Health and Homelessness: A Response to the Crisis Report
The Crisis report publicised in today’s media draws attention to the health problems experienced by people who have experienced homelessness. More specifically, the research finds that their life expectancy is on average 30 years less than the rest of the population. Researchers also found that drugs and alcohol play a role in one third of deaths of people who are homeless; that they are more likely to commit suicide; and, are more likely to be killed in a traffic accident.
The Universities of Salford and Lincoln have conducted research into multiple exclusion homelessness over the previous two years (as one of the four research teams in the ESRC/JRF funded programme). Instead of a statistical study, we were more interested in the insights that can be yielded from a qualitative study: we did this by conducting life story interviews with people who were homeless. This method has allowed us to identify and analyse the complex, intertwined events of an individual’s life. Many of our participants experienced some sort of physical or health problem; alcohol and substance misuse was also prevalent.
One interesting finding was the role of dyslexia in the life stories of people who had become homeless. Trent, a seventeen year old interviewee, discussed how dyslexia was caught up in his journey through education. Trent had vivid memories of being neglected by his alcoholic parents at the age of ten – the same age he developed a habit for alcohol himself. He discussed how these problems combined to lead to his early exit from high school:
Int When did you find out you had dyslexia then?
Trent It was when I was in Year 7, when I went high school. They thought I had something wrong with me, but they thought it was because of my behaviour, ‘cos I wasn’t at school or anything.
Trent When you were at primary school?
Rsp Hmm, they thought it was ‘cos I was a young lad, growing up, being naughty, but when I got to high school they found out I’d got dyslexia and it’s just, like I had to strive for my exams like, but I never got to do them in my own level. I got kicked out in the last year.
After leaving school early, Trent began to sell drugs and joined a gang. He also carried a gun to keep himself safe. Later, he realised that his friends were ‘using’ him (and giving him somewhere to sleep) only because he was giving them drugs. He identified a turning point in his life as the time he left them to move in to a hostel; once there, he received support to seek employment and independent accommodation.
In contrast to Trent, Scott was a forty-one year old interviewee (and just six years younger than the average life expectancy age identified in the Crisis report) who had experienced health problems throughout his life story. Scott was sexually assaulted by his father at the age of five. Because his father was arrested, Scott was ostracised by his family and, at the same time, he turned to smoking cigarettes, and eventually alcohol and drugs, too. He started smoking cannabis at age twelve, cocaine at twenty-one, and heroin at twenty-six. He described himself as a ‘right swine’ as a child. At the age of eleven he was involved in an accident which resulted in colitis and a pierced liver, lung, and kidney. He was away from school for a year and felt apathetic about education when he returned. He was placed in care but left at age fifteen when he moved to London. He slept rough for two years, and at age sixteen, he was raped. Scott then spent around fifteen years employed by Gypsies with whom he would travel internationally. When this ended, he struggled to work again and returned to rough sleeping and substance misuse. At forty he had a heart attack which prompted him to stop using drugs and cut down on alcohol.
What is interesting about these stories is that it allows us to think about the bigger picture of an individual’s life: it adds some meaning and depth to the statistics we read in research projects about homelessness. We can see from these examples that problems with health are not necessarily a result of homelessness, nor have they become homeless because of their health problems. It just isn’t that simple. Trent’s issue with dyslexia was not picked up on early in school; indeed, his behavior was attributed to be that of a ‘naughty boy’. Scott clearly had problems with his health from the unfortunate accident he experienced as a child. His pathway to alcohol and drugs is, according to Scott, his method of coping with the abuse he suffered as a child. Though he first used them when he was a child, he began to use harder drugs after he became homeless. The heart attack he experienced as a forty year old is attributed to his years of drug and alcohol use.
There are also two contrasting narratives in these examples, too. For Trent, he had a problem (dyslexia) which was combined with several others (parental neglect, being surrounded by other drug users) that would eventually lead him toward homelessness. Homelessness, one would hope, is the turning point for him to move forward and progress with his life. Scott, on the other hand, has experienced some kind of physical and mental distress for almost his entire life and for which his experience of homelessness has contributed.
