1. A RE THERE MISSED OPPORTUNITIES WITHIN HEALTH AND SOCIAL CARE PRACTICE THAT COULD PREVENT HOMELESSNESS ? Ruth Elias Jones

2. Research questions Background Methods Results Implications for interprofessional care

3. A IM To identify the precipitating factors to becoming homeless and in particular missed contact opportunities by health and social care practitioners and members of the voluntary sector.

4. R ESEARCH QUESTIONS How and with whom (members of the public services) do homeless people have contact with prior to becoming homeless? Which members of the public sector would homeless people most likely seek help and support from prior to becoming homeless? How might people access better support to prevent homelessness? Is there a common list of factors which should alert public sector workers to protect individuals from homelessness? What are the messages for the caring professions?

5. B ACKGROUND Homelessness is increasing Strongly associated with poor physical and mental health Little access to healthcare and other services Stigma and staff attitudes Mistrust of professionals and institutions Experiences of bad treatment and being let down

6. R ISK FACTORS Social factors Family background and childhood Health factors Institutional background Social isolation Unemployment Poverty Debt and mortgage/ rent arrears Eastern and Central European migrants Asylum seekers Physical, sexual or mental abuse or neglect Parents with drug or alcohol problems Family history of homelessness Involvement in crime at an early age Exclusion from school and lack of qualifications Family breakdown Poor physical health Mental illness Addiction and substance abuse HM forces Care Prison Hospital/psychiatric care

7. C HILDHOOD RISK FACTORS Experiences in childhood (under 16 years old) Truanted from school a lot Didn’t get along with parent(s)/step- parent/carer(s) Suspended, excluded or expelled from school at least once Ran away from home and stayed away for at least one night Violence between parents/carers Parent(s)/step-parent/carer(s) had a drug or alcohol problem Badly bullied by other children Physically abused at home Brought up in workless household Family was homeless Spent time in local authority care Sexually abused There was sometimes not enough to eat at home Neglected Parent(s)/step-parent/carer(s) had a mental health problem

8. M ETHODS Ethical permission granted Recruitment from Action Homeless hostels Male Currently homeless Resident of an Action Homeless property Willing and able to be interviewed – no physical or mental barriers to interview Conduction of semi structured interviews Transcription into MS Word Thematic analysis using NVivo

9. R ESULTS

10. D ESCRIPTION OF THE SAMPLE 12 interviews included Aged 20-55 Homeless for between 3 months and 33 years

11. C AUSES OF HOMELESSNESS Long term Medium term Short term LONG TERM Abuse MEDIUM TERM Mental illness Addiction SHORT TERM Relationship breakdown

12. A BUSE “I was taking drugs from the age of nine years old, I was drinking at the age of 10. And obviously depressed and had mental issues and my past issues [his abuse], I just couldn't cope with, so I took anything and anything to numb it out”

13. A BUSE “I was like being seriously hurt and that, when I was younger… That’s why I wasn’t seeing it as bad… I was thinking this is nothing compared to what’s happened, it’s nothing… I didn’t feel I was being threatened or it was abuse of any type… The way I was seeing it was the way I was raised up, well I’ve done something naughty, I needed to be punished”

14. M EDICAL MISMANAGEMENT “I had a really severe panic attack… The doctors put me on Valium and then in the evenings I used to have 2 or 3 pints, just to steady me nerves. In a sense, that’s, I think, where it began… I became self-medicating with alcohol” “Well I wasn't sleeping properly so they gave me sleeping tablets and depression, they said you're depressed, that's why you’re gambling…” “But doctors weren’t really especially interested… Some of them are very averse to helping people who have drug or alcohol issues. Some are sympathetic but there are quite a few who really just think you’re a waste of time.”

15. N OT ADDRESSING UNDERLYING SOCIAL PROBLEMS “ No you’re medically fit, you, there’s nothing wrong with your bloods, you can go” “But there were nothing from the GP to point me in the right direction for the advice and the help that I needed… I told him exactly how I felt, what was going on in my life and it was just ‘well its just a quick appointment, yeah I’ll give you these 20mg tablets that’s not really going to do anything’”

16. L ACK OF FOLLOW UP AND ONGOING SUPPORT “If they had continued my support on my release then maybe things would’ve been different” “We didn't hear any like ongoing support, we didn't get any phone calls… they thought everything was all right, you know what I mean, but then about 6, 7 months later my sister has been kicked out”

17. N OT RECOGNISING RISK FACTORS “I was a bit of a tearaway… rebellious, angry, I didn't really care about anything… that's why I’ve ended up in and out of prison all my life” “I feel that when I was a kid my needs weren't addressed properly because you know, I'd been expelled from two different schools”

18. DISCUSSION

19. M ESSAGES FOR THE CARING PROFESSIONS Greater awareness of homelessness and its causes Education and training on the risk factors Training and information about local resources to enable signposting Improved communication within and between professions Proactive stance to preventing homelessness

20. M ESSAGES FOR THE CARING PROFESSIONS We may be the only contact a person has with services We all have a role in identifying those at risk of homelessness It is our responsibility to work together Preventing homelessness may be as simple as doing our jobs correctly

21. “For many people, becoming homeless is not the beginning of their problems; it comes at the end of a long line of crises, a long line of interactions with public and voluntary sector services, a long line of missed opportunities. We must change that.” The Rt Hon Grant Shapps MP, Minister for Housing, 2012