Homelessness
Introduction
Experiencing homelessness means not having stable, safe, and adequate housing, nor the means and ability of obtaining it. Homelessness can be defined in many ways, and not all people facing homelessness face the same challenges, it has a wider meaning than just rough sleeping and describes a wide range of circumstances. By law, you are homeless if you have no available accommodation or if you have accommodation, but it is not reasonable for you to live there anymore. This means you can be considered homeless if you are temporarily staying with friends or family, if your home is in a very poor condition, or if it is no longer suitable for you because of disability or illness.
The number of people sleeping rough in England has risen substantially over the past decade. People who are homeless have some of the worst health outcomes in England and are more likely to experience and die from preventable and treatable medical conditions and to have multiple and complex health needs. Ultimately, a person cannot achieve good physical and mental health without a safe and stable home. The reasons that lead to homelessness are multiple and often extremely complex. Many people have needs that extend beyond the basic need for a home and impact on their health and wellbeing. Partners in Derbyshire face considerable challenges in responding to homelessness and rough sleeping, set against a backdrop of the global pandemic, increases in the cost of living and an increasingly un-affordable housing market.
Why is it important to Population Health?
It is well known that people experiencing homelessness face significant health inequalities, and poorer health outcomes than the rest of the population. Diagnoses of physical and mental health conditions are much higher than the general population, with the associated trauma of homelessness leading to worsening mental health, poor availability of good quality food, grueling physical conditions for those who sleep rough and the increased risk of self-medicating, leading to many of those experiencing homelessness facing early onset frailty. Many people who sleep rough experience a combination of physical and mental ill health and drug or alcohol dependency. Experiences of psychological trauma, adverse childhood events and brain injury are also common in people experiencing homelessness. The longer a person experiences homelessness, particularly from a young adulthood, the more likely their health and wellbeing will be at risk. The average age of death of someone experiencing homelessness is around 30 years lower than that of the general population. Homelessness is not only a housing issue, but also a public health issue.
Furthermore, people experiencing homelessness still face significant obstacles to accessing the healthcare they need. They face stigma and discrimination when accessing mainstream services; financial barriers in the need to physically attend appointments or pay for prescriptions; communication barriers when changing between care providers; and strict eligibility criteria, including exclusions from services when people do not attend appointments. These barriers to access mean that people experiencing homelessness are high users of emergency services, as treatment is often not received until a crisis point is reached.
The COVID-19 pandemic was a crucial turning point; helping the system to recognise homelessness as a public health issue. A range of measures like the Everyone In initiative, which began in March 2020 and had accommodated more than 45,000 people by December 2021, increasing access to vaccines through the Protect and Vaccinate scheme, and a range of measures to help prevent homelessness such as a pause on evictions and the £20 Universal Credit uplift, have led to an increased number of partnerships and work streams that have bridged gaps between the homelessness and health sectors and helped connect people with essential services. In the end, addressing homelessness is crucial for improving health outcomes and reducing health inequalities.
The Derbyshire Population Health Approach
The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.
When considering the topic of homelessness within The Derbyshire Population Health Approach:
• Prevention
The Ministry of Housing, Communities & Local Government’s rough sleeping strategy outlines its commitment to ending rough sleeping and preventing homelessness. The Homelessness Reduction Act 2017 includes duties for local authorities to assess, prevent and relieve homelessness. The NHS Long Term Plan includes a commitment to improve access to specialist homelessness mental health support for people sleeping rough in areas with the highest rates of rough sleeping. During the COVID-19 pandemic, local authorities, health services, and the voluntary and charity sector have worked in partnership to respond to homelessness, including the ‘Everyone In’ initiative. This has shown that with appropriate funding, integrated working and prioritisation of the most vulnerable in the society, there are opportunities for positive change.
It is clear that all agencies have a responsibility to prevent homelessness. We will work with partners and local communities to ensure that the factors that lead to homelessness can be better understood and identified, with effective pathways into preventative services in place, and clear and accessible referral mechanisms. We aim to embed this approach across Derbyshire, by implementing the strategic priorities of the Derbyshire Homelessness and Rough Sleeping Strategy (2022-27), to significantly reduce crisis presentations and ensure effective homelessness prevention interventions, partnerships and pathways are in place.