The Crisis/University of Sheffield report has highlighted the problems associated with poor life expectancy and health outcomes. To understand the role of alcohol and substance misuse, as well as problems with physical and mental health, an individualised analysis such as the life story approach has been useful in acquiring insight; it can also help us to identify where, who, and how in a person’s life course particular problems can be picked up on and addressed before they lead to homelessness. We hope this blog post helps to provoke further thought and discussion.
Doing Stuff with Homelessness Research
We’re now two years on from the beginning of this research project and we’ve come a long way. We’ve forged partnerships with homelessness service providers in Stoke, and conducted and analysed one hundred life story interviews with homeless people as well as around twenty stakeholders in the city. But while one significant part of the research process has come to an end, it is at this point that we start putting our work into the public domain. To begin with, there are some papers available to download, for free, here.
As you may or not be aware, our research project has been part of a wider programme of research in the multiple exclusion homelessness programme. The findings from the programme were launched at an event in London in September, which was chaired by Jon Snow, the Channel Four journalist, and attracted significant nationwide media attention. A JRF round-up document was also produced to coincide with this event and this can be accessed here. The round-up was received well across a wide audience and received support from many stakeholders in the field, including the Minister for Housing, Grant Shapps. It is also encouraging to see outputs from the wider research programme regularly being shared and disseminated via Twitter.
Yet, it feels as though there is so much more work that we can do. We have a number of academic papers which we are working on, but we also recognise that we have more to contribute and in ways we did not foresee when we began our research. Working with partner organisations in Stoke has helped us to share knowledge, understand what the goals are, and find ways of supporting each other to achieve what we all want: better outcomes for homeless people in the city. As an example, we recognise, as a group (the voluntary sector, local authority, and the research team), that more can be done with other public service bodies, and the private sector, to develop opportunities for homeless people to move forwards. We are finding ways to increase their awareness, demystify misconceptions around homelessness, and consider the role different services and employers may play in the life stories of individuals and the ‘ecosystem’ of the city.
We also want to improve the network of homelessness researchers in the country. At the moment, researchers appear disconnected from each other. This is partly because homelessness is an area of concern across disciplines, such as housing, social policy, and to a lesser degree, psychology. A mixture of disciplines is a welcome asset to the study of homelessness, but it will benefit from improved links between individual researchers and institutions. Finding ways of bringing them together and sharing knowledge will help to inform future directions of study and lead to better understandings of homelessness, new practices, and provide evidence for policymakers.
Finally, we’re looking to do more with the findings of our own research project. The life experiences of the people interviewed are fascinating. Listening to the stories, and reading them, inspires a tremendous mix of emotions: sadness, despair, anger, happiness, laughter, surprise, hope, fear, awe, and wonder - all the emotional responses you would expect to experience in hearing human stories. These are the things that remind us that, among the professional jargon, we are dealing with real human experience; we are reminded of why homelessness is such a serious social issue. But, there are limits to our abilities as a research team and for our work to have an impact on others, we are currently working with talented, creative individuals to help us re-tell these stories. We’re also looking for funding opportunities to do more creative work and engage larger, more diverse audiences and, at the same time, draw upon the talents of homeless people themselves. To exemplify this point, I’ll finish the post with a short film which was created by young people with experience of homelessness. Volunteers at the YMCA in Stoke produced this film with the support of regional television, and it was aired on local news about a year ago:
Toward a psychology of homelessness?
Since we started this piece of research two years ago we’ve learned about homelessness and we’ve learned about what is known about homelessness. As two members of our research team have a background in psychology (Phil Brown and I, Gareth), we have taken an interest in the contribution that psychology has made to the field of homelessness knowledge. We believe that it has much more to offer.
