Home truths

Social care professionals face a chicken-and-egg dilemma when
dealing with young homeless people with mental health problems.
What comes first, their poor mental health or their insecure living

This issue is looked at in the Mental Health Foundation’s latest
report, The Mental Health Needs of Homeless Young
1, which makes a strong case for a direct
link between housing problems and mental ill-health. The report’s
author, Barnardo’s researcher Jo Stephens, argues that “fragile and
insecure” housing renders people between the ages of 11 and 25
highly vulnerable to stress and psychological problems. “Insecure
accommodation is injurious to both mental and physical health,” she
adds. “Improved accommodation options will result in better

According to the report, people living in hostels and
bed-and-breakfast accommodation are eight times more likely to have
mental health problems than the general population – and this rises
to 11 times more likely for rough sleepers. Suicide is the biggest
single cause of death among street homeless people. Research by the
government’s social exclusion unit, published in 1998, estimated
that between 30 and 50 per cent of people sleeping on the streets
suffer mental health problems.2 An earlier Mental Health
Foundation survey of homeless young people found that 62 per cent
of respondents had a psychiatric disorder.3

So why are homeless young people more susceptible to poor mental
health than other people their age? The simple answer is because of
how they live: on the streets, on friends’ floors, in temporary
hostels and in bed-and-breakfast accommodation. Living in transient
situations can exacerbate pre-existing problems with mental health
– the same problems that may have contributed to, or been caused
by, their homelessness. In extreme cases, being homeless can
directly result in the onset of severe and enduring mental

Tony Newman is Barnardo’s principal officer for research and
development, and also edited the Mental Health Foundation report.
He believes stress makes young people more vulnerable to the
factors that damage mental health. “We have a situation where young
people with fragile emotional health and few assets, such as
friends, family, money and prospects, find themselves in a
situation where they can exert little control over their
environment,” he says.

Shelagh O’Connor, director of independent charity New Horizon Youth
Centre, says 80 per cent of the 16- to 21-year-olds who visit its
drop-in centre in King’s Cross, London, are homeless. In July, the
youth centre provided support to about 45 young people a day, and
this is expected to rise to 60 a day during winter.

Most clients have what O’Connor describes as a behavioural issue.
“We see people with depression and feelings of isolation,” she
says. “Unless we prevent them from deteriorating they do end up
with chronic mental health problems.” She estimates about 10 young
people a year at the centre go on to develop severe and enduring
mental illnesses.

Despite their best intentions, the accommodation services designed
to help homeless young people can inadvertently make their mental
health worse. The reality of living in a hostel with other homeless
people – many of whom are older and have their own problems – can
be damaging for young people, says Alan Wenham, multiple needs
worker at Centrepoint’s Vauxhall Cross project in south London. “It
is very difficult for young people living in hostels with others
whose behaviour is chaotic and erratic.”

Vauxhall Cross is one of homelessness charity Centrepoint’s five
hostels. Between 1 April and 30 June this year, the five projects
saw 44 clients and worked on a one-to-one basis with 20 of them. Of
those 20, a third reported having some kind of mental health issue
and half identified it as an emotional problem.

Wenham says clients cite family and relationship breakdowns, and
the lack of meaningful occupation of their time as the reasons
behind their mental health problems.

Charlotte Dickinson, a contact and assessment team manager for
homelessness charity St Mungo’s, says people who sleep on the
streets long term have a different experience of homelessness from
those who have always been in hostels or B&Bs. These
differences can make living in the same space challenging. She
says: “Rough sleepers have different needs from other people and
their lives are not as structured as those who have a roof over
their head.”

Another problem highlighted by the MHF report is the image of
mental health services. If a young homeless person has a mental
health problem they may resist contacting an appropriate service
purely because of its name.

Newman says such services need to be more aware of the stigma
around the term mental. He says: “Preventive services will struggle
to involve young people if they are sold on the basis of improving
or protecting mental health.”

O’Connor agrees that stigma is a barrier that prevents homeless
young people seeking help. “There is a very real fear attached to
being labelled as having a mental health problem,” she says.
“Homeless people are wary of going to an institution to deal with
their mental health.”

Elaine Greer, co-team manager of Camden and Islington Mental Health
and Social Care Trust’s Focus homeless outreach team, says not
enough mental health services cater for the young homeless
population. “There is a lack of services targeted at young homeless
people with emotional problems because they are not classified as a
serious mental illness.” The reluctance of young homeless people to
use the limited service provision may also stem from a lack of
awareness about their own problem, she adds.

Single homelessness charity Crisis runs a Winterwatch programme
that provides clients with additional support, including referrals
to mental health services, for four months of the year. But,
according to the charity, homeless people have little chance of
getting basic services, let alone specific help, because of their
transient lifestyles. Being constantly on the move often means they
lose touch with almost all services, including mental health

So what are the consequences of young homeless people not using the
few mental health services aimed at them? Many observers say far
too many young people are slipping through the nets of both
homelessness and mental health services. This results in
deteriorating mental health and fewer chances to break out of the
cycle. A Crisis spokesperson says: “There is a danger young
homeless people with mental health problems simply become older
homeless people with mental health problems.”

Despite the current difficulties young homeless people face in
accessing appropriate services, the right sort of help can be
effective. Crisis’s Winterwatch scheme, St Mungo’s contact and
assessment team and Centrepoint’s Vauxhall Cross have all developed
good working relationships with local mental health services that
are paying off for their clients.

So what can be done to improve the situation? The Mental Health
Needs of Homeless Young People
report calls for greater
inter-agency co-operation to help young people – something most
agencies say would help. A Crisis spokesperson says: “Agencies
coming together create a much stronger chance of succeeding than
working in isolation with a client.”

But it may need to go further than that. Wenham, O’Connor and
Dickinson all believe more specialist mental health services are
needed to meet young homeless people’s needs.

The report also says there is an urgent need for a range of early,
non-stigmatising interventions for young people with poor mental
health. Newman agrees and says the views of young homeless people
must also be considered. “Unless the voices of young people
themselves are heard and listened to we run the risk of responding
to the agenda generated by everyone except the people on the
receiving end of our good intentions.”

1 Mental Health Foundation The Mental Health
Needs of Homeless Young People, MHF, 2002

2 Social Exclusion Unit, Rough Sleeping, Cabinet Office,

3 The Mental Health Foundation, Off to a Bad Start: A
Longitudinal Study of Homeless Young People in London, MHF,

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