Homelessness: measuring need to design more inclusive services
| Date | 14 July 2023 |
| Pages | 648-667 |
| DOI | https://doi.org/10.1108/MHSI-06-2023-0065 |
| Published date | 14 July 2023 |
| Subject Matter | Health & social care,Mental health,Social inclusion |
| Author | Angela Woods,Rebecca Lace,Joanne Dickinson,Ben Hughes |
Homelessness: measuring need to design
more inclusive services
Angela Woods, Rebecca Lace, Joanne Dickinson and Ben Hughes
Abstract
Purpose –The purpose of this paper –the secondof three –is to report the findingsfrom a service user
needs assessment in those who have contact with a local homelessness service in the North-West of
England.
Design/methodology/approach –Data were collected using a semi-structured questionnaire that
included a section exploring Adverse Childhood Experiences. Aggregated data from a total of 100
completed questionnaires were analysed to understand the nature and scope of those accessing the
Homelessnessand Vulnerable Adults Service (HVAS).
Findings –Homeless people accessing HVAS face a number of challenges, which reflect their
upbringing and chaotic and complex lifestyles. Reports of multiple disadvantage, social isolation,
physicaland mental health problems were commonamong the cohort.
Research limitations/implications –This was a small cohort study, and the authors accept that this
may potentiallylimit the scope of the findings. Themes identifiedare, however, reflected in wider research
and official data collection sources. Future research may seek to widen the data collection methods to
offer a more representativecohort.
Practical implications –The provisionof co-ordinated multi-agency supportis essential to tackle health
inequalitiesexperienced by those who are homeless.
Social implications –The complex issues often experienced by those who are h omeless can further
compound the impact of social exclusion on health and wel l-being. The reduction of statutory
support and increased emphasison self-reliance can further impact those people on the margins of
society.
Originality/value –This study identifies how multiple deprivations and social isolation impacts upon
health and well-being,further compounding a person’s ability and willingnessto engage with services. It
raisesthe question of the systems failure to respond effectively.
Keywords Homelessness, Well-being, Health, Partnerships, Deprivation, Inequalities
Paper type Research paper
Background/introduction
Defining and measuring homelessness is notoriously difficult and complex (Watts et al.,
2022). Official data collection often relies upon recording the number of people seeking
housing support and accessing emergency accommodation annually [Office for National
Statistics (ONS), 2021]. The number of people rough sleeping is calculated by carrying out
a snapshot recording of the those visibly sleeping rough on a single night. As a result, this
can give a skewed picture, and discrepancies in data reporting are regularly highlighted
(Crisis, 2018). For example, official data last year suggested a downward trend in the
numbers of rough sleepers (Departmentfor Levelling Up, Housing and Communities, 2022),
while other reports proposed an increase of over 50% of those sleeping rough since 2010
(Homeless Link, 2021). Figures recently released from the Department for Levelling Up,
Housing and Communities (2023) identify that the numbers of people sleeping rough
across all regions in the UK has recently risen for the first time in four years and has
increased by 35% since 2010.
Angela Woods is based at
the School of Health and
Human Sciences, University
of Bolton,
Bolton, UK.
Rebecca Lace is based at
the Department of
Homeless and Vulnerable
Adults Service,
Bolton Hospitals NHS Trust,
Bolton, UK.
Joanne Dickinson is based
at the Department of
Homeless and Vulnerable
Adult Service, Bolton
Hospitals NHS Trust,
Bolton, UK. Ben Hughes is
based at the School of
Health and Human
Sciences, University of
Bolton, Bolton, UK.
The authors receivedno financial
support for the research,
authorship and/or publication of
this article. Theauthors would like
to acknowledge the contriibutions
made to the knowledge base by
those with livedexperience who
completed the survey.Thanks
also to those who work and
volunteer in widersupport
services in an effort to improve
the lives of thosewho are
homeless.
PAGE 648 jMENTAL HEALTH AND SOCIAL INCLUSION jVOL. 28 NO. 5 2024, pp. 648-667, ©Emerald Publishing Limited, ISSN 2042-8308 DOI 10.1108/MHSI-06-2023-0065
While measuring the nature and scope of homelessness continues to be challenging
(Woods et al.,2023), it is evident that homelessness remains an issue. The effects can be
catastrophic for those facing multiple disadvantages and social exclusion (Tweed et al.,
2021). Gaining a better understanding of the complexities faced by those experiencing
homelessness enables the delivery of effective and inclusive services (Dobson, 2022).
Causes of homelessness have been commonly reported as the interconnectionof structural
and individual factors (Public Health England, 2020). These include wider socio-economic
issues, such as lack of social housing, insecure private accommodation and recent
changes to the benefits systems (Crisis, 2018). On an individual level, poor mental and
physical health, loss of earnings and breakdown in relationships have also been cited as
increasing someone’s vulnerability to becoming homeless (Ranmal etal., 2021).
According to Dobson (2022), there are a core group of individuals who find it difficult to
break free from the cycle of homelessness and often present with complex needs. Recent
figures of those sleeping rough indicate that men outnumber women at around six to one
(ONS, 2021). Various reasonshave been suggested including greater risk of unemployment
and single men less likely to be seen as a housing priority and more likely to be required to
leave the family home when relationships breakdown. Conversely, women who are
homeless are often invisible to services and therefore less likely to be included in official
data collection (Bretherton and Pleace, 2021). Various studies describe a complex picture
of the pathways to homelessness for women and cite experiences of physical and sexual
abuse in childhood, domestic violence and poverty as increasing vulnerability (Bretherton,
2020;Mayock and Sheridan, 2012).
Those who become homeless asadults have often experienced disadvantage from an early
age, (Howe et al.,2022). A systematic review carried out by Liu et al. (2021) suggests that
over half of adults who are homeless report more than four Adverse Childhood Experiences
(ACEs). These include episodes of physical and emotional abuse, neglect and family/
relationship breakdown. The multiple-depravations and health inequalities encountered
prior to becoming homeless are often furthercompounded through the experience of being
homeless (Tweed, 2021). Poor mental health outcomes, suicidality and substance misuse
are common among those exposed to ACEs and who experience homelessness (Liu et al.,
2021).
Poor health outcomes can further increase the level of vulnerability (Dobson, 2022),
exacerbate the risk of disengagement and increase social isolation (Adamson et al., 2015).
Early experience of receiving poor care (familial and statutory) can foster mistrust in formal
support services and networks (Howe et al.,2022). This can mean people are less likely to
seek help which can limit the long-term impact of any interventions offered (Harland et al.,
2021).
Gaining a greater understanding of the needs and experiences of the homeless population
plays a fundamental part in developing services that are both accessible and effective.
Reporting on a needs assessment of those accessing a specialist Homelessness and
Vulnerable Adults Service (HVAS),this article will highlight key health and social care needs
of those accessing the service.Analysis of the data gathered from the questionnaire aimsto
further add to the evidence base underlining the impact of social exclusion and multiple
disadvantages, with a view to informfuture commissioning and provision of services.
Method
Data were collected using a survey (Appendix) based on a health audit tool used across
Greater Manchester. The content was adapted by Bolton NHS FT and Bolton Council to
gather specific accommodation data and identify an ACE score. The ACE questions (Felitti
et al., 1998) were included because of the known high prevalence of childhood trauma in
the lives of some of the population.The survey was conducted via members of the research
VOL. 28 NO. 5 2024 jMENTAL HEALTH AND SOCIAL INCLUSION jPAGE 649
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