Homelessness in the United Kingdom - Essay Example

Public Health: Module Public Health and Health Policy Module reference Number: HAP_5_002 Module Leader: Student Number: 2534567 Assignment Title: Public Health Cohort: Word Count: Student Name: Discuss the health problems and health service issues that are associated with homelessness. Homelessness in the UK is a serious issue of medical and social importance. There is such depth to this issue that over the years many questions have been raised by critics about the impact exerted by homelessness on stability of the British society. Despite much written about this subject over time, reality is that homelessness is still every bit as much a reality in the country presently as it was many years back. In order to evaluate the extent to which homelessness in the UK works to exacerbate health problems and spawn myriad health service issues, discussion presented in this essay will draw on evidence from a large variety of credible sources to see what past and contemporary research has to say on the subject. The gravity of this matter of homelessness is evident from statistical data revealed in one of the latest newspaper reports in the country. According to this report, as many as 112070 people identified themselves as homeless in the UK in 2014. This figure represents a whopping 26% increase in homelessness over the last four years which demonstrates the hideous proportions of this very serious matter in the country. While the rate of homelessness has increased by 26% which is a spine-chilling reality in itself, the number of those people who sleep on the streets or pavements has tremendously increased by 75% (Henley 2014). This is saying something about an ever-increasing wealth gap between the rich and poor in the UK. This gap is at its worst in the present contemporary times as a result of which homelessness has also increased at a gigantic pace. There is a definite link between homelessness and health issues in particular mental health as it is suggested by many that both entities are inextricably linked to each other. Research claims that the use of institutions like psychiatric hospitals to treat the mentally disordered homeless people has fallen in the UK. However, particularly high fear levels have been noticed in those who “spent a large proportion of their lives in psychiatric hospitals” (Glover-Thomas 2002, p. 157). It is claimed that such patients when discharged to live freely in the community have only served to “add to the homelessness problem” (Glover-Thomas 2002, p. 157). The correlation between homelessness and adverse mental health is of such extent that about 1/3rd of all homeless people are diagnosed with different critically severe mental health issues like suicidal distress, chronic substance abuse, schizophrenia, and paranoia (Videbeck 2013, p. 6). Actually, homelessness brings the suffering person close to such distressful situational conditions that there remains no escape from debilitating mental health conditions. This is why the risk of mental health issues among homeless people is particularly high. It is no news that there is a strong stigma associated with mental health disorders. When homeless people already stand almost no chance to benefit from socialization opportunities because there aren’t any, mental health diseases make them completely isolated which exacerbates the problem of homelessness as poor socialization skills take away the will to struggle and survive (Bhugra 2007, p. 106). Usually, homeless people try to turn to each other to make non-judgmental socialization possible so that they could socialize without being judged, but mental health diseases which are almost always around the corner leave them with no social networks available. When mentally ill homeless people are left with no opportunities to socialize, they rapidly turn into social outcasts and no possibility for change remains. The issue of homelessness in society can be addressed by promoting a healthier population. When there is an apparent dearth of social networking opportunities and dozens of mental health disorders, homelessness becomes seriously exacerbated. Public health activities can promote a healthier population by removing the stigma associated with homelessness. This stigma can be removed by presenting a better image of the homeless people to general population to stress that not all homeless people happen to be criminals, petty thugs, or drug abusers. Rather, many homeless people just happen to be underprivileged because of hard life circumstances. Provision of better socialization and healthcare opportunities can turn around the situation for them. Such steps require effective measures to be put in place to prevent diseases, promote health as well as prolong life among the homeless population in our community. Public healthcare delivery professionals aim to help people stay healthy, avoid getting ill, and gain as well as enhance their knowledge about various important matters such as immunisation, nutrition, substance misuse, drug recovery, pregnancy, sexual health and children’s health (White et al. 2010, p. 92). Stanhope and Lancaster (2000, p. 4) also confirm that the primary functions of public health services are to monitor the public’s health status, undertake health assessment, and monitor those communities which are at risk by identifying the health problems