Mental Illness among Homeless in London Borough of Tower Hamlet The WritePass Journal

Mental Illness among Homeless in London Borough of Tower Hamlet Abstract: Mental Illness among Homeless in London Borough of Tower Hamlet ). It is the perception of lack prospects and potential that is credited with keeping many individuals in the indigent state. Among the homeless male versus the general public, there is a higher association with illnesses including schizophrenia by a 50% v 34%, personality disorders 37% v. 11%, substance dependence issues 74%5 v. 19% further increasing the need to study and identify the specific factors surrounding this ratio (Dunne et al, 2012). These statistics indicate the much of the mental disorders are amplified in conjunction with the homeless population which raises another area of concern; where the individuals afflicted as result of becoming homeless or did they become homeless as a result of becoming ill? This critical consideration will add to the assessment of determinants and the manner in which they work to keep the indigent population on the rise (Wright, 2014). In accord, the essay aims to discuss how the borough of Tower Hamlets has been identified as having the hig hest mental health needs in the UK, with over 45% of the population of the borough claiming incapacity benefit due to their ill mental health. This very high rate indicates the presence of a set of conditions that are expected to be identifiable, adding to the appeal of this study. As the literature confirms that mental illness is a significant urban health issue accompanied by crucial repercussions such as homelessness, the essay will aim to highlight the ways in which this issue relates to the London borough of Tower Hamlets. As the results are directly relevant to those in the Tower Hamlets, many other indigent populations exhibit similar conditions, which this study will assist to illuminate. 3 Urban Context and Determinants The literature surrounding homelessness and mental health indicates that factors in the urban context play a major role in the development of this urban health issue (Fitzpatrick et al, 2012). This is an indication that this area of research is not only necessary but vital to the effort to sustain and improve the state of the homeless population. Determinants such as poverty, exclusion, attainment and wellbeing all hold significant implications for homelessness (Frankish, Hwang Quantz, 2005). Elements that are cited to aid in the determination homeless population causation include the lack of general or low strata employment opportunities (Fitzpatricket al, 2013). This perception of no means to find work is compounded by ill health and the absence of health care. As those in the poorer classes fall sick, there is a trend to allow this sickness to become overriding, thereby adding to the detrimental factors surrounding a persons living situation (Dawson et al, 2013). Outside social f actors can have distinct impact on the determinants surrounding the homeless populations. With natural disasters and war placing many of these individuals in the homeless situations due to associated factors, there is a need to quantify each new social influence in order to minimize the harmful impact. Feeding directly into the homeless epidemic and the mentally unstable is the common lack of disability services that will have the resources to aid them (Wright, 2014). This scenario of inadequate infrastructure only adds support to the contention that each new determinant in the homeless cycle increases the likelihood that the person will not be able to escape the condition. With evidence supporting the position that it becomes harder to function in day to day society the longer a person remains indigent, there is a clear and present time factor that must be added to the determinants of the homeless (Wright, 2014). Additional factors such as difficulties in maintaining secure and good quality accommodation due to mental illness will also be discussed in the essay as contributors to homelessness (Breaky, 1992). Determinants to the homeless condition have been attributed to the high rate of substance abuse and addiction among the indigent population (Wright, 2014). This is an indicati on that there is truth to the argument that many people choose their addictions over a place to live comfortably. Further, this very aspect is magnified by the lack of affordable, quality housing in many areas (Buckman et al, 2013). With no avenue to find a roof, the drive to work towards making their life better has a trend of stalling as these determinant continue to hold the person back. This essay endeavours to shed light on recent changes to government policy, such as reforms in welfare support and social housing, the recession, and government cuts to public services in the UK had impacted those who were most vulnerable to homelessness. Each shift in public policy and perception has the potential to add or detract from the living situation of the indigent population (Wright, 2014). Yet, in many cases, available opportunities are overlooked due to the fact that the persons in question have no means to become acquainted with the