Trauma in Temporary Accommodation

In our recent research into Covid in Temporary Accommodation, we were struck by just how many traumatised individuals we spoke to. This was very much a non-scientific impression from our interviews rather than a rigorous research result. We had set out to ask about Covid, not about trauma.

And yet it seemed to be there in the background as we spoke to people, like some dystopian mood music: Violence, death, assault, chaos, and a desperate lack of control over basic things that most of us take for granted, such as the knowledge that where you sleep tonight is also where you will sleep tomorrow. One individual attempted suicide during the eight weeks we conducted our interviews. Others spoke of suicide as a potential way out of an unbearable situation:

A trauma is an event which leaves a person feeling unable to cope. Traumatic stress reactions are normal reactions to abnormal situations that leave individuals feeling helpless or terrified, experiencing a lack of control, unpredictability, loss of safety, and/or fear of serious harm or even death. Trauma can come from a clearly defined event such as an assault or an accident, or it can come from long-term exposure to stress that is hard to bear.

Many people will experience a traumatic event at some point in their life; the unexpected death of a loved one, a car accident, a divorce, a diagnosis of a long-term chronic illness, or even childbirth. But becoming homeless is a trauma most of us are fortunate enough to be spared, and yet it is happening to an increasing number of people in England.

While anyone technically can become homeless, it is not a level playing field. Homelessness often follows relationship breakdown or finances stretched to breaking point, sometimes repeated again and again over generations. Growing up in poverty, without a supportive family or social network, greatly increases the risk of someone ending up homeless. It is not surprising then that this describes the majority of the homeless population. Finding yourself homeless often comes as the culmination of a series of other traumas.

To add insult to injury, people experiencing homelessness are vulnerable to further trauma once they have lost the security that having a home provides. As our research revealed, living in Temporary Accommodation often means exposure to repeated violence, lack of basic safety measures like the ability to lock a door, a high death rate among residents, and a living environment characterised by neglect and infestations.

According to the NHS, about 1 in 3 people who experience severe trauma develop Post Traumatic Stress Disorder (PTSD). This is a clinical condition that describes an over-exposure to trauma, leaving the sufferer unable to move on from the traumatic experience. They are quite literally stuck, either continuously reliving the trauma, in permanent alert mode or attempting to deal with difficult feelings by not feeling anything at all (known as emotional numbing). In our research, three out of the 19 individuals we spoke with had been diagnosed with PTSD.

Some people cope better with exposure to highly stressful events than others. It is not possible to predict who will recover from trauma and who will go on to develop PTSD, but we know that individuals who do not receive much support from family or friends are much more susceptible to developing PTSD after a traumatic event.

These individuals are also less likely to engage with the services that might diagnose PTSD. Given what we know about homelessness, its causes and effects, it would not be surprising if the numbers were higher than what is officially recorded. Researchers have documented that the rates of traumatic stress are extremely high, and may even be normative, among those experiencing homelessness.

To help individuals who suffer from PTSD, Mind.org suggests avoiding crowding the person, not touching them without permission and trying not to startle or surprise them. The worst place for someone who suffers from PTSD is a chaotic environment where they have little or no control.

With some notable exceptions, this unfortunately describes most Temporary Accommodation in England. While some Local Authorities, charities and other stakeholders working with the homeless have adopted Trauma Informed Care, placing people in Temporary Accommodation with limited follow-up care risks undermining any gains that may have been achieved using this gentle caring approach.

Temporary Accommodation at its worst is everything Trauma Informed Care is not. One of the people we interviewed told us he preferred to spend the night on the streets, even though he had a room in a hostel. He could just about cope with the days, but he simply couldn’t get any sleep in the hostel at night.

The reality of living in Temporary Accommodation is that it too often is a stress filled, dehumanizing, dangerous situation to find yourself in. While Trauma Informed Care is an excellent practice that should be adopted by all that work directly with people experiencing homelessness, it is a plaster on a gaping wound.

The bigger the delay in getting homeless individuals into housing, the more psychological barriers are created by the experience of homelessness. While it is not possible to find a home for everyone who needs it straight away, all stakeholders involved in Temporary Accommodation must collaborate to make the experience as short, safe and healthy as possible to minimize the potential of additional traumatic experiences and prevent a vicious cycle.