The Department for Levelling Up, Housing and Communities assessed there to be 74,320 households that are homeless in the UK as of 2022. Being homeless has been found to lead to deep rooted health inequalities and inaccessibility to certain healthcare services. This article will be exploring why homeless people experience these inequalities and how the government and the NHS can help improve accessibility to healthcare.
Homelessness and health issues are interlinked. In the 2016 ‘Health needs Audit’ it was found that 78% of homeless people report living with a health condition; this is more than double the figures in the general population. Furthermore, the organisation Crisis found the life expectancy (average number of years a person has before death) for homeless people to be 47, which is drastically lower compared to the general population's life expectancy of 77. The life expectancy of homeless women is even lower, at 43 years, compared to 80 for women in the general population. Additionally, it was found that death by unnatural causes can be up to four times more common than average in rough sleepers. From these statistics we can see that as a rule, being homeless impacts physical health negatively leading to earlier mortality.
However, there are different health problems that come with being homeless depending on your age. For example, the organisation Shelter found that living in temporary accommodation can put children at a much greater risk of experiencing infections or having accidents. For young people, some of the health problems they experience can be the increased risk of sexually transmitted infections and unwanted pregnancies due to reduced access to protection and contraception. People above the age of 50 start experiencing cognitive and functional impairments prematurely which also lead to premature deaths.
Some of the common health conditions experienced by homeless people is a higher prevalence of infectious diseases. Examples of these include HIV, tuberculosis, and hepatitis C. They also commonly experience increased mental health problems, issues with substance abuse, lung diseases and malnutrition. It is worth noting that unfortunately, sometimes it is actually the mental health problems and issues with substance abuse that actually leads to people becoming homeless in the first place as they may be unable to earn an income and pay rent. Then, being homeless only exacerbates these issues as it is a highly stress-inducing and difficult time.
Many times, homelessness is a result of difficult situations or sudden changes that people have experienced in their lives (e.g. losing their job, death of someone who financially supported them) leaving them without a place to stay. These situations tend to be incredibly stressful which is why it is more common to find homeless people experiencing mental health problems such as anxiety and depression. In many cases, a life-changing and stressful event can also trigger the development of other mental health conditions such as bipolar or schizophrenia.
The organisation Shelter stated: ‘Children who have been in temporary accommodation for more than a year are over three times more likely to demonstrate mental health problems such as anxiety and depression than non-homeless children.’ Similarly, around 70% of young people who find themselves homeless report to experience mental health problems and around 33% of young people in this situation self-harm.
Mental health problems can be up to twice as high within people who are homeless, and it has been found that psychosis is nearly 15 times as high. These issues will be continued to be perpetuated due to the lack of access to healthcare and mental health services.
The homeless population face stigma and barriers when trying to access health services and social care services. They face discrimination due to their background and lack of a permanent address as well as lack of a network of contacts around them. Even registering for a GP is difficult without a fixed address, even though this is not a requirement to sign up for a GP surgery. The NHS often communicates through letters, emails or texts and this can therefore pose a problem to homeless people who may not have a permanent address or access to a mobile. They may also not be able to afford the transport to get them to their appointments, especially if they are at specialist hospitals further away from their base. It is not uncommon for patients who have missed their appointment to be discharged from the service, and then have to be referred all over again if they still need to be seen. This is a time consuming process as referrals can sometimes take between months to years.
Beyond this, whilst homeless people may be eligible for free prescriptions on the NHS, others may not be aware of this or know how to secure this. This can then put them off seeking care in the first place, as they believe they won't be able to afford the medications. Similarly, some health conditions can be simply managed with over the counter medications from the pharmacy but these are not free of charge, and homeless people may simply be unable to afford this.
The simplest thing both the government and the NHS can do is work together to make healthcare more accessible to everyone.
In October 2021, NICE published a new draft guideline with the aim of reducing some of the health inequalities homeless people experience. There were various ideas that they presented such as offering services which are mobile and have flexible appointment timings, so they are more accessible to the homeless population. Having transportation services to and from appointments would also make it easier for the homeless population when they need to seek help.
There should also be an increased understanding that if appointments are missed and they should ensure not to discharge them from the service. Instead, they should check up on the individual to see if they are okay and need support attending appointments. The NICE guidelines suggested the introduction of peer supporters who can help individuals from the homeless population to remain engaged with appointments and any follow up care. One of the most important things the NHS can do is to create long term relationships with those who struggle to access and engage with healthcare appointments.
Ultimately, as homelessness is more of a social and political issue, it is essential that the government invest in ways to reduce rates of homelessness - e.g. providing more affordable houses and tackling the cost of living crisis. This will subsequently reduce the health issues associated with homelessness.
Author: Fateha Khawaja
Editor: Dr Latifa Haque