The turn to a social and cultural understanding of homelessness is a relatively recent development in the literature on homelessness. Previously, many ideas about homelessness have made assumptions about why it happens (usually the responsibility is assumed to lie either with the individual themselves or, alternatively, is the fault of ‘society’). A further assumption is that if we know what makes people homeless, then we can know how to ‘cure’ it. But recent authors of homelessness have looked at it from a different perspective: they have taken a deeper interest in the wider experiences of homeless people and by doing so have gained a richer understanding. This isn’t just about what homelessness is, or necessarily how it ought to be fixed; it is about understanding the meaning of experience to those individuals and how they see themselves within the social world (among their friends, family, peers, support workers, etc.).
The application of psychology, as we are discovering, has much to offer in our understanding of homelessness. It can also help to support practitioners with the services they offer. The ‘Psychologically Informed Environment’ Approach (PIE) is highlighted in the Mental Health Good Practice Guide and points out:
“User-led services that work to encourage engagement but not reproduce dependency will be more effective than those that overlook the social dimension of person-centred services.” (p. 19)
It is an approach being taken up by St Mungo’s.
The PIE approach is one example of what could potentially be a wider offering of psychological knowledge to the area. We would be really interested to hear your views about the role of psychology for homelessness. Whether you have been, or are homeless, whether you work with homeless people or are involved in policymaking, please share your views. We would also like to hear from any other psychologists, academics or in practice, who may be working in the area of homelessness or a related field.
Feel free to leave a comment here or contact one of us via email. Our researchers are listed here.
How do people get off drugs without professional help?
I don’t have any definitive answer to this question and I’m sure there isn’t a single solution. But, the question has been raised due to a couple of cases I’ve examined in our interview transcripts.
Isolation: how important can it be for drug use cessation?
Let’s name the first example ‘Heath’. Heath was a cocaine user. He maintained employment and earned enough money, by both legal and illegal means, to live independently and fund his habit. But Heath decided he’d had enough. He’d been losing weight, losing sleep, and gotten involved in a number of fights. He left his job and his home, making himself intentionally homeless, to assist his drug use cessation:
“I decided to go cold turkey and make myself homeless to get myself off it”
And this was, for Heath, a rational and premeditated strategy:
“If I haven’t got a home, I haven’t got no money have I? And if I haven’t got no money, I can’t have it”
Without the money to support his habit he reports experiencing a period of six months ‘cold turkey’. He simply waited. Heath also perceived the absence of social support as a positive in his ‘recovery’:
“I was on my own, I wasn’t seeing anyone. I was hiding everywhere. It was nice weather though so you can go a field, just sit, chill out, think about what you want to do with yourself”
And what’s more, his homelessness was perceived as a ‘small’ issue compared to the main goal:
“I knew that being homeless was for my own good. There was a greater purpose to it, wasn’t there?”
And so that was Heath.
Let’s name the second example ‘Kieran’. Kieran used amphetamines. His motivation for giving up his habit was to prove to a family court judge that he was ‘clean’ and fit to see his children. His strategy was to accompany a friend who drives a truck long distances:
“I started going with him, just in the wagon, away all week and I did it through going with him really. Just slept it out really, ‘cos there’s no medication they can give you for withdrawal off amphetamines, just sleeping tablets really.”
What Heath and Kieran have in common is they both identified a need and motivation that was powerful enough for them to undertake a ‘cold turkey’ withdrawal. They also considered they had to significantly disrupt their lifestyles by means of changing the ‘place’ in which they occupied and, by implication, the company they were keeping. In Heath’s case, too, short-term poverty was crucial for his plan to succeed. They knew what, in their current lifestyles, would harm their chances of succeeding and so they removed themselves from those potential dangers. But, they seemed to act alone: neither Heath nor Kieran talked about enlisting the support of drug cessation agencies to help them.
These sections of the transcripts are of interest because they seem to run counter to what we (or at least ‘I’) may think of as a standard pathway for drug cessation – if there ever could be such a thing. There is little or no talk of medication, counselling or other professional intervention, and no talk of social support systems, networks, or role models. As a small chapter in a life story interview, these individuals talked about their drug cessation period as a time in which they were motivated, empowered, rational, and resourceful human beings. And they also valued isolation and freedom from possible interference and disruption from the world around them.
