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Why it's important to identify hidden homelessness

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As winter draws in people often start to think more about what it means to be homeless, and what it means to survive a cold night on the streets. It is easy to empathise when we are on our way home to a warm house, and see someone huddled up on a bench with a blanket, explains Samantha Dorney Smith. 

sam dorney smith

Last year’s autumn street count found that there were 4,134 people rough sleeping in the UK on that night.

Visible street homelessness, however, is just the tip of the iceberg.

In every area where you see people rough sleeping, there will be always be many more people adapting to different forms of homelessness, e.g. sleeping on night buses, or taking a nap in 24-hour fast restaurants, squatting, or ‘urban camping’.

Often this group of homeless people are much more difficult to identify. It may surprise you to know that many of these people still manage to shower and change every day – either using day centres, or leisure centres – but they are often embarrassed by their situation, and will go to some lengths to disguise it.

Harder still to identify are the ‘sofa-surfers’. Such people do have an address, but their situations can span a wide breath of scenarios between people who have considerable resources and support networks, to young men and women with very limited support who can often be placing themselves in dangerous situations just to get a bed for the night.

“One concerning issue that is currently being addressed revolves around the difficulty some homeless people have getting registered with a GP.”

Many more homeless families (78,180 households nationally), who are living in insecure bed and breakfast or other temporary accommodation will often not even think of themselves as being homeless – even if the whole family is living in one hotel room.

However, it is thought that all these people are at increased risk of early death and a Lancet article rather shockingly shows that the mortality rate among socially excluded groups including homeless people, is nearly eight times higher than the population average for men, and nearly 12 times for women.

There are many suggested reasons for this – homeless people will often come from poorer backgrounds, are ‘tri-morbid’ (meaning they have concurrent physical, mental health and addictions problems), and there are many life style factors to consider, for example smoking and poor nutrition, which also affect their life chances.

However, access to healthcare is also a major contributing factor. One concerning issue that is currently being addressed revolves around the difficulty some homeless people have getting registered with a GP.

“Do you think that your service is able to identify people who are currently homeless, or at risk of homelessness?”

There is plenty of evidence of high numbers of late and acute stage attendances at A&E in the homelessness group, partly due to poor or no access at primary level.

As such it is vital we identify people experiencing homelessness and give them extra support – not least to signpost them effectively to services that might help them out of homelessness.

Next year a new private members bill, the Homelessness Reduction Act will convey a duty on all public services to refer people experiencing homelessness for housing support. However, although the act will be accompanied by guidance, no resource is currently available to support its implementation.

So, it may be down to you, and your services to champion this yourselves.

Do you think that your service is able to identify people who are currently homeless, or at risk of homelessness? Do you talk to your patients about their accommodation status? Would you know where to refer someone currently experiencing homelessness?

If so, your service may be the service that makes that vital difference to a person’s life, and starts them on the road that will change their life chances for good.

Sam Dorney-Smith qualified as a Registered Nurse (Adult Branch) in 1996, Specialist Practitioner (Practice Nursing) in 2003 and Nurse Prescriber in 2005. 
Sam has a post grad research diploma, has had several journal articles published, and has sat on numerous homeless health related steering groups. She was previously seconded to the DH.


If you would like to join a homeless health network, visit The Faculty of Homeless and Inclusion Health

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