To mark World Homeless Day 2021, the SSA’s Natalie Davies examines the data to understand what homelessness looks like, who it affects and what harms it causes.

Homelessness is synonymous with rough sleeping. However, it’s much broader in nature and scope than this. The term ‘homelessness’ covers a spectrum of living situations – all characterised by a lack of safety, security, and stability. It includes people who sleep or bed down in the open air, people who live in temporary accommodation, people for whom local authorities have a legal duty to secure a home (the ‘statutory homeless’), and people who deal with their situation informally, for example staying with family and friends, ‘couch-surfing’ or ‘squatting’ (the ‘hidden homeless’).

The term ‘homelessness’ covers a spectrum of living situations – all characterised by a lack of safety, security, and stability

Putting a figure on how many people are homeless is a complicated task. The Big Issue does an expert job of explaining where the different estimates come from, and why some groups of people may be missed by counts and may not consider themselves to be homeless.

Acknowledging the limitations of estimates, leading charities approximate that the total number of homeless people is in the hundreds of thousands (1, 2), and furthermore, suggest that the most visible form of homelessness is just the ‘tip of the iceberg’. People living in temporary accommodation outnumber those sleeping rough. People who fall under the umbrella of the ‘hidden homeless’ outnumber those in temporary accommodation. And, outnumbering people currently homeless are the millions on the brink of homelessness.

Causes of homelessness

There are many factors associated with (but not necessarily the cause of) homelessness, including being discharged from the armed forces, bereavement, domestic abuse, financial issues, harassment or abuse, lack of affordable housing, leaving prison, mental health problems, poverty, relationship breakdown, substance use problems, unemployment, violence and welfare reforms. Some of these factors refer to a person’s individual circumstances, others refer to environmental, social or structural problems.

A 2018 study reported that people become homeless largely due to factors outside of their control, for example, due to the lack of affordable housing, the decline of the social housing sector as a proportion of all housing, unemployment, and poverty – especially childhood poverty.

One of the biggest causes of homelessness is the loss of a private tenancy. In 2019, 18,820 (27%) households in England were recognised as being homeless by their local council after an eviction from a privately-rented home. The same year, the housing and homelessness charity Shelter estimated that three million private renters were ‘one pay cheque away’ from being unable to pay for their home. An estimate that is likely to have changed during the COVID-19 pandemic.

Drug and alcohol problems may sometimes be the ‘triggering event’ for homelessness, the reason given for someone losing their tenancy or being asked to leave home. More generally, however, substance use problems seem to increase a person’s vulnerability to homelessness, and to increase that person’s vulnerability while homeless.

The experience of multiple types of exclusion, deprivation, and suffering, has been described as ‘multiple exclusion homelessness’. For example, it might refer to homelessness along with substance use problems, a history of living in institutional care (such as prison, local authority care, mental health hospitals, and wards), and participation in ‘street culture’ activities (such as begging, street drinking, ‘survival’ shoplifting, and sex work).

A study examined pathways into multiple exclusion homelessness among people in seven UK cities (Belfast, Birmingham, Bristol, Cardiff, Glasgow, London, and Leeds), and found that:

  • substance use and mental health problems tended to arise early in people’s pathways – consistent with theories that childhood trauma can undermine coping mechanisms in young adulthood, with potentially long-term consequences for their health, wellbeing, and social functioning;
  • homelessness, ‘street lifestyles’, and adverse life events typically occur later in these pathways – strongly implying that these experiences are more likely to be consequences of marginalisation rather than the origins or causes.

Health inequalities and drug-related deaths

The inequality in life expectancy between homeless people and the general population is stark. In 2011, the homelessness charity Crisis reported that the average life expectancy for homeless people was 48 for men and 43 for women – around 30 years younger than people in the general population. A third of the deaths among homeless people were related to drink and drug use.

Between 2013 and 2017, there was a 24% increase in homeless deaths in England and Wales (from 482 to 597). The average age was 44 years old (44 years for men, 42 years for women), and more than half died from causes related to drugs (32%), alcohol (10%) or suicide (13%) – much higher than the 3% of deaths attributable to drugs, alcohol, or suicide in the general population over the same period.

Ben Humberstone, who in 2018 was Head of Health Analysis at the Office of National Statistics, said:

“What’s striking about these figures is how different they are to the general population – 55% of the deaths of homeless people are related to drugs, suicide or alcohol, also known as the diseases of despair, compared to just 3% of deaths from these causes among the general population.”

An analysis by the homelessness charity St Mungo’s showed that the number of drug-related deaths among people sleeping rough or in emergency accommodation increased substantially between 2013 and 2018, from 125 to 294 (a 135% increase). The biggest rise across that time period was between 2017 and 2018, when the number of deaths jumped 55% from 190 to 294. These deaths were overwhelmingly linked to the use of opiates (e.g., heroin, morphine or fentanyl), often combined with alcohol and other substances.

In 2013, a total of 1,344 drug-related deaths in England were reported to the National Programme on Substance Abuse Deaths (NPSAD). Almost half (48%) of people who died were unemployed, and a similar proportion (47%) were known to live alone. Reports from coroners to a national surveillance programme in England suggested that that half the deceased were unemployed and half were living alone or with no settled home. Of the 1,115 drug-related deaths that met the classification of ‘drug misuse’ deaths, 4% of people died in public places such as parks or public facilities.

Ending homelessness

The UK Government has pledged £100m to end rough sleeping by 2027 which is an ambitious (and much-needed) attempt to address the individual and societal burdens of homelessness. The past ten years have, however, seen many cuts to funding in this area which (1, 2):

  • directly impacted homelessness services, as well as drug and alcohol services – undermining their ability to deliver treatment and support.
  • exacerbated the conditions that lead to homelessness, including people living below the poverty line (e.g., due to cuts to working-age benefits and tax credits) and being unable to access basic financial support, healthcare and social care.

Homelessness in all its guises is harming the health and well-being of hundreds of thousands of people in the UK, and is a risk for millions of people who are living with daily financial and housing insecurity. For more resources about homelessness on World Homeless Day, see the official website.

Article adapted from the Drug and Alcohol Findings hot topic, “‘Dignity first’: improving the lives of homeless people who drink and take drugs”.

by Natalie Davies

The opinions expressed in this post reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the SSA.

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