Can you have good mental health without housing?

18 October 2018
By Rebecca Pritchard
Director of Services for Crisis
Rebecca Pritchard

Housing (shelter) is one of the basic needs identified by Maslow – and is a key platform upon which psychological wellbeing and self-fulfilment is built. Decent, secure and affordable housing is a vital component of good mental and physical health.

Homelessness creates stress, anxiety and uncertainty in adults, and homelessness in childhood is an inter-generational phenomenon, associated with poorer long-term outcomes in health, education, employment and future homelessness. Homeless children experience more trauma than their peers, and are more likely to fall through the safety net of statutory services if they are moving between schools, GPs and health visitors.

Homelessness also impacts upon an adult’s access to health care services. Registration with a GP can be difficult without a stable address (not impossible – but lists are often closed) and there can be little continuity of care; and access to specialist services becomes harder without good primary care.

People who move frequently from one temporary arrangement to another are isolated from their support networks. This can increase reliance upon professional services. Homeless people often resort to using A&E departments for basic care, because of difficulties accessing a GP. Many report experiencing stigma and poor levels of care, which they linked to being homeless.

Homelessness and mental health difficulties are interconnected for many individuals – but the root causes often lie in policy and funding decisions. For example, there is clear evidence that changes to the welfare system, as a result of austerity, have increased homelessness. These same changes have created a hostile and distressing environment for many people with mental health difficulties to navigate – with several suicides linked to their experiences of being sanctioned and left destitute.

Distress and social crisis are not the same things as illness, but chronic distress left untreated can develop into more complex issues, especially where people resort to self-medication (with alcohol or drugs) to manage symptoms. A failure to address social issues such as homelessness are contributing to individuals (practitioners and patients) and systems becoming overwhelmed by levels of distress.

Mental health and homelessness share many solutions. Stable housing is in itself a protective factor for mental health. The importance of prevention measures, rapid rehousing, early interventions and treatment to prevent the exacerbation of illness, and matched care rather than stepped care (adopting a Housing First model) are widely accepted to make economic sense and reduce distress to individuals in both health and homelessness. But although we know what should be done, too little evidence is being put into practice.

The current scale of homelessness in Britain is a mental health crisis. The health and housing sector should come together to demand that government takes action to tackle homelessness and improve mental health. This should be done by addressing the issues of housing supply and reinvesting in support services that lift social pressures, social crises and distress, and help people find and keep a stable home.

Rebecca (Bex) Pritchard is currently Director of Services for Crisis. She has served on several voluntary Boards including Richmond Fellowship and currently Evolve Housing + Support.

This blog is the fifth in a series of editions of The Reformer on housing policy.