Between mental health and youth homelessness
Homelessness among young people
It is difficult to provide accurate data on the number of young people experiencing homelessness. Estimates depend on the definitions of the populations that are used and the ability of research staff to access members of that population to form representative samples (Warnes et al 2003).
Pleace and Fitzpatrick (2004) conducted work on behalf of Centrepoint to develop a baseline estimate of the number of young people between the ages of 16 and 24 who experienced homelessness in England over the course of 2003. A young person was defined as being ‘homeless’ if they didn’t have, or were imminently going to lose accommodation that they could reasonably be expected to occupy. Between 36,000 and 52,000 young people were estimated to have been ‘found homeless’ by local authorities. Of these, between 4,700 and 6,700 individuals (13%) were thought to have had recent experience of sleeping rough. However, the researchers commented on the paucity of reliable data with which to determine whether youth homelessness was increasing or decreasing in England year on year.
Mental health problems in young people
In recent years there has been an upsurge of scientific and media interest in the mental health of young people. In a recent study commissioned by the Nuffield Foundation, which examined
adolescent mental health in the UK over the past 25 years, emotional problems including anxiety and depression had increased for both girls and boys since the mid 1980s (Hagel 2004). This study took account of increasing tendencies among parents to rate teenagers as problematic, but real changes in problem levels remained. Other UK research has supported this trend not only for anxiety and depression but also for conduct disorders and self-harm behaviours (MHF 2005).
These findings are markers for the presence of common mental health problems rather than for more severe and enduring conditions such as schizophrenia, which appear more stable in their prevalence. However this also points to the importance of looking beyond psychiatric diagnoses for evidence of compromised mental health among young people. From a mental health perspective, emotional competence, connection to others, attitude to self, neighbourhood trust and autonomous expression (among other concepts) are important indicators of mental health and if frustrated can become the precursors for some common mental health problems (World Health Organisation [WHO] 2001). This perspective serves also to emphasise the value of interventions to strengthen young people’s resilience and thereby reduce their risk of encountering mental health problems.
Our understanding of the long-term consequences of child and adolescent mental health problems is at a relatively early stage. Nevertheless, it is true that the majority of adult mental health problems can be traced back to initial symptom identification between the ages of 11 and 15 years (Kim-Cohen et al 2003). Longitudinal research also demonstrates a negative correlation between childhood mental health problems and earnings, qualifications, employment, relationships and family formation, general health and disability later in life (MHF 2005). There is then an emerging body of evidence that points to the long-term costs of child and adolescent mental ill-health for individuals, their families and communities.
1.3.1 Associations between mental health and homelessness It seems reasonable that in most cases the loss of one’s home will bring about stressors that can deplete an individual’s mental health. Thus, it is estimated that between 30% and 50% of single people experiencing homelessness have mental health problems compared with between 10% and 25% of the general population (Warnes et al 2003). More specifically in a London based study of young people experiencing homelessness in which psychiatric diagnostic criteria were used, two thirds met the threshold for a mental disorder (Craig et al 1996). In the same study 70% of those with a diagnosable mental illness had experienced their first symptoms before their first episode of homelessness.
It seems likely that as well as creating or exacerbating mental health problems, homelessness might itself be precipitated by a mental illness. There is also the possibility that other factors may put individuals at risk of both homelessness and mental health problems. Against this backdrop Centrepoint (2005) has reported a lack of adequate provision to manage the increase in mental health problems amongst young people, which if untreated can lead to far greater long-term problems. As long as there is homelessness there will be an associated burden of mental ill health above that which exists in the general population. People who live in bed and breakfast or hostels are 8 times more likely than the general population to experience mental health problems, and those who sleep rough are at 11 times the risk (Wright 2002).
Asylum seekers and refugees
The number of asylum seekers entering the United Kingdom has fallen in recent years with 31% fewer asylum applications being received in 2004 compared with 2003 (National Statistics 2006). Some of the mechanisms put in place by Government to bring down these figures can increase the risk of homelessness for this group. For example, Section 55 of the Nationality, Immigration and Asylum Act (2002) provides opportunity for authorities to no longer have obligatory responsibilities if an application for asylum is not made as soon as reasonably practicable after entering the UK. In 2003, nine thousand individuals were refused support as a result of Section 55 and a common consequence of this action was homelessness (Refugee Council 2004). Government's support structures also impact on young asylum seekers such as the National Asylum Support Service (NASS), which supports waiting claimants from the age of 18 until a decision is made on their asylum application. A positive outcome, such as being granted refugee status means the young person becomes entitled to receive mainstream welfare benefits. The ending of NASS support (subsistence and temporary accommodation), which ends after 28 days, can itself precipitate a period of homelessness (Stanley 2001).
Drug and alcohol users
The relationship between substance use and homelessness is complex and can be reciprocal in nature. Thus, substance use may lead to a period of homelessness, which in turn may worsen the substance use behaviours. In a study of young people experiencing homelessness across England and Wales 73% were found to be current drug users, a majority of whom had left home because of family conflict (Wincup et al 2003). However, of those who were using heroin and/or cocaine more than half started only after becoming homeless. Similarly, in a pan-London study of homelessness among all age groups 83% were found to be substance users and their levels of dependency and the likelihood of them injecting drugs increased the longer they remained homeless (Fountain and Hawes 2002). This negative association between homelessness and substance use is further compounded by the pessimistic views held by some service providers. Wincup et al (2003) report a tendency for housing workers to feel insufficiently skilled to provide meaningful care to young substance users and to attribute negative feelings towards this specific group