policies. Individuals with mental health problems have faced considerable difficulties due to these changes such as understanding when they need to claim the benefits, how the new benefits work, and uncertainty about how the changes will affect their circumstances (Wright, 2014). Many times, the very complex nature of the policy or regulation diminishes the effectiveness of the intent by reducing access. As a further example of this issue rai sing modern concern, in some cases, individuals may also face difficulty getting access to, and using a computer to claim their benefits online (Dawson et al, 2013). These common issues that highlight the high risk of the mentally ill facing homelessness due to financial hardship and provide a possible explanation as to why there is such a high degree of mental illness among the homeless. Due to the fact that registration to a GP generally requires proof of a home address, homeless people are more likely to access healthcare through emergency services (Crisis MORI, 2002). This creates many issues including access, payment, sustained care and exacerbated social expense. Further, this poses problems on both the individual and the general population as the individual may not receive the health advice and respect that they deserve for reasons such as the emergency department only being intended for emergency health conditions, and due to social stigma around homelessness; such as the homeless may be associated with mental ill health, substance abuse and lack of hygiene (Riley, Harding, Underwood Carter, 2003). It is a common trend among the homeless to face a lack of insurance and the unwillingness to visit the doctor aside from the direst of circumstance. These factors have been cited as contributors of poor physical and psychological wellbeing which the homeless indiv idual faces when trying to access public health care, which only serve to compound the homeless condition (Wright, 2014). In many cases social pressure to avoid using the medical services, serves to drive the homeless even further from finding quality care, only serve to further add to the issue. A final determinant to be discussed in this essay is the cost of this urban health issue faced by the National health services, which in turn is passed on to the larger national population (Dunne et al, 2012). In many cases the variance of social support has changed alongside the political views of the ruling establishment. This condition causes many fits and starts to any existing system, which in turn serve to slow down both effective outreach and long-term strategy. Cost has the potential to become an overbearing feature of any policy creation effort (Dunne et al, 2012). In some cases the zeal to reduce the public budget for these issues is weighed against the need to devote time and resources to this part of the population (Fitzpatrick et al, 2013). With a common lack of representation among the law makers, the lower classes have often suffered the lack of finance and social support that is required to implement any effective strategy. Modern evidence shows that mental illness for the NHS is costly as it is the largest cause of disability in the UK. Social and informal care for the mentally ill is costing  £22.5 billion, where 13.8% of the national budget is spent on mental health (National Mental Health, 2012). This is a defining motivation for lawmakers on any side of the aisle to find a method of addressing the issue. Statistics also show that  £77 billion a year was being spent on welfare benefits for mental illnesses in 2009 (National Mental Health, 2012). This is a trend of rising cost that will only be reversed through study and relevant and considered implement of infrastructure. The lack of a coordinated strategy to reduce the homeless issue only creates a potential for the issue to become intractable and even harder to combat (Wright, 2014). The impact of these costs on the national economy was damaging, increasing national debts thus affecting the general population through increases in tax, public s ervices, and as previously mentioned, cuts to national healthcare (National Mental Health, 2012). This issue touches each person in society in a direct manner, meaning that with the easing of homeless condition there will be a corresponding easing of social pressure of the whole of society. Therefore it is necessary for these determinants to be discussed as contributing factors to the urban health issue. 