Health risks of homelessness

Few things matter more to people than their health. But when you have access to plenty of food, water, medical care and support, it can be easy to take your good health for granted.

When you don’t have a home, all of this can break down. People who are homeless are at greater risk from a variety of illnesses compared to the general public.

This year Homeless Link completed a health audit, using information from 2,500 people to determine the health problems experienced by those who are homeless. This report which continues on from data published by the charity every year since 2010, looks at physical and mental health, substance misuse and use of medical services, as well as the cost of illness and recommendations of policy changes.

Homelessness can contribute to poor health for a number of reasons, such as rough sleeping leading to exposure, alcohol and drug use, a poor diet, abuse and lack of access to medical care. But poor health can lead to financial strain caused by medical bills, an inability to work and sustain yourself, as well as depression and stress, all of which can make you more likely to become homeless. This leads to a vicious cycle- homelessness contributes to ill health, and ill health makes it harder to overcome homelessness.

Compared to the general public, the homeless population are more likely to suffer almost all long term physical health problems, particularly joint and muscle, breathing and vision problems. One exception is heart and circulatory problems which are less prevalent, possibly because these conditions occur later in life, and the average age of people who are homeless is low. The average age of death for those who are homeless is between 43 and 47.

The percentage of the homeless population who have diagnosed mental health problems (45%) is almost double that of the general public (25%). People who are homeless are 10 times more likely to experience depression, and 3 times more likely to suffer from schizophrenia. Also, 10% of those surveyed had a ‘dual diagnosis’ of mental health and substance abuse issues. Having a dual diagnosis can cause services to restrict support, as they are unable or unwilling to help people who are using drugs or alcohol. Unfortunately, the inability to get support leads people to self-medicate with drugs and alcohol, which only increases their problems.

Of the people who took part in the audit, 39% said that they were taking drugs or recovering from a drug problem, while 36% said they had taken drugs during the last month. Cannabis was the most commonly used drug, followed by prescription drugs that had not been prescribed for them, and heroin. Alcohol misuse was also a big issue: 27% of respondents reported they were recovering from an alcohol problem. Around two thirds said they drink more than the recommended amount each time they drink, and more than a third drink twice or more times a week. The data suggested that men drink more frequently than women.

Given the poor health associated with homelessness, it is unsurprising that those who are homeless are ‘heavy users’ of health services. The number of hospital admissions and A&E visits for the homeless population is four times more than the general public. This adds up to a cost of £85 million per year. Of those surveyed, 35% had been to A&E in the last 6 months, but around 45% didn’t have anywhere suitable to go upon leaving the hospital. Those who are forced to sleep rough after receiving medical treatment are less likely to recover, and as a result the expense of the care is wasted, putting a strain on the NHS. The main reason respondents gave for using A&E was violent incident or assault. Clearly, housing needs have to be addressed alongside medical needs, otherwise the cost is increased for everyone.

The data of the study confirmed that there are strong links between health and housing situation. Those who were rough sleeping, squatting or in other forms of precarious accommodation had higher levels of poor physical health, as well as drug and alcohol problems.

Given the strong link between homelessness and ill health that this survey indicates, Homeless Link recommends better care, better commissioning, better policies, and stronger inspection and accountability as four areas of improvement. All modest proposals, geared towards people who are homeless receiving the same rights and services as anyone else, including registration with a GP, a free check up and care plan, substance misuse services, access to both housing and healthcare, and policies and procedures that guarantee these.

The ill health and incomplete treatment of people who are homeless hurts us all, not just morally but also financially. Given the cost that short term solutions have on our public services, why is it still so hard to get reliable medical treatment to the people who both use  and need it the most? The good news is that in the past few years beneficial policy changes have been made. In 2010, the government launched Inclusion Health, a programme to improve health services through better commissioning and leadership, with a focus on people who are homeless. Since then, a number of legal changes have been made to reduce inequalities between patients when it comes to accessing services, including post-hospital care and accommodation. But the figures for this year show that this is only the beginning. Given the increase in rough sleeping, the reduction of welfare expenses, and the lack of investment in homelessness services, more than a plaster needs to be put on the deep wound that homelessness causes society.

Alex Charlton