Let’s open our eyes to the relationship between homelessness and mental health3 min read

It’s time we opened up the conversation about mental health to include the most vulnerable. How can mental health services be more inclusive to the homeless?

Every day, the UK’s homeless are walked past. We all do it. We walk past the most vulnerable in our society, who sit with a cup, or a sign, asking for help. We may find ourselves suspicious of them: ‘what are they really going to spend the money on?’, ‘they could choose a different life’, ‘are they just pretending?’

Rarely do we take the time to think about the harm a lifestyle on the streets causes to a person’s physical and mental health.

The homeless are exposed to a life without basic stability and dignity. Without a safe place to be, with few experiences that remind them they matter, that they are recognised or even exist. They are exposed to physical abuse, spitting, urination, sexual assault and property theft, creating feelings of fear and increased isolation from society. 

Unsurprisingly, this has some pretty severe consequences on mental health. 44% of homeless people have a mental illness, compared with 23% of the general population. It is astounding that it is not more; indeed, this number only reflects those homeless people who have managed to access mental health services for a period sufficient enough to receive a diagnosis.

There are mental health services though. So why don’t rough sleepers use them?

The reality is: we’re asking a group of people that we have repeatedly made to feel they don’t matter, to trust the services they have often been let down by and with that, trust the majority of health professionals with whom they feel no identification with.

Crisis’ study of over 500 UK rough sleepers found that almost half of all service users believe they are undeserving of help. The perpetual range of abuse a homeless person is subject to on the street, alongside failed service provision are at the root of this. Crisis also found that homeless service users – some of the most vulnerable people in the country – feel ashamed and stigmatised at being homeless, and that a high proportion feel invisible to others.

The loneliness felt by the homeless makes seeking support harder, with entrenched levels of social isolation further entrenching an ‘us’ and ‘them’ mentality and an utter alienation with society.

But let’s say somebody sleeping rough does come into contact with a support service. Maybe they are admitted to hospital or are arrested. Maybe someone will recognise they need mental health support, so they’ll make a referral to an NHS mental health service.

A referral usually takes a week to be processed; two weeks to be assigned a mental health worker and 16 weeks for a space to become available for that individual to then be seen face-to-face.

Our current system expects a homeless person with recognised bad mental health to survive for another 19 weeks on the streets – a level of ‘real life’ most of us can’t even comprehend, nor could handle – and on top of that:

A) Remember the specific details of the mental health appointment

B) Get themselves up, with all their belongings and work out where and how to get to their appointment (no smartphone to power up Google Maps)

C)  Find money – usually at least £4.00 – for a bus fare.

Is it any surprise most don’t turn up; when we’re essentially setting them up not to?

Sometimes a mobile phone number on the client’s record is relied on to check on the client’s whereabouts. When inevitably there’s no answer, a variation of the following note is entered on a client’s file:  

“Due to lack of engagement, this case will be closed.”

Another person, in genuine and desperate need of support, lost to a safety-net hardly fit for purpose.

What’s the solution?

Unfortunately, there is no easy solution. And there certainly isn’t a quick one.

Individually, do what you can. If you are walking past someone on the street, acknowledge them. If they say good morning, respond. If they ask for money, answer them, even if the answer is no. Small gestures and interactions remind them that they are valued and deserving of your time.

Value needs to be given to the most vulnerable in our society on a policy level, too. The minute you take an individual from the statistics: look at their family, their capabilities and their aspirations, you are giving value. If our systems valued the homeless, more time and money would be given to providing the mental health rehabilitation they need. They wouldn’t be struck off from caseloads – statistics and tick-boxes – after one unattended appointment; they would be given a real chance. They would be invested in.

Austerity has demicated public services, so there is neither the time nor resources for them to effectively support the homeless. Third sector organisations offering homelessness support are also stretched. You can put on all the charity sleepouts in the world but it’ll never reform a broken, under-resourced system. We must demand our government recognises – and crucially, invests – in the value of the most vulnerable in our society. This is the very least they deserve.

Flora is the Collaborations Lead for indx media, developing and overseeing our relationships. Flora currently works as a support worker for adults with complex needs. Her previous jobs include being a caseworker for refugees and asylum seekers and working with young people with disabilities – and later this year Flora will begin training to be a child and family social worker. Flora has a BSC Psychology degree from the University of Sussex. Flora identifies as a gay woman and is interested in social mobility, gender equality and LGBTQIA+ rights.