How joined-up services can help people experiencing homelessness
Lack of appropriate accommodation to support the health and care needs of people experiencing homelessness leaving hospital is putting lives at risk
STRATEGY
Image: Istock
Dr Caroline Shulman
Co-Clinical Lead, Homeless Health, Healthy London Partnership
JJ Nadickbernd
Programme Manager, Homeless Health, Healthy London Partnership
Issue: 63 | December 2022
People experiencing homelessness (PEH) are dying young – often 30 years earlier than most people. They frequently have multiple and complex needs, often starting with early complex trauma during childhood. Many people who are homeless have experienced neglect or abuse resulting in significant mental health problems, addictions (commonly from self-medicating and blanking out trauma) and profound physical health problems. At least a third of deaths of people experiencing homelessness are from causes responsive to health care.
Through a snapshot audit of inpatients experiencing homelessness, we identified huge unmet care, support and housing needs among this cohort. Sadly, this is not news for many in the homelessness sector, and as the cost-of-living crisis continues to worsen, a high-level of need for housing will likely continue to grow. So, how did we approach the audit, and what were our key findings and recommendations?
Audit approach
We undertook a point in time audit over one week in February 2022. In this we looked at 19 hospitals across London finding 150 PEH. We looked closer into the details of 86 cases across 15 acute hospitals and 18 people in mental health hospitals to understand the health, care, support and accommodation needs involved.
Key findings
The level of complexity of need of PEH in hospital was massive. Almost two-thirds had three or more physical health problems and half had mental health issues.
Out of the 86 people in acute wards, there were 14 admitted with sepsis or following collapse or cardiac arrest. Others had experienced strokes, multiple severe infections, amputations, head injuries, complicated diabetes – the list goes on.
There were people who had suffered from significant physical trauma as a result of accidents, suicide attempts or assaults. Many had underlying factors including mental health problems, and/or addiction, as well as immigration issues.
The combined physical health, mental health, psychological and addictions needs meant that 92% of people needed some form of care or support following their hospital admission.
A significant finding was the lack of intermediate and long-term care and accommodation for a safe hospital discharge. There was often a mismatch between the type of accommodation and support needed compared to what was available.
For example, there are significant gaps in provision for people with high physical support needs in combination with mental health difficulties and/or addictions.
Summary of short and long-term needs
92%
needed short or longer term intermediate care
1%
needed accommodation alone
45% were projected as requiring short-term intermediate care/support and 46% requiring long-term accommodation with care/support.
The lack of options resulted in delayed hospital discharges, putting greater pressure on beds in an already stretched system. Some think homelessness is just a housing issue, although in our audit there was only one person that just needed accommodation.
The needs are housing, health and social care and this audit has been able to begin to quantify this need.
Recommendations
Though the needs are complex, the numbers are not huge. We know what works. What is needed is sustained commitment to continued development of services with investment over a longer time frame. And just as NICE guidance recommends, these need to include a range of intermediate and long-term accommodation and support options to enable equity and choice with improved health outcomes long-term.
Services need to be:
- Shaped through co-production with people with lived experience
- Person-centred and trauma-informed, with multi-agency teams sharing an understanding of the individual’s needs
- Reflecting the value of trusting relationships to support engagement as an essential part of recovery, through the employment of people with lived experience and third-sector partners
Clearly, we need to ensure better co-ordinated support in the community to prevent people from becoming so unwell they need hospitalisation. But when a hospital admission does occur, it must be recognised as an important opportunity to prevent early death.
It is essential this opportunity is seized, and people are not discharged back to the street or to inappropriate or unsafe accommodation. This joined-up approach needs to link health housing and social care – both in hospital and the community.
To support appropriate safe discharge from hospital and to prevent hospital admissions, there is an urgent need for intermediate care – more commonly associated with elderly people – to provide short or long-term support to help individuals recover and rehabilitate safely.
“It is essential this opportunity is seized, and people are not discharged back to the street or to inappropriate or unsafe accommodation.”
