Down and Out Report - St Mungo's Inquiry into Mental Health and Homelessness
Rough sleeping should be tackled as a public health issue, with the Department of Health taking a lead on improving mental health services for vulnerable people, concludes a new report published recently (Dec 2009) by homelessness charity St Mungo's.
"Down and Out?" is the final report of St Mungo's Call for Evidence into mental health and street homelessness. It brings together expert evidence from more than 90 national and local organisations from across health, social care, housing, young people's services and homelessness agencies, who contributed between April and June this year.
The report, including specially commissioned evidence from homeless people themselves, highlights how a lack of integrated health services can lead people with mental health problems into sleeping on the streets. It also shows how difficult it can be for a rough sleeper to have mental illness properly treated as part of their recovery.
Common problems were raised, including:
- Barriers to treatment - from poor access to GPs to the lack of effective services for people with both mental health and substance use issues
- Lack of leadership and vision - the Department of Health, despite growing work around health inequalities, has yet to carry out significant analysis of health experiences of groups such as rough sleepers who face chronic exclusion
- Lack of high support housing - people are crying out for more long term housing with a specific mental health remit
Charles Fraser, Chief Executive of St Mungo's, said: "We all instinctively know street homelessness can cause mental health problems, and mental health problems can cause street homelessness, yet to us it seems health services and policy makers do not make that connection.
"This Call for Evidence report shows there are many examples of good practice, and certainly many committed professionals. Overall, however, there is a systematic failure to adequately meet the mental health needs of homeless people, which undermines the universal principles of the NHS."
The statistics are stark. New figures on 300 recent rough sleepers now currently living within St Mungo's hostels - where problems can be recognised by experienced and specialist workers - reveal that 69% have a mental health need while 61% have both a mental health need and a substance use issue.
Charles Fraser said: "The evidence clearly calls for central leadership and vision. The draft New Horizons strategy, taking forward our nation's mental health, barely mentions those with most complex or entrenched needs, such as rough sleepers, while the Government's existing rough sleeping strategy 'No-One Left Out', gave mental health no more than a passing mention.
"Just as Communities and Local Government has a lead minister for homelessness, we want the Department of Health to have a minister directly responsible for health and homelessness. This would ensure an integrated strategy from the centre.
"An important first step would be for New Horizons to explicitly recognise the needs of rough sleepers as a group which face extreme exclusion.
"It is time to ensure that nobody with a mental illness ever sleeps rough."
Click here to read Down and Out? Executive Summary
Click here to read Down and Out? Full Report
St Mungo's four key recommendations from 'Down and Out?'
- the Government needs to act decisively to ensure nobody with a mental illness sleeps rough
- the Department of Health needs to show leadership and recognition of the extent to which its service problems lead to, and fail to help people away from, rough sleeping
- commissioners should routinely and explicitly address how to include excluded groups such as rough sleepers
- specialist commissioning is also required
Rough sleeping figures - nearly 3,500 people slept rough last year in London alone, according to CHAIN, the most comprehensive and widely used database in the capital. This was a 15% rise on the previous year. Changes in recording and outreach patterns can impact on figures year on year, part of this rise, for example, may be accounted for by innovative services reaching those in need more effectively. The fact that more than half of rough sleepers were new to rough sleeping in London highlights the need for preventative work. See
http://www.broadwaylondon.org/CHAIN/NewsletterandReports
The Government's official estimate for June 2009 was that 464 people were sleeping rough on any single night in England, 263 of these in London. See CLG
http://www.communities.gov.uk/news/corporate/1331065