So this leaves me thinking: is there a ‘kind’ of motivation do people need, or harness, to cease drug use? And, what are the factors that affect whether someone decides to ‘go it alone’ or to access professional drug cessation support? To what extent can the quest for permanent cessation from drug use be considered a personal journey, and when and how can it succeed with the intervention of others?
The Homelessness Conversation: Time for a Change?
Over the last year or so, I have tried to keep pace with the debates, conversation, news, and information about homelessness. A growing familiarity with the debates, coupled with the pressures of completing this project work among others, has left me with a feeling of apathy about continuing participation in these conversations. I have blogged and commented less frequently and felt less inspired by what I have read about homelessness issues.
In addition to this, I have learned from writing this blog that there are significant restrictions on what I can discuss in it. The blog, as you may know, is primarily about our research project into the life stories of homeless people. But as I have discovered, this requires the challenging act of balancing two objectives: firstly, writing an engaging blog post which is deserving of the readers time and attention; and secondly, maintaining the confidentiality of the sensitive and personal issues that have been shared with me during the research interviews. There are many insightful stories about the lives of the homeless people that have been shared with me, but reformulating these into anonymous accounts for the purpose of public consumption is somewhat more difficult. Perhaps a more skilful or imaginative writer would have tackled these challenges better than I have.
However, as we are currently working through an analysis of these interviews, I am provoked into thinking about issues of homelessness that I see dominating public discussions and how these are matched to what I ‘see’ in our research. These two ways of perceiving homelessness do not match each other.
The common, public conversations of homelessness are usually formed in the following ways: homeless people are presented as victims of their circumstances and of the state (inadequate policy and service provision – particularly due to cuts in public spending), and homeless people with high-level needs (evidenced by the presentation of extreme case examples). These are important debates and discussions, but do they serve their intended purpose in the public domain? Personally, I think these discussions are easy to ignore. Extreme cases, by their nature, do not represent the entire spectrum of homelessness circumstances; what’s more, service cuts will take place in the context of much wider cuts in public spending. And who is participating in these debates anyway? Is it the individuals and organisations with a clear, vested interest? Or do these debates include the general public, too?
These are points of interest because I can see from our own interviews there is a different kind of conversation to be had about homelessness. Indeed, there are stories of intolerable abuse and neglect and there are stories of poverty and disadvantage. But there are also stories of individuals navigating a pathway through their lives often in ordinary ways and frequently where homelessness is depicted as an incidental period of their lives. This is not to say that homelessness is not a serious and challenging problem, but it is to say that there is much more to understand about the lives of homeless people than that which can be obtained through the public discussions about the issue. One example I have observed is someone who I follow on Twitter: @vendazero. @vendazero, a Big Issue vender but no longer homeless, does tweet about homelessness and associated issues, but he also tweets about the ordinary aspects of his life – these are the things that highlight the commonalities between us all. This is, for me, a compelling and accessible way in which I can understand more about, firstly, the man, and secondly, the homelessness. This is where I see, as I have witnessed in the interviews, grounds for a common understanding.
I guess the point of this blog post is to ask the question: are there different ways of having the conversations that we need to be having about homelessness? I have mentioned what I perceive to be the public discussions that frequently highlight extreme cases and worst-case scenarios. And I have suggested that these are more difficult to understand and to engage with than the kinds of conversations that are had by undertaking a more – dare I say it – ‘holistic’ view with those who are affected the most. By diversifying the conversations we are having about homelessness can we increase our understanding of it? Can we bring more people into the discussion? By doing this, can we open up new forms of tackling the issue?
What are your thoughts?