and the priorities. Secondly, their function is to formulate policies that are designed to solve the health problems and priorities at local and national levels. World Health Organization (WHO) also asserts that there is a need to ensure that all communities regardless of their labor or socioeconomic backgrounds have adequate access to appropriate and cost effective care, including health promotion and disease prevention services (Detels et al. 2015, p. 326). In the UK, various policies have been initiated and structural reforms of the health system have been undertaken to effectively address the issue of homelessness. However, in order to achieve optimum results, the needs of all population need to be understood in a better way. Using the tool of epidemiology is a good way to address and monitor the population’s needs (Tulchinsky & Varavikova 2014, p. 108). Research points out that the principal aim of epidemiology is to study human population and identify priorities for research, causes of illness, disabilities, and death. There is a population focus in epidemiology which is of high importance (Merrill 2010, p. 2). It is claimed that epidemiology has gained more recognition in recent years because it helps to identify those marginalized groups among larger population which happen to be at greater risk than others for illness. This information is then used by researchers to “improve the health and social conditions of people” (Merrill 2010, p. 2). It helps researchers to establish where and how what actions should be taken to reach desired objectives and control the evil early on before it becomes too entrenched in society to be controlled. Epidemiologists help to collect and analyse records of diseases. Epidemiology is worth mentioning in this context of homelessness in the UK because all epidemiological investigations not only focus on public health assessment, but also try to find causes of diseases (Merrill 2010, p. 5). In this particular field of education, general consensus is that homelessness is one of the key factors associated with mental health diseases. Therefore, the foundation of epidemiology is built on monitoring the health problems of a community. It also aims to investigate those important factors which help to prevent outbreak of mental health problems. Both infectious and non-infectious diseases are very common among homeless people in addition to mental health disorders. Infectious diseases are caused by pathogens which include bacteria, fungus and viruses. Others include Tuberculosis, Ebola and HIV. Infectious diseases spread directly or indirectly from person to person (Engelkirk et al. 2008, p. 38). Non-infectious diseases are those that are caused by various factors like lifestyle, genetics and environment. They include diabetes, malignant breast cancer, and asthma. All these diseases can turn into epidemics among homeless people in various ways. This condition is worsened by the fact that homeless people also lack access to medical care services like housing, medication and general care. Homelessness is defined as a kind of situation in which people lack houses where they could live in addition to lacking other basic needs of life also. Basically, homeless people stand at the first step of Maslow’s hierarchy of human needs because their most basic needs are not even fulfilled. It is claimed that certain biological, behavioural, and structural deficiencies result in homelessness. Research also confirms that certain kinds of deficiencies are more common among homeless people (Oliver 2013). Also, it is worth nothing that such deficiencies have been found to be more prevalent in women than in men (Oliver 2013). Research claims that of all other social, psychological, and contextual factors, it is poverty and homelessness which most negatively affect mental health of people (Oliver 2013). As mentioned already, last year 11, 2070 people declared themselves as homeless in the UK and the number of people sleeping rough in London also grew by 75% (Henley 2014). These figures are reliable as they were obtained by Henley from extensive research study conducted in the UK. This data demonstrates that homelessness is a crisis in England and in certain areas of the country, social deprivation increases the level of homelessness. Many variables besides social deprivation are used to determine the level of homelessness like income deprivation, employment, health deprivation and disability, education level, barriers to housing and services, crime, living environment and deprivation, etc. (European Monitoring Centre for Drugs and Drug Addiction 2008, p. 24). In central London and in almost all the boroughs around the UK, there are high numbers of people sleeping rough on street due to homelessness (Robinson 2008, p. 58). Although the office of national data does not provide any figures for the number of rough sleepers yet, in practice there is a number of community outreach teams which make it their duty to provide outreach to the homeless people who make their homes in what is popularly known as card box cities in various locations such as the pavement, front areas of shopping buildings, train stations and park benches. The local authorities are known to make provisions for a good number of such homeless people through accommodation in bed and breakfast basis. But for the majority the only available option is card board cities. Cardboard city is basically a term used to “describe the habitations of homeless people living on city streets” (Dominelli 2009, p. 96). Living behind cardboard boxes even in severly harsh winter conditions made these people susceptible to a range of diseases. This is why Rick Henderson (2014) claims that people experiencing homelessness can increasingly suffer from long term physical health problem as well as being diagnosed with mental illnesses. Henderson is the chief executive of Homeless Link and he conducted a survey lasting for four years to publish national data about the health and living conditions of the homeless. This survey included more than 2500 homeless people across England. 