Tailored responses needed to address rough sleeping and mental health
In the early 90s, I provided culturally sensitive support to those who were street homeless, having originally come from Ireland to look for work. The people I worked with were incredibly vulnerable. Their bodies were ravaged after years of street drinking and. their mental health was completely shattered.
I remember one man called John, who had moved to London at the age of 21, leaving a supportive family and a rural idyll behind him. He managed to get a few jobs on building sites, moved into shared accommodation and would go to the local pub for a pint or two. Those nights at the pub eventually got longer; John missed his family and was unprepared for the reality of going it alone. After a while, he lost his job and his flat. By the time we met again, John was 36 and had been living on the streets for 13 years. There were periods of respite and sobriety but he had been diagnosed with psychosis, likely induced from years of alcohol abuse.
Our last attempt to get John proper housing failed. His dual-diagnosis of psychosis and substance misuse meant that he was excluded from mainstream housing support, leaving a profound feeling of hopelessness. John died at 38 years old. His body was repatriated back to Ireland, wearing a suit we had bought him. His family were never truly aware of what had happened to him.
I tell this story because more than twenty years later, we are still seeing a rise in street homelessness. Research suggests that up to 80% of people living on the streets have a mental illness - half of which have a diagnosed condition. This is often complicated because of other issues including substance misuse and long-term physical conditions.
Like John, people do not fit into neat little boxes, and, therefore, we need to explore all the options and create new ways of delivering high-quality homes with the best support and care when needed.
I will be speaking about this topic with my mental health hat on at Homeless Link’s annual conference in July, discussing effective and new methods to prevent and tackle rough sleeping – one of the key themes of the event. I’ll be on a panel with chief executives representing the homelessness, multiple needs, criminal justice, domestic violence sectors, as well as the voices of lived experience, as we answer questions from the audience and share best practice and learning.
We know that having a safe place to call home is a key proponent of good mental health, and yet thousands of people are living in poor quality, temporary accommodation. We also know that this is directly connected to developing mental illness or eroding mental health, so that people are vulnerable to becoming seriously unwell.
Being in a stable home reduces the risk of spiralling into debt and gives you a better chance of realising your potential, yet for so many, this feels out of reach. For people with serious mental illness, housing can be an ongoing source of stress and fear, and admission to hospital or a stay in prison can bring tenancies into question and problems on discharge.
So, what are the solutions? To begin with we know that one-size doesn’t fit all, which means that there should be options ranging from independent living to more supportive arrangements.
Supported housing must be funded properly. You cannot develop a therapeutic alliance with someone when you are only visiting them for 15 minutes every couple of days. When people languish or move from one temporary arrangement to another, it creates the perfect conditions for anxiety to flourish. For children in this situation, the impact can be felt for a lifetime.
The Housing First model goes a long way to challenging this dynamic, as sustaining a tenancy is seen as the springboard to addressing health issues, dealing with debt and seeking employment and importantly offers individuals and families an opportunity to live with respect and dignity.
Housing associations and local authorities have a vested interest in developing models that meet the needs of people experiencing complex disadvantage, not only in terms of the practicalities, such as ensuring people pay rent, but crucially for the wider benefit of society.
What we do about housing now is relevant to what society’s mental health will look like in 20 years’ time. Better housing and access to the right support could seriously challenge some of the biggest societal and health inequalities faced by generations to come. Now’s the time for a proper investment in our future; I look forward to hearing the other panelists’ views at the conference in July.
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Chief Executive at Centre for Mental Health
Sarah is Chief Executive at Centre for Mental Health and has worked in mental health and criminal justice for 27 years.
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