Special Interest Group for the Homelessness (SIGH)

Setting for Action

References

Targets for improvment

Access to Services

SIGH is affiliated to the Community Practitioners and Health Visitor’s Association. It is a national group of professionals who work with homeless people.
We applaud the government’s aim to improve the health of the general population and to improve the health of the worst off in society.

However the strategies outlined are not sufficient to address the needs of homeless people.
The avoidance of the extremes of victim blaming or dependence fostering, in the promotion of health, by the partnership approach, involving statutory and voluntary agencies and the individual may be pertinent to the needs of the settled population.

However this will fail to address the needs of mobile homeless families and individuals.
This government has not amended the 1996 Housing Act (HMSO1996) in which the responsibility to permanently house homeless people in priority need was removed from local authorities.
Consequently families with children, pregnant women and single vulnerable people who have experienced homelessness may face many years of repeated homelessness their only housing option being a series of short term leases in the private sector.
In addition there are unknown numbers of homeless people who fall outside the definition of ‘priority need’ who are in housing need.

Settings for action

~ Healthy Schools – focusing on children.

The psychological effects of homelessness on children and adolescents are shown in the development of behavioural and emotional disorders. Of 194 children in homeless families, aged 2 – 16 years, surveyed in Birmingham, 30% were found to have mental health problems sufficiently severe to need referral to specialist services (Vostanis, Cummella, Grattan and Winchester 1996). In addition homeless school age children are disadvantage educationally and socially (Power, Whitty and Youdell 1995).Traveller children are particularly affected as they may be required to move location at short notice (HMSO 1994) It is recognised that school nurses play an important role in the health of school children. Health visitors who are not mentioned in the Green paper, have a very significant role in promoting the health of pre school age children and their families.

~ Healthy Workplaces – focusing on adults.
The majority of homeless people are unemployed (Hutchinson and Gutteridge 1995) so any health programmes aimed at the workforce would not reach this group.
Reasons for homelessness are often associated with loss or lack of employment such as redundancy and mortgage arrears, eviction from tied accommodation or leaving institutions (Reading Borough Council 1997). Welfare to work programmes may have little impact on this group, the majority of households being headed by a single parent with pre school age children (Hutchinson and Gutteridge 1995). Homeless people who are not in priority need may have greater difficulty in joining the workforce. It is difficult to find employment when homeless and vice versa. Homeless asylum seekers are not allowed to work for 6 months (HMSO 1996).

~ Healthy Neighbourhoods – focusing on older people
Any health promotion initiatives aimed at older people in the community would not reach those that are homeless because of the temporary nature of their accommodation and their mobility.

UNDERSTANDING THE CAUSES OF ILL HEALTH
We endorse the resolve to tackle the causes of ill health.
However, the strategies will fail to affect those that are homeless.

~ Social and Economic Factors

The anti poverty "Welfare to Work" programmes may have little impact on homeless people.
Single parents with pre school age children may not be affected by the Welfare to Work programme and therefore likely to remain on benefits and in poverty for long periods (Oppenheim and Harker 1996). Homeless people who are not in priority need may have difficulty in joining the workforce as they have no address. Finding a home when unemployed is also difficult. Empirical knowledge reveals that those homeless people that are employed occupy positions in the lower socio - economic groups.

Therefore in comparison to the general population, homeless people are more likely to be unemployed, have greater difficulty in finding employment and more likely to be dependant on benefits and therefore in poverty for longer periods.

Despite being in greater poverty this group often experience circumstances which increase poverty.

A survey by the Child Accident Prevention Trust (1991) revealed that the types of temporary accommodation used by housing authorities was, ‘Ill designed, ill equipped and ill maintained’. Poor cooking and food storage facilities in temporary accommodation may cause families to resort to eating from fast food outlets. Such foods are likely to be more expensive and less nutritious than home cooked foods (Conway 1988). Families placed in temporary accommodation in a different area of a town may have the added expense of public transport in order to maintain contact with the extended family or informal support network. Alternatively to save the cost of transport, they may have less contact with family thereby reducing support and gifts in kind that a family might otherwise provide (Hutchinson1997).