Some reflections on the research interviews
This is my ‘post-it note’ blog post on some of the things I have learned about homelessness this year. I have interviewed 104 people in the last seven months and we have yet to begin analysing the majority of the transcripts at this time. I guess this is indicative of the research process. We collect data and then work out a way to start to make sense of it all; we aim to report findings without losing accuracy and meaning, and without over-simplifying the complexities of individuals’ experiences. But here are some of the things which spring immediately to mind from what interviewees have told me:
- There is an enormous range of homelessness circumstances, the events which have preceded it, the ways in which it is experienced and perceived – the unique, individual, and complex experience of homelessness and exclusion is stressed across the interviews
- The high prevalence of parental divorce in the lives of young people preceding homelessness and reports of unsettled family life
- The widespread (and undetected by the authorities) instances of physical, emotional, and sexual abuse in childhood including rape of both boys and girls by close family members, neglect, home imprisonment, exploitation by adults for financial purposes
- The lack of judicial involvement and any other professional input in addressing the consequences of the above abuses
- The apparent lack of positive role models in childhood, both authority figures and in the family
- The identification of self as the ‘black sheep’ of the family, feelings of being treated less favourably than siblings
- Victimisation and bullying in school, most often described as the victim, but sometimes as the perpetrator
- Identifying the ‘wrong crowd’ as leading one astray, whilst also fulfilling a deeper need for group belonging and feelings of being wanted and popular
- The apparent ease of which schooling can be discontinued by the age of around 14
- A willingness to experiment with hard drugs in childhood, ignorant of what is actually being taken
- The identification of predatory ‘friends’ and acquaintances who lead the individual into hard drug use and who are fully aware of the consequences they are leading them towards, for example, a life of crime, prostitution, gang membership
- The apparent failure in the short-term of the criminal justice system to deter to offending behaviour, perhaps instead to even encourage or reward it
- A lack of aspiration, and awareness, of the opportunities that can be afforded in adult life
- An apparent lack of self-confidence and poor estimations of self-worth, feelings of resignation and powerlessness
- In some instances, the resilience, industry, and self-discipline that can be drawn upon in spite of the exclusionary nature of homelessness and its associated problems
- In some instances, the desires to have children and ‘right the wrongs’ from one’s own parenting
- In some instances, the desires for future careers in the homelessness sector and wanting to help others
Relocation and wholesale life change: Does it work?
‘Location is everything’ – this is a statement widely accepted as true among homebuyers and those people on the TV. But how important is location for someone who is homeless and wanting to escape the problems in their lives that are preventing them from moving forwards?
The need for relocation is considered necessary among many for a wholesale life change. But what is a wholesale life change? It is something that many homeless people talk about as being necessary for them to turn away from the problems, habits, and people that they are familiar with and move into the future and life that they desire. ‘Wholesale life change’ is the best term I can think of to describe this process. Wholesale life change may not always be wanted; it can actually be unwanted too. I’ll use two examples to illustrate my point: the first, change for recovering drug users; the second, women escaping domestic violence.
Firstly, drug users have often discussed the difficulties in breaking free of their habit. But breaking free of the habit is complex. There are key people in their lives that are linked to drug use and they are part of a community of like-minded people. Like any community there are unwritten but widely understood rules, norms, and expectations. It is a familiar existence. When they decide to stop using the drugs and exit that community they also need to find new meaningful activities, new housing, and make new friends and relationships. To slip back into the ‘old’ lifestyle can be very tempting. To create a new life in the same place is difficult and therefore a wholesale change may be needed. Change includes relocation and the chance to start a fresh, different life.
In contrast to these are victims of domestic violence. Some flee their homes and the places they know to go somewhere they can be safe and hidden. They are escaping someone who is a threat to their personal safety and well-being. But relocation presents difficulties such as moving away from family and friends, and possibly uprooting children too. It is an imposed wholesale change which can often be unwanted.
What interests me now though is to know how much value there is in these wholesale life changes. Do they work? Is this a route out of, and away from, the life that they are trying to escape? What are the long-term consequences? Are they successful in achieving the life they want by going through these changes? I am hopeful that I will be able to find, and interview, some more people who can help me to answer some of these questions.
How well integrated is the online homelessness community?
Over the last year I have been writing this blog and discovering more about homelessness through the numerous resources that other people have been producing online. There are, it seems, many other bloggers such as those who work in the homelessness sector and those who are homeless themselves. It’s interesting and informative to find out about the concerns and views that those people have.
I’ve also been using Twitter to find out even more and it seems as though this is a tool that is popular not just among those mentioned above, but also for the various social enterprises and the corporate Tweeters - the voluntary sector organisations who share information about their activities. There are things going on out there that I never would have imagined had I not tapped into the online community.