4 Conclusions and Recommendations The aim of this paper is to critique strategies such as the Tower Hamlets Homelessness Statement 2013 to 2017, the Homelessness Act and other interventions that tackle homelessness and mental illness as separate entities (Crisis, 2009). This review of material will create the opportunity to identify strengths and weaknesses in the approaches that could in turn be amended. Further, this review will provide a basis for long term strategy based on the continuous need to refine public policy in order to reduce the burden on society as a whole (Wright, 2014). Yet, in every case the solution must be both ethical and motivated by the desire to enhance the homeless population’s potential to achieve stability. The recommendations that will evolve as a result of this study will involve coordinated treatment programs (Coldwell Bender, 2007) such as Assertive Community Treatment (ACT), which aim to serve psychiatric outpatients whose mental illness causes serious functioning difficulties in aspects of life including work, social relationships, residential independence, money management, and physical health and wellness, all of which can have an impact on housing status (Dixon, 2000). Other possible avenues designed to create options including community housing initiatives, political action through policy reform, enhancing current infrastructure such as Habitat for Humanity and the National Coalition for the Homeless. This consideration of a wide range of evidence creates a variety of opportunities to explore and address the issues facing the modern homeless population (Iversen et al, 2011). It is expected that this study will conclude that the ACT is an effective measure in combating the cor e issues which lead to and maintain homelessness, and aim to recommend that government funding should be utilised to promote programs such as ACT which will make lasting changes in the homeless community. Further, there is an expectation that there will be a combination of past and prior factors that have contributed to the homeless population and that it will require a well-rounded intervention method in order to provide better prospects. In the end, the base goal of this essay is to provide potential paths for further research which will in turn work to alleviate the dismal conditions associated with the indigent condition. 4 References Bassuk, E.L., Rubin, L. Lauriat. A.S. (1986). Characteristics of sheltered homeless families. American Journal of Public Health. 76(9). 1097-1101. Breaky, W.R. (1992). Mental Health Services for Homeless People. pp101-107. Cited in: Homelessness: A National Perspective. Eds. Robertson, M.J. Greenblatt, M. (1992). Buckman, J., Forbes, H., Clayton, T., Jones, M., Jones, N., Greenberg, N., Sundin, J., Hull, L., Wessely, S. and Fear, N. (2013). Early Service leavers: a study of the factors associated with premature separation from the UK Armed Forces and the mental health of those that leave early.  The European Journal of Public Health, 23(3), pp.410415.Coldwell, C.M. Bender, W.S. (2007). The Effectiveness of Assertive Community Treatment for Homeless Populations With Severe Mental Illness: A Meta-Analysis. Am J Psychiatry. 164(3). 393-399.Communities and Local Government. (2009). Rough Sleeping England Total Street Count. Retrieved from: http://webarchive.nationalarchives.gov.uk/20120919132719/communities.gov.uk/publications/corporate/statistics/roughsleeping2009 Accessed: 17th February 2014 Crisis MORI. (2002). Critical condition: Homeless people’s access to GPs. London. Dawson, A., Jackson, D. and Cleary, M. (2013). Mothering on the margins: Homeless women with an SUD and complex mental health co-morbidities.  Issues in mental health nursing, 34(4), pp.288293. Dixon, L. (2000). Assertive community treatment: Twenty-five years of cold. Psychiatric Services, 51, 759-765. Dunne, E., Duggan, M. and OMahony, J. (2012). Mental health services for homeless: patient profile and factors associated with suicide and homicide.  Mental health. Fazel, S; Khosla, V; Doll, H; Geddes, J (2008). The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis. PLoS Med 5 (12). doi:10.1371/journal.pmed.0050225 Fitzpatrick, S., Bramley, G. and Johnsen, S. (2013). Pathways into multiple exclusion homelessness in seven UK cities.  Urban Studies, 50(1), pp.148168. Frankish, C.J., Hwang, S.W. Quantz, D. (2005). Homelessness and Health in Canada. Canadian Journal of Public Health. 2(96). 23-29. Hwang, S.W. (2001). Homelessness and health. CMAJ. 164(2). 229–233. Iversen, A., van Staden, L., Hughes, J., Greenberg, N., Hotopf, M., Rona, R., Thornicroft, G., National Mental Health. (2012). Development Unit. Factfile 3. The costs of mental ill health. Retrieved from: nmhdu.org.uk/silo/files/nmhdu-factfile-3.pdf Accessed: 16th February 2014 NHS Tower Hamlets. (2011). Homelessness: Factsheet. Tower Hamlets Joint Strategic Needs Assessment 2010 ­2011 . Retrieved from: towerhamlets.gov.uk/idoc.ashx?docid=f8390127-f61d-491b-8323-cea75d92a228version=1. Accessed: 16th February 2014 Riley, A.J., Harding, G., Underwood, M.R., Carter, Y.H. (2003). Homelessness: a problem for primary care? British Journal of General Practice. 473-479. Tischler, V., Vostanis, P., Bellerby, T. Cumella, S. (2002). Evaluation of a mental health outreach service for homeless families. Arch Dis Child. 86. 158–163. Tower Hamlets Clinical Commissioning Group. (August 2013). Mental Health Joint Strategic Needs Assessment for Tower Hamlets. Tower Hamlets Health and Wellbeing Board. Tower Hamlets Homelessness Statement. (2013). 2013 to 2017 Consultation Draft. Retrieved from: towerhamlets.gov.uk/lgsl/851900/868_housing_strategy_and_polic/homelessness_strategy.aspx Accessed: 17th February 2014 Rees, S. (2009). Mental Ill Health in the Adult Single Homeless Population: A review of the literature. Crisis, PHRU. Retrieved from: crisis.org.uk/data/files/publications/Mental%20health%20literature%20review.pdf. Accessed: 16th February 2014 Story, A., Murad, S., Roberts, W., Verheyen, M. Hayward, A.C. (2007). Tuberculosis in London: the importance of homelessness, problem drug use and prison. Thorax. 