1 or more people among them suffered from physical health problem and more than 8 out of 10 suffered from mental health issues (Henderson 2014). Homelessness is detrimental to the health of the community. Medical health and homelessness services can work together in an effective way in order to ensure that people’s health needs are taken into consideration as quickly as possible. Homelessness could affect people in a community by social isolation and loneliness. Consequently, people in a community could be diagnosed with depression, mental health problems, and physical illness. Loss of earnings, redundancy, moving to new areas, housing costs also contribute to the development of physical and mental health problems in a community. Poverty, inadequate housing provisions by the local authorities, and lack of employment are major causes of homelessness. High rent and mortgage arrears quite often cause evictions and repossessions which then result in homelessness and mental disorders. Mental illness causes behavioural changes also. For instance, paranoia which can create conflict in families and can cause people to move out in more stable homes is one example of such behavioral changes. Break up in marriages and more often domestic violence can split up families and give rise to homelessness in the affected parties. Women suffering from domestic violence are quite often placed in refuge by the council. Similarly, children who become vulnerable due to family break ups and domestic violence can become fundamentally displaced through fostering and adoption which in themselves may have major psychological implications for the children in later years. In such kind of situations, the Children Act 1989 stresses that special attention should be focused on meeting needs of children in order to ensure adequate protection and safeguarding for their healthy development (Fortin 2009, p. 243). Some illnesses that are related to homelessness are medical conditions resulting from poor hygiene, risk to infection, and poor nutrition. Homelessness itself can also contribute to drugs and alcohol abuse in the community. People can become part of a negative culture from living rough in the community and this may have serious consequences on the environment as they may be compelled to engage in stealing and robbery activities in the community. It may also impact heavily on public services and resources such as the police, prisons, probation services, ambulance service, and crisis intervention agencies. In context of social implications of homelessness, it is worth mentioning here that homelessness has its own unique social implications. An interesting observation at some train stations involves some homeless person selling The Big Issue magazine as a form of work activity for which homeless people get paid a small income. The majority of homeless people are otherwise unemployed. It is a well-known phenomenon to find a lot of homeless people engaged in prostitution as a way of earning an income. This, however, has its fair share of negative effects as it can cause a great number of sexually transmitted diseases and other costly medical conditions such as HIV due to unprotected sexual activities. Homelessness is known for breeding the drug and alcohol culture which attracts a great majority of poor people toward itself (Brinkerhoff et al. 2013, p. 160). These people who sleep rough also generate an increase in crimes as well as causing public disturbances which lead to upsetting the social atmosphere. Homelessness is increasing despite the fact that this social problem is associated with many social ills which should be avoided at all costs. This problem threatens the reputation of a society which is why it is critically important to look at the causes of this social problem to be able to engineer smart strategies later. This would require changes at governmental and local authority levels in particular a look at social and health policy. At a Governmental level, more housing should be provided and political groups should include in their manifestos the need to build a number of new homes. In the 1980s, high rise blocks were known to house thousands of tenants, but there also occurred great many suicides especially among mentally ill people. The rate of suicide for men increased by 32% (Stein & Wilkinson 2007, p. 143). The government decided to pull down lots of such homes in all boroughs. However, with the present situation of increasing homelessness and inadequate housing for people, it may be a good idea to revert to building such tall buildings again, but with improved security and suicide prevention adaptations. The government should also facilitate private