~ Housing
We appreciate the intention to address poor housing conditions and to meet priority need with the additional resources of nearly £800 million over 2 years. However priority need is not specified. Does this refer to those legally defined as ‘homeless’ and in ‘priority need’ or is ‘priority need’ to be decided by local authorities.

As there has been no new housing legislation to reverse the removal of responsibility from authorities to permanently house those that are ‘homeless’ and in ‘priority need’ (HMSO 1996) this initiative, funded by the Governments Capital Receipts Initiative is unlikely to address homelessness.

New targets have been suggested for reducing deaths from heart disease and stoke, reducing accidents, reducing deaths from cancer and reducing deaths from suicide.
Unless decent, affordable, permanent housing is available for all, homelessness will persist and there will be barriers to achieving these targets.

• Heart disease and stroke due to:

• Poor diet

• lack of cooking facilities

• lack of food storage

• lack of money Stress

• overcrowding

• Cancer Difficulty keeping / securing screening appointments

• mobility – non-delivery of call / recall letters.

• mobility – non-delivery of call / recall letters

• Stress

• Lack of play space

• Faulty fittings – gas / electricity

• Accidents Poor facilities – Live and cook in same room

• Stress

• Disrepair of buildings

• Parents lack control in shared environment

• marital breakdown

• Uncertain future

• Disempowerment

• Mental health Stress and overcrowding –
  anxiety, depression, family strife
  

• Suicide is the biggest single cause of death for young single homeless people. The life expectancy of someone who sleeps rough is 42 years, compated with national average from men at 74 years and 79 years for women. (Crisis 1996)

Despite the health needs of homeless people being high, access to services is poor.
Many families in temporary accommodation are moved away from their primary health care teams and do not know where to access service or are reluctant to change (Health Visitor’s Association and General Medical Services Council 1989). Because of the temporary nature of their accommodation they may secure only temporary registration at a GP and therefore treated by practitioners who do not have access to their medical histories. Similarly, distance from other support agencies may make access difficult for clients or have cost implications for agencies such as social services. The intention to improve access to services is applauded.

However as homeless people have poor access to primary health care their needs might not be recognised by the New Primary health Care Groups that will have responsibility for planning and developing local health services.

It is important that community trusts remain to ensure that the particular needs of this client group are addressed.

References

Child Accident 1991 Safe as Houses?
Prevention Trust Child Accident Prevention Trust, London

Child Accident 1991 Safe as Houses?
Prevention Trust Child Accident Prevention Trust, London

Conway J (ed) 1988 Prescription for poor health: the crisis for homeless families
Shelter, London

Crisis 1996 Still Dying for a Home
Crisis, London

Health Visitor’s and Association and General Medical
Services Council 1989 Homeless families and their health
BMA, London

HMSO 1996 The Asylum and Immigration Act

HMSO 1994 The Criminal Justice and Public Order Act

HMSO 1996 The Housing Act

Hutchinson K and Gutteridge B Health visiting homeless families: the role of the specialist
Health Visitor Vol 68 No 9 372 – 374 1995

Hutchinson K 1997 A study to determine the health priorities of homeless families and how they correspond to health visiting priorities.Unpublished MA Dissertation, University of Reading

London Homelessness Forum 1993 The experience of homeless families in Private Sector:Leased temporary accommodation, London Homelessness Forum, London

Oppenheim C and Harker L 1996 Poverty the facts
Child Poverty Action Group, London

Power S, Whitty G and and Youdell D 1995 No Place to Learn Homelessness and Education
Shelter, London

Reading Borough 1997 Homeless Guide
Council Reading Borough Council

Vostanis P, 1996 The Impact of Homelessness on the Mental Health of

Cummella S, Grattan and Winchester C Children and Families
Department of Psychiatry, University of Birmingham

Kath Hutchinson - Special Interest Group for the Homelessness
28.04.98