Healthcare and Homelessness

Try starting a conversation about healthcare for the homeless and see if you can play myth buster bingo.

Myth 1 – Housing is nothing to do with doctors

Homelessness is bad for your health, so from that point of view homelessness is a doctor’s problem. One survey found that 73% of homeless people reported a physical health problem and rates of mental health diagnoses in the homeless are increased too, nearly twice that of the general population. Have you ever tried to treat an infection in a patient who is living rough? Could you improve the depression of a woman who has to move from sofa to sofa every few days  as her friends will only let her stay a couple of nights at a time? Of course as a doctor you could stick to the biomedical remit, make the diagnosis and prescribe the tablets, but it is unlikely that your patient will get better. According to Maslow’s hierarchy of physiological needs (such as a comforting sleep) and personal security both must be met before we can consider the higher needs (like keeping the doctors appointment or getting a blood test). Little wonder then that those without secure housing have difficulty keeping appointments with the doctor or complying with medication.

Furthermore, being homeless means you are less likely to have good access to healthcare. A report in 2002 found that single homeless people were more than 40 times less likely than the general population to be registered with a GP. As a result, homeless people are less likely to receive preventive care; more likely to attend Accident and Emergency Departments at times of crisis; and are more difficult to discharge once they are in hospital. If you care about the use of NHS resources, then it is worth considering that a study in the US in 2011 showed that housing a homeless person saved the healthcare services almost $43,000 in the first year. Similarly, projects in the UK have repeatedly shown reduced use of Accident and Emergency Departments and fewer hospital inpatient days as a result of housing interventions.

 

Myth 2He made himself intentionally homelessness 

Well, yes, some people do leave a tenancy, a family home or a relationship. They may run away from debts or other problems they cannot face and apply for housing support, but does this equate to a positive choice to make life difficult? A divorcee is intentionally divorced, but who blames them if the marriage was irreparable?

Lack of budgeting skills, mental health problems, drug and alcohol addiction can make maintaining a tenancy difficult (Rees 2009), but with the right help, most people choose to live in a warm, stable, safe environment. Think back to when you were in primary school and you drew your future home. No-one ever drew themself sleeping under a bridge or behind Sainsbury’s, so how much of an informed choice is homelessness really? As the saying goes, “Never judge a man until you have walked a mile in his shoes”.

 

Myth 3 – There is not really anything you can do.

It takes the right approach. It is rarely as simple as handing over keys to an apartment and problem solved. Life is more complicated than that. Building trust, managing addictions, supporting mental health, developing new skills all takes time. But yes, the success of numerous projects shows that it is possible to make a lasting difference. In just the first six months of the M-path project in Manchester, of 110 homeless individuals receiving community case management, 68% achieved a positive improvement in their housing status (with subsequent reduction in A&E and hospital bed use). Similar success rates in clinical trials would have a new drug being lauded in the press.

 

Myth 4 – I bet that is really hard

This is not so much a myth as just a really odd statement. Renal medicine is hard, vascular surgery is hard, caring for challenging populations is hard, every specialty in medicine is hard, just in different ways. But just as every doctor needs to have some idea of what to do when presented with a diabetic emergency, if only to call for help from the right team, it would be a great idea if we all had an idea of how to set about managing someone with a problem of homelessness.

Simple steps to make access easier may not be as hard as you think. Registering patients in general practice without asking for proof of address; accepting a care of address for post; checking how to get in contact; or agreeing a support worker as a key contact can all make a difference. Telephone triage may be impossible if your patient has no phone, so leave a few slots available to be made over the desk, or as drop in for particularly vulnerable patients. Avoid hospital appointments at the start of the day, as it is hard to get to an early appointment if you have no alarm clock and little cash. Accept that the alcoholic is likely to smell of alcohol and may need to drink if kept waiting a long time. Taking a non-judgemental stance and acknowledging how hard the situation may be is something we do when a patient has difficult medical problems, how about doing the same when a patient has tough social circumstances?

 

Myth 5 – The problem is exaggerated by the press/charities

Finding reliable figures for UK homelessness can be difficult, because definitions of homelessness vary and, to some extent, who you count may depend on the aims of your survey. Rough sleepers may be the visible homeless, but many more people are affected by the insecurity of homelessness if we count those staying on the sofa or floor of friends and family, living in temporary hostel accommodation, in women’s refuges or in bed and breakfast accommodation. Over 161,000 households applied for homelessness assistance in the UK in 2014/15, enough to populate a large town.

 

Healthcare for the homeless, always worth a conversation. Have a go, play myth busting bingo.

 


Pip Fisher, Director of Student Experience at Manchester Medical School worked as  GP for over 7 years with the marginalised. After chairing our event, Refugees & The Homeless: Real Stories, she gives both her perspective on the homeless crisis.

 

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