Health and Homelessness: A reflection on "Everyone In" and the people forgotten in Temporary Accommodation

Today is World Health Day, which is a good opportunity to reflect on health among people experiencing homelessness. We know that a person’s health, physical as well as mental, is greatly compromised without the security of a home.

Research by Homeless Link indicates that around 73% of people affected by homelessness have a physical health problem, while 80% face problems with their mental health. These figures are corroborated in our own research: in a 2013 survey of the people we support, 94% reported experiencing mental health issues (Not Home, 2014) and 30 out of 35 participants reported that their physical health was affected by the damp and poorly maintained conditions of the temporary accommodation they were living in.

In addition to the burden it is on the individuals living in these situations, there is a burden on public services from people who are homeless and experiencing poorer health outcomes, and requiring more public sector intervention than the average person, including hospital admissions and outpatient services (not staying overnight in hospital).

The biggest risk to public health in recent times, the COVID pandemic, increased the vulnerability of homeless individuals and the government responded with an unprecedented campaign to get everyone off the streets through ‘Everyone In’. It was a great success. Through targeted funding and collaboration across sectors, approximately 15,000 individuals were given a roof over their head in the first months of the pandemic.

There is much to learn from this success, not least the remarkable difference it made to political will and focus that the problem of homelessness was treated as a health crisis.

Homelessness was of course always a health crisis, individually as well as nationally, long before COVID came along. Homeless people are far more likely to have health problems than the general population, yet the complexity of the healthcare system, the barriers to accessing services, and the long waiting lists can result in people getting lost in the system, despite being in dire need of health care.

And yet the health of people experiencing homelessness is generally seen as an individual problem, until COVID came along and forced us to think differently. But even in the extraordinary early days of the pandemic, when solutions and funding previously unthinkable were suddenly available, the response to the ‘health crisis among the homeless’ did not go beyond rough sleepers.

In 2020, we carried out research into COVID among people stuck in Temporary Accommodation and found that, while many knew they needed to wash hands and self-isolate, this was simply not always possible because they had to share facilities such as kitchens and bathrooms.

Most striking however, for the people we interviewed, was that COVID was just another challenge in a long list of challenges. Some were already effectively self-isolating because disability or mental health problems left them unable to leave their rooms. Others were unable to access bathrooms for similar reasons, and the majority found their mental and physical health deteriorating through lock-down from an already low point.

So what can we learn from this? Much can be achieved with the right combination of focus, funding and collaboration. Treating homelessness as a health crisis provided a mandate which unlocked just that for those left on the streets in 2020. They were no longer in it for themselves; they were part of a national crisis that it was in all our interest to address.

But households in Temporary Accommodation still too often fall outside of government definitions of homelessness. Without incorporating TA consistently into the definition, efforts to reduce homelessness will fall short of producing permanent solutions, and leave more than 96,000 households, including 124,290 children, stuck in situations that are compromising their health. If the political will can be maintained and extended to include households in Temporary Accommodation, beyond COVID, real progress is possible.

Justlife is the co-secretariat of the APPG on Households in Temporary Accommodation, where we are pushing for change informed by our research as well as the research and knowledge of the wider sector. Click here to find out more.