But my questions to you are these:
How do you use these (online) resources and what are your reasons for doing so?
How would you describe your experience of the ‘online homelessness community’?
How well integrated, in your opinion, are all these resources?
Please share your views…….
Improving the homelessness debate – Learn to ‘wow’ your readers by using evidence
By writing a blog about my research into homelessness I have undertaken a commitment to share, with all those who care to take an interest, the findings and other such details about the research. There are a number of other blogs and resources I have discovered online during this time too. Using these tools to share with the wider world the finer details and debates of homelessness I believe is a commendable activity. By reading and commenting on such blogs I am also committing myself to sharing with the authors how the evidence gathered in my own research supports or contests their views.
Evidence is important. It helps to separate fact from opinion. Evidence can also be used to support an opinion. Help to improve the quality of the debates and the clarity of your arguments by using evidence.
If you intend for your opinion in your blog to convince the reader that what you are arguing has some substance then consider looking for some evidence to support what you are arguing. Do not, for example, simply suggest that the answer to rough sleeping is to increase the number of hostel beds (especially if you work in a hostel or other homeless organisation). It will be clear to your reader that there is a large element of bias in your assertions, especially if you have not cited any objective evidence. You will fail to convince them.
Do consider searching through research and publications in resources such as those being collated by Homeless Link’s Homeless Pages. Alternatively, if the point you wish to make is simply based on your own experience be explicit about it – it lets the reader know what you are using to substantiate your views and that you are not claiming to speak for the sector as a whole.
Do consider writing a post based on a piece of completed research outlining your views on how the evidence from that research may influence your own policy or practice. Invite your readers to do likewise and you will be adding value to their knowledge base too.
Remember: Researching and gathering evidence is a resource-intensive activity, the purpose of which is designed to help you increase your knowledge and help you strengthen your arguments for improved policy and practice.
Heroin – It’s a love affair
Heroin/gear/smack – it has a significant presence among the homeless in Stoke. It’s not everyone’s cup of tea, but for those who heroin is the habit of choice it is interesting to listen to how heroin use is talked about within the context of the life course.
Heroin is something which can be talked about as a relationship. It can be loved because of the wonderful effect is has upon the user, but hated because of the sickness it can cause and the power it holds over them. A heroin habit can be rationalised as a relationship because the ‘hate’ side is ‘something that you just put up with’. Talking about heroin use in these terms can be a useful communicative device too because it can convey to non-heroin users in a way that they can understand some of the complexity, and confusion, of maintaining a habit.
Heroin is the only relationship that matters. For the user, maintenance of the habit is critical to well-being. It may become necessary to use heroin to simply function as a human being. It is needed ‘to feel normal’, not high anymore, just normal. Relationships with family, partners and friends are less important, as is a job and a secure home.
Though the destructive and harmful elements of a heroin habit are known to the user, the acquisition of the habit has been, in retrospect, a logical and progressive journey. Past events such as family upbringing, serious incidents of loss, and the influence of ’a bad crowd’ are given significance and assigned meaning. This assists the user to understand why they began using, and possibly why they continue.
In the ‘storyworld’ (a term used by narrative analysts – it is not intended to sound as though the speaker is telling tales) of the user there exists other individuals who have played a complicit role in the maintenance of the habit. Family members (often, but not always acting in the interests of the user) may supply money and/or protection. But in the world of the user the other main characters are other users. Other users are frequently people who find and associate with the user or are ‘bumped into’ in places such as hostels or on the streets.
A heroin habit provides a structure for day-to-day living. Get up, use whatever is left from the previous day, if any, and then find another means of scoring. It’s a tough days work and it carries risks but the addiction is a force greater than the moral conscience. Guilt and remorse is dampened by further heroin use.
The life of the user has been ‘time wasted’. There is hope, in the future, to ’be somebody’. Before now life has been lived one day at a time and no future has been planned for. The future, from the present perspective, usually has no content – it’s empty.