62(8). 667-671. Wessely, S. and Fear, N. (2011). The stigma of mental health problems and other barriers to care in the UK Armed Forces.  BMC health services research, 11(1), p.31. Wright, J. (2014). Health needs of the homeless.  InnovAiT: Education and inspiration for general practice, 7(2), pp.9198. Mental Illness Among Homeless In London Borough Of Tower Hamlet Abstract: Mental Illness Among Homeless In London Borough Of Tower Hamlet ). Statistics also show that  £77 billion a year was being spent on welfare benefits for mental illnesses in 2009. The impact of these costs on the national economy was damaging, increasing national debts thus affecting the general population through increases in tax, public services, and as previously mentioned, cuts to national healthcare. Therefore these determinants will also be discussed as contributing factors to the urban health issue. Strategies Interventions for Critique; Speculated Recommendations Conclusions: The aim of the paper will be to critique strategies such as the Tower Hamlets Homelessness Statement 2013 to 2017, the Homelessness Act and other interventions that tackle homelessness and mental illness as separate entities (Crisis, 2009). The recommendations I will make will involve coordinated treatment programs (Coldwell Bender, 2007) such as Assertive Community Treatment (ACT), which aim to serve psychiatric outpatients whose mental illness causes serious functioning difficulties in aspects of life including work, social relationships, residential independence, money management, and physical health and wellness, all of which can have an impact on housing status (Dixon, 2000). I expect to conclude that ACT is an effective measure in combating the core issues which lead to and maintain homelessness, and aim to recommend that government funding should be utilised to promote programs such as ACT which will make lasting changes in the homeless community. References Bassuk, E.L., Rubin, L. Lauriat. A.S. (1986). Characteristics of sheltered homeless families. American Journal of Public Health. 76(9). 1097-1101. Breaky, W.R. (1992). Mental Health Services for Homeless People. pp101-107. Cited in: Homelessness: A National Perspective. Eds. Robertson, M.J. Greenblatt, M. (1992). Coldwell, C.M. Bender, W.S. (2007). The Effectiveness of Assertive Community Treatment for Homeless Populations With Severe Mental Illness: A Meta-Analysis. Am J Psychiatry. 164(3). 393-399. Communities and Local Government. (2009). Rough Sleeping England Total Street Count. Retrieved from: http://webarchive.nationalarchives.gov.uk/20120919132719/communities.gov.uk/publications/corporate/statistics/roughsleeping2009 Accessed: 17th February 2014 Crisis MORI. (2002). Critical condition: Homeless people’s access to GPs. London. Dixon, L. (2000). Assertive community treatment: Twenty-five years of cold. Psychiatric Services, 51, 759-765. Fazel, S; Khosla, V; Doll, H; Geddes, J (2008). The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis. PLoS Med 5 (12). doi:10.1371/journal.pmed.0050225 Frankish, C.J., Hwang, S.W. Quantz, D. (2005). Homelessness and Health in Canada. Canadian Journal of Public Health. 2(96). 23-29. Hwang, S.W. (2001). Homelessness and health. CMAJ. 164(2). 229–233. National Mental Health. (2012). Development Unit. Factfile 3. The costs of mental ill health. Retrieved from: nmhdu.org.uk/silo/files/nmhdu-factfile-3.pdf Accessed: 16th February 2014 NHS Tower Hamlets. (2011). Homelessness: Factsheet. Tower Hamlets Joint Strategic Needs Assessment 2010 ­2011 . Retrieved from: towerhamlets.gov.uk/idoc.ashx?docid=f8390127-f61d-491b-8323-cea75d92a228version=1. Accessed: 16th February 2014 Riley, A.J., Harding, G., Underwood, M.R., Carter, Y.H. (2003). Homelessness: a problem for primary care? British Journal of General Practice. 473-479. Tischler, V., Vostanis, P., Bellerby, T. Cumella, S. (2002). Evaluation of a mental health outreach service for homeless families. Arch Dis Child. 86. 158–163. Tower Hamlets Clinical Commissioning Group. (August 2013). Mental Health Joint Strategic Needs Assessment for Tower Hamlets. Tower Hamlets Health and Wellbeing Board. Retrieved from: towerhamletsccg.nhs.uk/Get_Involved/Tower%20Hamlets%20Mental%20Health%20Joint%20Strategic%20Needs%20Assessment%20Part%20One%20-%20Population%20Needs.pdf Accessed: 17th February 2014 Tower Hamlets Homelessness Statement. (2013). 2013 to 2017 Consultation Draft. Retrieved from: towerhamlets.gov.uk/lgsl/851900/868_housing_strategy_and_polic/homelessness_strategy.aspx Accessed: 17th February 2014 Rees, S. (2009). Mental Ill Health in the Adult Single Homeless Population: A review of the literature. Crisis, PHRU. Retrieved from: crisis.org.uk/data/files/publications/Mental%20health%20literature%20review.pdf. Accessed: 16th February 2014 Story, A., Murad, S., Roberts, W., Verheyen, M. Hayward, A.C. (2007). Tuberculosis in London: the importance of homelessness, problem drug use and prison. Thorax. 62(8). 667-671.