• Population
A number of people are at greater risk of homelessness as a consequence of individual factors, for example existing health conditions. They are also more likely to experience homelessness on more than one occasion and may be in contact with several ‘systems’ to meet their needs. Research and evidence indicate that the following inclusion health groups are more likely to be homeless than the wider population:
- People experiencing mental illness
- People experiencing threatening behaviour, abuse or violence
- People with substance misuse problems
- People with experience of the criminal justice system
- People experiencing a relationship breakdown
- People with multiple and complex needs
- People seeking asylum, refugees, and migrant workers
Local authorities must provide emergency accommodation to those considered in priority need and who are not homeless intentionally after 56 days. In the initial 56 days the local council will have a duty to help the person keep their current accommodation or help them secure accommodation for six months. People are categorised as priority need if; they have dependent children in their household, are homeless as a result of being a victim of domestic abuse, they or a member of the household is pregnant, they or a member of their household is vulnerable.
In Derbyshire, 382 households were homeless due to a relationship breakdown, 344 households were homeless due to domestic abuse and mental health was the biggest support need identified amongst homeless households in 2020/21. We recognise that people experiencing homelessness are individuals and have different and unique circumstances and needs. Through the Derbyshire Homelessness and Rough Sleeping Strategy we intend to deliver solutions that are tailored to the individual needs of people.
• Evidence
The reasons that lead to homelessness are multiple and often extremely complex. Nevertheless, local data from district and borough councils indicates that 2,963 homelessness assessments were made in 2022/23 in Derbyshire, indicating we have a sizeable number of people who are homeless or living in temporary accommodation, sleeping rough or living in overcrowded properties.
System partners in Derbyshire will ensure that policies and interventions are informed by data and research, emphasizing evidence-based approaches to prevent and address homelessness, and to evaluate the effectiveness of existing programs. This is one of many actions listed within the Derbyshire Homelessness and Rough Sleeping Strategy, which commits to ensuring that data is captured widely and effectively across the system to understand homelessness in Derbyshire and the wider determinants, and that this data is used to improve interventions and joint approaches.
For example, we know that significant parts of the County are very rural and as such homelessness in these areas is often hidden. People who are experiencing homelessness or in housing difficulty are more likely to try and make temporary arrangements with family and friends, compared with more urban areas with greater provision available. We will undertake research into the nature and extent of rural homelessness across the County and raise awareness within rural communities of the help and support that is available to people who are at risk of experiencing homelessness.
• Causes
Underlying causes of homelessness include structural, societal, and economic factors, such as poverty and deprivation, unaffordable housing, unemployment, exclusion, and discrimination.
Across Derbyshire, we will continue to work with partners to develop and deliver effective, targeted, and consistent homelessness prevention services targeted at the main causes of homelessness – in particular we will undertake research into the causes of family evictions across the County in order to gain an in-depth insight into this area and develop targeted interventions accordingly. It is anticipated that increases in the cost of living will lead to people finding it increasingly difficult to meet their housing costs. As a Derbyshire housing and health system, we will work in partnership to ensure adequate services are in place to improve people’s financial capability, including accessing education, employment, and training. We will also ensure that there are targeted interventions to support both tenants and landlords in order to minimise evictions from the private rented sector. The impact of homelessness on families with children can be significant – not only do children feel an overwhelming sense of displacement having lost a sense of home, experiencing homelessness and living in emergency accommodation can impact upon access to healthy meals, limited access to bathrooms and laundry facilities, potentially having to move away from family, schools, and wider support networks. We will work closely in partnership with a range of agencies including Children’s Services to minimise the detrimental impact of homelessness on families, specifically children.
It is also well evidenced that domestic abuse is a key risk factor for homelessness. Following the enactment of the Domestic Abuse Act 2021, the delivery of the county-wide Homelessness and Rough Sleeping Strategy will ensure that for those experiencing domestic abuse there are a range of options and choice available to assist them in having a safe home to live in.
• Collaboration
A collaborative partnership approach is fundamental to being able to effectively tackle homelessness. The Derbyshire Homelessness Officers Group (DHOG) is a successful partnership of homeless leads from the 9 District and Borough authorities (including Staffordshire Moorlands), together with representatives from Public Health and other members of Derbyshire County Council which reports to the Derbyshire Housing and Health Systems Group.DHOG’s purpose is to promote homelessness reduction and prevention through strategic leadership. DHOG has worked collaboratively with a wide range of local system partners to develop the Derbyshire Homelessness and Rough Sleeping Strategy, which is a is a multi-agency document and has been developed with partners to tackle the underlying causes of homelessness, create effective pathways out of homelessness, and design out system blockages. It has been recognised that this strategy sets out an ambitious plan and vision for tackling homelessness over the next five years, and to successfully deliver this will require significant commitment from all of the local authorities and key partners.
Latest Derbyshire Data
Trend Data
Derbyshire Quilt
Prevalence Maps of Derbyshire
The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.