies
The experience of homelessness can have seriously detrimental effects on your physical and mental well being. This is especially true for rough sleepers, who have an average life expectancy of just 42 years, compared with the national average of 74 for men and 79 for women[20].
However, poor physical or mental health, along with dependency issues, are problems for the entire homeless population, whether they are sleeping rough on the streets, in hostels, or in overcrowded or temporary accommodation.
Physical disabilities, mental ill health or dependency issues can also trigger, or be part of, a chain of events that lead to someone becoming homeless.
Problems such as these can make it more difficult for people to engage with services and get the help and support they need and too often services are not set up to respond to the needs of homeless people.
Poor physical health
Homelessness and poor physical health go hand in hand. It is perhaps to be expected that sleeping on the streets, in hostels, in squats or in substandard or overcrowded accommodation can have a damaging effect on your physical well being. Homeless people are also 13 times more likely to be a victim of violence - much of it perpetrated by the general public.
A survey of homeless people living in hostels[21] showed that more than two thirds were suffering from physical health problems which included conditions such as bronchitis, pneumonia, trench foot, frostbite and wound infections; respiratory (such as asthma, bronchitis and pneumonia) and cardiovascular (such as heart problems, blood pressure issues and diabetes) conditions; and cancer, epilepsy/seizures, renal damage, hernia and liver damage.
It is not just the physical experience of homelessness that leads to poor physical health. Homeless people lack adequate access to healthcare services. The same survey of hostel residents found that more than one third of those who required treatment did not receive any.
Crisis research has found that homeless people are 40 times more likely not to be registered with a GP than the general public and 55% have had no contact with a GP in the previous year[22]. Emergency services, such as A&E, are often used instead of a GP and homeless people who are not registered with a GP will often have untreated medical conditions that potentially escalate into a situation requiring urgent medical attention[23].
Mental health
Mental ill health is both a cause and a consequence of homelessness. It is widely acknowledged that there are higher rates of mental health problems in the homeless population than in the population as a whole. The onset of mental illness can trigger, or be part of, a series of events that can lead to homelessness. Mental health issues might well be exacerbated or caused by the stresses associated with being homeless.
- 32% of clients of homelessness services in England have mental health needs and 14% have a personality disorder[24].
- 35% of those sleeping rough in London have mental health support needs[25] and rough sleepers are 35 times more likely to commit suicide than the general population[26].
- A recent report for Crisis[27], found that the homeless population has twice the levels of common mental health problems when compared to the general population. Psychosis is 4-15 times more prevalent in the homeless population.
Drugs and alcohol
Problems with drugs or alcohol can be part of a person's spiral downwards into homelessness. For example, a family bereavement may lead to depression or mental illness and drugs or alcohol might then be used as a coping mechanism, to numb the pain. Two thirds of homeless people cite drug or alcohol use as a reason for first becoming homeless[28] and those who use drugs are seven times more likely to be homeless than the general population[29]
There are high levels of stress and mental illness associated with being homeless and it is not uncommon for those traumatised by homelessness to seek solace in drug or alcohol abuse.
Of course, not everyone who has problems with alcohol or drugs becomes homeless and not every homeless person has problems with drugs or alcohol abuse. However, levels of drug and alcohol abuse are relatively high amongst the homeless population.
- 39% of clients of homelessness services in England had issues with alcohol and 42% had issues with drugs.[30]
- In London, 49% of rough sleepers have an alcohol problem and 40% have a drug problem[31].
Serious mental illness is often accompanied by substance misuse problems. Around 10-20% of the homeless population have both a mental health and substance misuse problem - so called dual diagnosis. Services for this group are particularly poor as dependency services find it difficult to cater for people with mental health issues and vice versa.
[20] Crisis (1996) Still Dying for a Home
[21] St Mungo's (2005) SOS Sick of suffering briefing
[22] Crisis (2002) Critical Condition
[23] St Mungo's (2008) Homelessness: It makes you sick
[24] Homeless Link (2009) Survey of Needs and Provision (SNAP)
[25] Broadway (2009) Street to Home, Annual Report for London, 1st April 2008 to 31st March 2009
[26] Crisis (1996) Still Dying for a Home
[27] Crisis (2009) Mental Ill Health in the Adult Single Homeless Population: a review of the literature
[28] Crisis (2002) Home and Dry
[29] Kemp P et al (2006) ‘Homelessness amongst problem drug users: prevalence, risk factors and trigger events' Health and Social Care in the Community 14 (4), 319-328
[30] Homeless Link (2009) Survey of Needs and Provision (SNAP)
[31] Broadway (2009) Street to Home, Annual Report for London, 1st April 2008 to 31st March 2009
