Articles of interest

Young Offenders: Running away and homelessness are life events experienced by a substantial number of young offenders aged 16 to 20 years.

Care Leavers: Thirty percent of young single homeless people have been in care and 20% of care leavers experience some form of homelessness within two years of leaving care.

NEEDS OF THE POPULATION

Poor mental health: There is a compelling body of evidence indicating that many homeless

young people suffer from severely degraded mental health. Mental health problems are eight times as high for people living in hostels and bed and breakfast accommodation and eleven times higher for those whom sleep rough, compared to the general population.

Poor physical health: As with mental health, the homeless population tend to suffer from a similar range of physical problems as the general population, but more often and more severely due to restricted access to basic commodities.

Risk taking behaviour: Self neglect may result from a combination of practical barriers and the manifestation of mental health problems. Self-harming is thought to be relatively common among young homeless people and suicide is the biggest single cause of death among the street homeless. There is a relatively high prevalence of sexual risk behaviour among the young homeless population. Substance use also has a significant effect on security of domicile. Criminal activity can be an inevitable and unavoidable consequence of lengthy periods of insecure domicile. It is preferable to see this risk taking behaviour as something that can be treated, rather than as a dimension of some people’s lives that may be to some extent deliberately chosen.

Vulnerability: Young people understand the dangers of street living and harbor associated fears.

Young homeless people are more likely to be the victims of crime rather than the perpetrators.

Social exclusion: While ‘street children’ are the most visible section of the young homeless population, they comprise the smallest. Many more young people with insecure domicile have high levels of need. Homelessness degrades job opportunities, impedes the acquisition of social capital, undermines the young person’s sense of identity and exposes young people to a wide range of dangers and stressors.

CHALLENGES OF WORKING WITH THE POPULATION

Accuracy of diagnoses: Mental health issues may be less easily diagnosed than physical health issues by both clinician and patient, especially when there are complex presentations. Diagnostic procedures in adolescence are fraught with difficulties, in that the line between disorders requiring

a clinical response and the troubles many children experience during ‘ordinary’ growing up is a fine one. The behaviour of homeless people may be construed as indicative of mental health problems when it may in fact be adaptive behaviour. It is important to avoid unnecessarily pathologising the problem. Homelessness is essentially a housing or socio-economic problem that can be addressed to a large extent by effective legislation and may be only one dimension of the multifaceted lives of young people.

Co-morbidity: Co-morbidity between mental health problems and substance use is high, but this issue should be treated cautiously in terms of what is problematic ‘use’. There is a challenge inherent in meeting the needs of homeless people with severe and multiple problems.

Stigma: Knowledge and understanding of mental health problems among young people is low.

While statistics are useful for justifying need, distressed young people may not necessarily be helped by a focus on diagnostic procedures. If a diagnosis is accepted, then discrimination against people with mental health problems may result in their being housed in the poorest accommodation.

Dependency: For many young people with insecure domicile, dependency on others – often people with similarly fragile accommodation – may become normative.

Positive choice: Homelessness may be preferable to sustained abuse or social isolation, or a conscious expression of independence. However, it remains a positive choice made in a context where the range of choices is narrow and mostly undesirable, not one chosen from a number of valued options.

Access: Insecure domicile and high levels of mobility result in young people relying excessively on acute rather than preventive services. Young people with low confidence and self-esteem are reluctant to make full use of public services.

Trust: Young homeless people may distrust statutory and regulatory services. Contact may be irregular, placing additional demands on the informal and voluntary sectors.

Lack of a voice: Young people may not have the experience to recognise and articulate their needs. Unlike most young people however, they may have few or no responsible adults to advocate on their behalf.

Diversity of population: Tensions may occur when the age range served is too broad, especially as adolescents just a few years apart may have had very different experiences and have very different needs.

Need for support: Despite housing long being identified as a pre-requisite for good health, a roof is not always the whole solution and can actually serve to exacerbate underlying problems. Loss of tenancies, further homelessness or use of insecure housing will not be avoided unless financial and emotional security are addressed. On going social support from both lay and professional sources also has proven benefits in reducing psychiatric morbidity.

STRUCTURAL BARRIERS

Resource constraints: Pressures on time and resources mean that workers often have to deal with presenting problems rather than underlying causes.

Lack of statutory cohesion: The homeless are under-represented in CAMHS, and are particularly vulnerable to poor co-ordination between child and adult services. In addition, there is no departmental responsibility for the overall impact of government policies on homeless people.

Care system: Currently the care system provides inadequate preparation for independent living There are additional pressures on care leavers because they lack the safety nets that others can fall back on.

Housing system: There is a lack of appropriate, accessible and affordable accommodation for young people as a whole. For vulnerable young people, the choices are far narrower.

Interagency collaboration: There is a need for more effective inter-agency working when dealing with a population characterised by multiple needs.

Service focus: Many resources currently reach less dependent and better functioning service users.

The Mental Health Needs of Homeless


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