The aim of the essay plan at hand was to outline the mental health issues that are being faced by the homeless population in the UK, with specific references to the borough of Tower Hamlets. The plan covered the main contextual factors and determinants of the urban health issue, the main implications and public consequences of the issue in both the City of London in general and the UK, and offered an outline for the critique of current interventions to combat the issue. The plan concluded with speculated recommendations and conclusions for the extended essay.
Introduction:Where 10,000 of the UK’s homeless population can be found in London (Story, Murad, Roberts, Verheyen & Hayward, 2007), mental health issues have been established as prevalent among the homeless in specific urban areas in the city of London. The borough of Tower Hamlets has been identified as an area of historic and ongoing homelessness as it is a highly deprived area of East London. Deprivation and severe poverty has been identified as one of the most significant determinants of physical and mental health (NHS Tower Hamlets Clinical Commissioning Group, 2013). In accord, Tower Hamlets has a soaring prevalence of these determining factors, which encourage the development of mental health problems. Thus, homelessness has been identified as a significant aspect of poor mental health in this borough (NHS Tower Hamlets Clinical Commissioning Group, 2013). It has been suggested that mental health issues may actually be a leading factor in the onset of homelessness, where the stresses of homelessness further exacerbate existing psychological issues.
Rationale:Epidemiological data shows that common mental health problems such as anxiety and depression have been found to be over twice as high, and psychosis has been found to be fifty to one hundred times more prevalent in the homeless (Bassuk, Rubin & Lauriat, 1986). A local audit in East London has shown that serious mental illness is more prevalent in the black rather than the white population (NHS Tower Hamlets Clinical Commissioning Group, 2013). The prevalence of alcohol and drug abuse has been found to be widespread within the homeless community (Fazel, Khosla, Doll, Geddes, 2008) thus the essay will aim to shed light upon this aspect of substance abuse as the largest contributing factor to homelessness. The essay will also aim to provide further insight to how the statistics were found to be markedly higher in the borough of Tower Hamlets than the proportion across other London boroughs all together (alcohol 26%, drugs 36%) (NHS Tower Hamlets, 2011). Furthermore, the gender, ethnicity and age aspect of homelessness will be discussed, as there are marked differences between genders and races in regard to the issues faced in homelessness. For example, single men between the ages of 25-44 have been identified as the most common demographic group associated with homelessness (Hwang, 2001), yet children have also been found at a high risk of facing homelessness, accompanied by a high risk of developing mental health issues (Tischler, Vostanis, Bellerby & Cumella, 2002). The situation for those living rough is intensified when substance misuse is co-morbidly present with existing mental health problems (Rees, 2009). In accord, the essay aims to discuss how the borough of Tower Hamlets has been identified as having the highest mental health needs in the UK, with over 45% of the population of the borough claiming incapacity benefit due to their ill mental health. Furthermore, certain groups such as rough sleepers, domestic violence victims, sex workers and ex offenders are at a higher risk of homelessness and 70% of these individuals will be likely to have a mental health condition (Tower Hamlets Homelessness Statement, 2013). As the literature confirms that mental illness is a significant urban health issue among the population of Tower Hamlet accompanied by crucial repercussions such as homelessness, the essay will aim to highlight the ways in which this issue relates to the London borough of Tower Hamlets.