sector involvement in deprivation of new homes for rental. During the Margaret Thatcher era, large portions of the old mental hospitals estates were sold off to private entrepreneurs who then developed into housing estates. This made thousands of homes available to local residents. However, by closing down sectors of the hospitals and moving services in to the community as per the community care act 2000, a drastic reduction in the capacity of hospitals occurred to provide inpatient facilities. This change of focus into community care does not seem to have improved care into the hospital 30 years down the line. In fact, it has proven to create more problems in the care and maintenance of long term mentally ill people in the community. More recently, closure of some A & E departments in the country (e.g. Lewisham Hospitals and others) has caused a public outcry as populations were left deprived of the local facilities for emergency treatments (Rose 2013). This suggests that there is a need of improvement on health and social policy. There should be more work opportunities for people to earn incomes that enable them to afford their homes and pay their mortgages. In the National Health Service or NHS, considerations should be given to the need for an increase in the number of community mental health teams (CMHT) and community nursing staff. Both local and national authorities as well as non-governmental authorities should work hard to improve the awareness issues through public health education. Also, there should be creation of more public health services. For example, more GP surgeries with improved waiting times and more therapy and rehabilitation centers should be made available. Also, the UK government should build specific houses where the homeless people could fearlessly live. This is because the entire homelessness issue in the UK has served to create “a self-perpetuating ‘homelessness industry’” (Robinson 2008, p. 169). In order to put an end to this flourishing industry, there is a need to carry out research and find out the causes of homelessness. In other words, the reasons that make people become homeless should be researched. By doing this, they will be able to find solutions to homelessness more effectively. The UK government ensures that charities have always and will continue to support the homeless people by providing them with basic needs like the Food Bank (Great Britain Parliament 2013, p. 120). Food Bank is responsible for providing food to these vulnerable people. However, the food is not enough as the number of homeless people is increasing in the UK every year. Hence, the government should fund these charities consistently to help them provide basic needs to the homeless. However, food banks have also received criticism for contributing to problems of hunger by institutionalizing “the usage of surplus foods to feed poor and needy people” (Shetty 2002, p. 150). Concluding, there is no mistaking this reality that homelessness is a grave and deadly evil associated with potentially disreputable consequences. Due to being attached to such a prodigious collection of health concerns and medical service delivery issues, homelessness has always remained a subject of hot debate in the UK. Consideration should be given by the UK government to the key points about homelessness and implications for nursing practice. Homelessness causes many mental health disorders like depression and anxiety which are known around the world as major causes of suicide. There is also a need for care professionals to carry out thorough assessment that gives regard to aspects of homelessness related to depression. Care professionals need quality training for easy recognition of the impact of the homelessness on the health of patients. Care professionals should be able to provide more psycho-social education to patients to help them live an independent life. Such strategies can bring an improvement in the self-esteem level of homeless people. References: Bhugra, D 2007, Homelessness and Mental Health, Cambridge University Press. Brinkerhoff, D et al. 2013, Essentials of Sociology, Cengage Learning. Detels, R et al. 2015, Oxford Textbook of Global Public Health, Oxford University Press. Dominelli, L 2009, Introducing Social Work, Polity. Engelkirk, PG & Duben-Engelkirk, JL 2008, Laboratory Diagnosis of Infectious Diseases: Essentials of Diagnostic Microbiology, Lippincott Williams & Wilkins. European Monitoring Centre for Drugs and Drug Addiction 2008, Selected Issue 2008: Drugs and Vulnerable Groups of Young People, Issue 2008, Office for Official Publications of the European Communities. Fortin, J 2009, Children’s Rights and the Developing Law, Cambridge University Press. Glover-Thomas, N 2002, Reconstructing Mental Health Law and Policy, Cambridge University Press. Great Britain Parliament 2013, Can the Work Programme work for all user groups?: first report of session 2013-14, The Stationery Office. Henderson, R 2014, ‘Homelessness is a public health crisis’, The Guardian, viewed 01 June 2015, Henley, J 2014, ‘The homelessness crisis in England: a perfect storm’, The Guardian, viewed, 01 June 2015, Merrill, R 2010, Introduction to Epidemiology, Jones & Bartlett Learning. Oliver, V 2013, Healing Home: Health and Homelessness in the Life Stories of Young Women, University of Toronto Press. 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