Homelessness can be associated with severe poverty and is a social determinant of mental health. It can also have a severe impact upon an individual’s physical health and homeless people are more likely to be victims of crime.
On average, homeless men die 30 years earlier and homeless women 37 years earlier than the general population in England. People sleeping rough or in insecure or unstable accommodation have significantly higher levels of mental and physical ill health, substance abuse problems and higher rates of mortality than the general population.
The causes of homelessness are often complex so that preventing homelessness is a difficult issue to address. However, it is known that some factors and experiences can make people more vulnerable to homelessness, including poor physical health, mental health problems, alcohol and drugs issues, bereavement, experience of care, and experience of the criminal justice system.
There is a statutory duty for local authorities to provide advice and assistance to households who are homeless, or threatened with homelessness, and is some cases to provide suitable accommodation. In certain circumstances they also have a duty to provide emergency accommodation.
The Homelessness Reduction Act 2017 made far-reaching changes to homelessness legislation and significantly amends the Housing Act 1996. It came into force in April 2018. Under the Act, local housing authorities will be required to intervene at earlier stages in order to prevent homelessness and to take reasonable steps to help those who become homeless to secure accommodation, or to maintain their existing accommodation. Its main purpose is to ensure that everyone who approaches a local authority because they are either facing homelessness or actually homeless should receive some assistance, whether they are in priority need or not, and irrespective of whether they may be considered intentionally homeless.
The Housing Solutions Team carries out prevention work which includes assisting applicants to find and secure their own accommodation. The chart below shows the large number of cases in which homelessness prevention was successful.
In Herefordshire the number of homelessness applications has declined in recent years. In 2015/16 there were 114 applications, representing a rate of 1.4 per 1,000 households, well below the rate for England of 5 per 1,000.
Figure 1. Homelessness applications - decisions made per 1,000 households
Source: Public Health England
In 2017/18, the rate of those considered to be statutory homeless in Herefordshire was 0.6 per 1,000 households, lower than in England (2.4) and the West Midlands (3.3). This rate had fallen from 3.3 per 1,000 households in 2011/12.
The rate for those statutory homeless eligible people not in priority need was 0.1 per 1,000 in 2017/18: also lower than in England (0.8) and the West Midlands (1.1).
Although numbers are difficult to establish with certainty, the number of rough sleepers in Herefordshire was estimated at 11 in 2017, down from 21 the previous year. The Hereford Winter Shelter was open between December 2016 and March 2017. In this period a total of 66 (59 men and 7 women) individuals stayed for a total of 861 nights. The approximate average stay per person was 13 nights. This compares to a total of 79 individuals staying for a total of 1,124 nights in 2015-16, which was an approximate average stay per person of 14.2 nights.
The Herefordshire Homelessness Prevention Strategy 2016-2020 sets out a series of actions aimed at reducing homelessness and rough sleeping in the county.
Homeless Link’s Homeless Health Needs Audit
The Homeless Health Needs Audit is a tool developed nationally that aims to i) increase the evidence available about the health needs of people who are homeless and the wider determinants of their health, ii) bring statutory and voluntary services together to develop responses to local priorities and address gaps in services, iii) give people experiencing homelessness a stronger voice in local commissioning processes, and iv) help commissioners understand the effectiveness of their services.
The audit was undertaken in Herefordshire between December 2016 and February 2018 and was used to capture the health needs data of people who were/are sleeping rough, sofa surfing, otherwise chaotically housed or living in specialist supported accommodation. Auditing was undertaken through face-to-face interviews by Home Group, Supported Housing for Young People Project (SHYPP) and Herefordshire Council’s Outreach Service (HCOS).
One hundred and two audits were completed. The majority of respondents were male (82%), white British (92%) and the average age was 34.5 years. Participants were sleeping in a hostel or supported accommodation (n=43; 42%), in emergency accommodation (n=23, 23%), rough on the streets or in a park (n=15, 15%) or on someone’s sofa/floor (n=14, 14%). Six percent of respondents did not have recourse to public funds.
Backgrounds in institutions, including prison, local authority care and mental health admissions were common. The majority of respondents identified the cause of their most recent homelessness to be related to the loss of their individual personal support networks.
- Physical health: The most common physical health problems identified were joint/bone/muscle problems (26%), dental problems (19%), eyesight/eye problems (16%) and asthma (16%).
- Mental health: Participants experience high levels of stress, anxiety and other signs of poor mental health. Overall 76% of respondents reported a mental health problem/behaviour condition. Dual diagnosis (severe mental health issue and substance misuse) was reported by 18% (18 people, 78% of whom were told in the last 12 months); 14% reported psychosis (of whom 71% were told in the last 12 months). Just under half of those with a mental health problem felt that they were not receiving treatment that they would benefit from, this included respondents with severe mental health conditions and common mental health conditions.
- Drugs and alcohol: 43% of respondents did not use drugs, 15% used cannabis only and 42% used Class A, prescription or other non-cannabis drugs. 25 people identified themselves as having a drug problem or being in recovery, of which 32% felt they would benefit from more treatment. Approximately half of respondents drank frequently (from almost every day to once or twice a week). Those that drank, drank on average 10.7 units on a typical day.
- Access to services: 78% of respondents were registered with a GP and 29% with a dentist. Use of acute care services was common, and frequent. Mental health problems and self-harm/attempted suicide contributed to approximately 40% of A&E, ambulance and hospital admissions. Violence and accidents were the main reasons for approximately 30% of use of these acute services.
- Staying healthy: Basic nutrition in this population was identified as a problem with only 19% of respondents reporting an average of 3+ meals per day. Uptake of preventative health interventions was low in this population, for example <10% of respondents had the flu vaccine last year.
The audit concluded that health inequalities faced by people who are homeless are considerable and the loss of decades of life, compared to average life expectancy, is stark. Whilst prevention of homelessness and insecure accommodation, and the risk factors that lead to it are paramount in reducing such inequalities, so is meeting the needs of population who are homeless. This audit has identified considerable need for physical and particularly mental health support. It has shown high use of acute, emergency and secondary care, often driven by mental health problems.
 Impact of homelessness, Homeless Link
 Homelessness Kills: An analysis of the mortality of homeless people in early twenty-first century England, University of Sheffield and CRISIS, 2012
 Causes of homelessness, Homeless Link