Urban Context and Determinants:The literature surrounding homelessness and mental health indicates that factors in the urban context play a major role in the development of this urban health issue. The essay will endeavour to discuss determinants such as poverty, exclusion, attainment and wellbeing, which all hold significant implications for homelessness (Frankish, Hwang & Quantz, 2005). Long term unemployment and overcrowded households have played a major role in the development of mental illnesses, and have even lead to homelessness (NHS Tower Hamlets Clinical Commissioning Group, 2013). Additional factors such as difficulties in maintaining secure and good quality accommodation due to mental illness will also be discussed in the essay as contributors to homelessness (Breaky, 1992). Moreover, light will also be shed on recent changes to government policy, such as reforms in welfare support and social housing, the recession, and government cuts to public services in the UK, and their impact on those who were most vulnerable to homelessness. Individuals with mental health problems have inevitably faced considerable difficulties due to these changes such as understanding when they need to claim the benefits, how the new benefits work, and uncertainty about how the changes will affect their circumstances. In some cases, individuals may also face difficulty getting access to, and using a computer to claim their benefits online (Crisis & MORI, 2002). These issues highlight the high risk of the mentally ill facing homelessness due to financial hardship, and provide an explanation to why there is mental illness among the homeless. Due to the fact that registration to a GP generally requires proof of a home address, homeless people are more likely to access healthcare through emergency services (Crisis & MORI, 2002). This poses problems on both the individual and the general population as the individual may not receive the health advice and respect that they deserve for reasons such as the emergency department only being intended for emergency health conditions, and due to social stigma around homelessness; such as the homeless may be associated with mental ill health, substance abuse and lack of hygiene (Riley, Harding, Underwood & Carter, 2003). These factors will be discussed as contributors of poor physical and psychological wellbeing which the homeless individual faces when trying to access public health care. Moreover, the waiting time in emergency departments will affect both the individual and the general public as the individual may not want to seek medical help due to long waiting hours and discrimination, and the general public may have to wait longer to be seen for an emergency due to homeless individuals being seen for general health concerns. Another factor that is aimed to be discussed in the essay is the cost of this urban health issue faced by the National health services. Evidence shows that mental illness for the NHS is costly as it is the largest cause of disability in the UK. Social and informal care for the mentally ill is costing ?22.5 billion, where 13.8% of the national budget is spent on mental health (National Mental Health, 2012). Statistics also show that ?77 billion a year was being spent on welfare benefits for mental illnesses in 2009. The impact of these costs on the national economy was damaging, increasing national debts thus affecting the general population through increases in tax, public services, and as previously mentioned, cuts to national healthcare. Therefore these determinants will also be discussed as contributing factors to the urban health issue.
Strategies & Interventions for Critique; Speculated Recommendations & Conclusions:The aim of the paper will be to critique strategies such as the Tower Hamlets Homelessness Statement 2013 to 2017, the Homelessness Act and other interventions that tackle homelessness and mental illness as separate entities (Crisis, 2009). The recommendations I will make will involve coordinated treatment programs (Coldwell & Bender, 2007) such as Assertive Community Treatment (ACT), which aim to serve psychiatric outpatients whose mental illness causes serious functioning difficulties in aspects of life including work, social relationships, residential independence, money management, and physical health and wellness, all of which can have an impact on housing status (Dixon, 2000). I expect to conclude that ACT is an effective measure in combating the core issues which lead to and maintain homelessness, and aim to recommend that government funding should be utilised to promote programs such as ACT which will make lasting changes in the homeless community.
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Breaky, W.R. (1992). Mental Health Services for Homeless People. pp101-107. Cited in: Homelessness: A National Perspective. Eds. Robertson, M.J. & Greenblatt, M. (1992).
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Riley, A.J., Harding, G., Underwood, M.R., Carter, Y.H. (2003). Homelessness: a problem for primary careBritish Journal of General Practice. 473-479.
Tischler, V., Vostanis, P., Bellerby, T. & Cumella, S. (2002). Evaluation of a mental health outreach service for homeless families. Arch Dis Child. 86. 158–163. Tower Hamlets Clinical Commissioning Group. (August 2013). Mental Health Joint Strategic Needs Assessment for Tower Hamlets. Tower Hamlets Health and Wellbeing Board. Retrieved from: http://www.towerhamletsccg.nhs.uk/Get_Involved/Tower%20Hamlets%20Mental%20Health%20Joint%20Strategic%20Needs%20Assessment%20Part%20One%20-%20Population%20Needs.pdf Accessed: 17th February 2014
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