“I kept falling down the stairs” - Disability recommendations for the homelessness sector

Disability is highly prevalent among people living in Temporary Accommodation (TA), from problems with mental health to physical impairments, and more hidden disabilities. People living with a disability are more likely to experience poverty and be in need of support, which makes them more vulnerable to homelessness. Once homeless, the environment in TA can be disabling, exacerbating symptoms and experiences of disability.

Under the Equality Act of 2010, someone is considered disabled if they live with a physical or mental impairment that has a substantial and long-term negative impact on their ability to do normal daily activities. The focus is on the effect rather than the diagnosis.

We have previously written about disability in TA, and the need for more research to get a better understanding of the need and the gaps in services. In 2020 we carried out research into how Covid affected people in TA and found that seven out of 19 interviewees had a disability, without counting mental health. That is more than 35% compared to a national figure of around 20%. One person had been stuck in their room for six years due to their disability; another was unable to reach the shower room on a different floor as he was "wheelchair bound" in a multi-storey building without a lift.

To get a more detailed picture of some of the issues that emerged from this research, we carried out two more interviews in April 2022. This time, specifically looking at disability in TA.

Rebecca and Bobbi both have mobility issues although for different reasons, intersecting with mental health and other problems. While Rebecca was placed in TA on the third floor in a property without a lift, Bobbi was placed on the first floor in TA with a lift that was often out of order. Rebecca was only moved to the ground floor after months of falling down the stairs.

Both talked about having problems opening heavy fire doors to enter and exit the building, increasing the risk of falls, or in Rebecca’s case, making it impossible to open. She was left waiting for other people to open the door for her. For Bobbi a handrail by the bath would have made it much less precarious to shower, and yet they didn’t feel they could ask. Rebecca, unable to open windows and doors by herself, also didn’t feel able to ask for adaptations to be made.

They had both been given a diagnosis which can deteriorate with stress - Multiple Sclerosis (MS) and Graves’ disease. The stress of the environment they found themselves in in TA had a detrimental effect. For Bobbi it led to a relapse of their MS which increased the mobility and balance issues they were already facing. For Rebecca, the stress contributed to an incident that led to a three-week coma, after which she had to learn to walk again. These experiences did not improve their mental health.

"When I went to court, they said that due to my disability they had a duty of care."

In both cases, the relevant local authority accepted they had a duty of care due to disability, and yet they were placed in accommodation that was highly unsuitable to their needs. According to a new large-scale study by Crisis, this is a common experience.

Bobbi and Rebecca both told us there were many people with disabilities in the accommodation they were placed in, and yet there is very little collaboration between the disability support sector and Housing/homelessness organisations. A report for the Equality and Human Rights Commission on being disabled in Britain found that disabled people had been placed fairly quickly, but in inappropriate housing by their Local Authority.

Approximately 20% of the general population in the UK live with a disability of one kind or another. Not everyone living with a disability wants to share their story. Some might not want to be defined by their disability, while others might not have come to terms with it or will be worried about the stigma that is still attached to disability. This makes it harder to get a clear picture of the numbers.

However, research indicates that disability rates are much higher among people experiencing homelessness than among the general population.

A study by Crisis of 14,922 individuals, 70% of whom were homeless while the others were either at risk of homelessness or had a history of homelessness, found that 39% reported having a disability. Another study, looking into the connection between autism and homelessness, found that 12% of a group of people experiencing homelessness showed strong signs of autism. The prevalence of autism in the general population is approximately 1%.

The UN Special Rapporteur on adequate housing found an even higher percentage of disabled people in US homelessness shelters. In her report from 2017 she made the following conclusion:

"Homelessness disproportionately affects persons with disabilities. In a vicious circle, disability often leads to homelessness and homelessness, in turn, creates or exacerbates impairments and additional barriers linked to stigma and isolation. Of the homeless adults in shelters in the United States of America, 43 percent have a disability. Persons with psychosocial and intellectual disabilities are particularly vulnerable to homelessness and its effects." (p.8)

Justlife’s Health Engagement Workers support people like Rebecca and Bobbi to access support services and ultimately move away from homelessness. With the help of Justlife, both Rebecca and Bobbi have moved out of homelessness and are settled in private accommodation that is suitable to their needs.

If disability is not talked about in housing and homelessness services, it will not feature in policies, strategies, programmes or budgets. From neurodiversity and autism to physical and sensory disabilities, large groups of people experiencing homelessness are facing additional barriers to accessing services.

“I’m getting to the stage where my mental health is quite bad (… ) I just want to come home and relax.”

Some might think that there are other more important problems to worry about, but this argument fails to appreciate how connected these problems can be. The added stress of not being able to do basic things like reading a letter, leaving your room or opening the front door, is going to intersect badly with other problems such as mental health and substance misuse, thus contributing to a negative cycle. It is also likely to lead to missed or delayed appointments with services.

“I was brought up to be independent, where there’s a will, there’s a way”

Further, the inability to decide and care for yourself affects many people experiencing homelessness badly, whether disabled or not. This can lead to institutionalisation and loss of key life skills that are needed to successfully move on in life. Ensuring that people living with a disability in TA are placed in environments that don’t actively work against independent living and decision making should be a matter of priority.

While it is a matter of dignity for the individuals who are affected, it is also a question of public funds. There is a considerable added burden to health care and other services from deterioration, falls and accidents that needn’t have happened.

“I kept falling down the stairs, the stairs were so steep… I just kept falling down, I was literally covered in bruises from head to toe”

While it seems to be highly prevalent, the response and understanding amongst those providing TA seems patchy at best, leaving homeless individuals in situations that are often not suitable to their needs. This can have significant and long-term effects and act as a barrier for people trying to move on out of homelessness.

Disability is a broad term that covers a vast array of needs, and as such it is not possible to devise a single unified response to the needs of disabled people in TA. Further, it is clear that there is a shortage of TA that is suitable for people with disabilities. Most of the properties being used for TA are old and crowded, and the increased pressure on the cost of living is only going to exacerbate the shortage of suitable housing.

There are, however, fairly simple steps that can be taken to improve the situation, and begin to place disabled individuals on an equal footing with their non-disabled peers:

• Training for both housing officers, support staff and TA providers in how to deliver services for people with special assistive needs, including how to look out for disabilities and ascertain needs. The autism toolkit for homelessness services should be widely used.
• Collaboration across sectors, for example through TAAGs. While there is a close link between the experience of homelessness and disability on the ground, support services are siloed and rarely work together.
• Involving residents of TA in the design of services, to ensure lived experience of conditions in TA feed into decision-making, ensuring people with different disabilities are able to participate
• Basic rights, including the ability to enter and exit the room, bathroom and building independently, should be made clear in locally agreed standards charters. These can be agreed through local TAAGs.
• Communication. A culture of open communication along with specific tools for communicating needs should be available and made clear to all residents of TA. Tools should be available in different formats to suit different needs and to foster greater knowledge among persons with disabilities of their rights and how to exercise them.
• Be proactive about assistive technology - setting up handrails etc, whether it is requested or not, is cheap and simple.
• Repairs/maintenance – upkeep of lifts must be seen as essential, particularly since wheelchair users tend to be placed in multi-storey buildings where they rely on lifts to get in and out of the building.
• Retrofitting assistive technology – for example door openers where there are heavy fire doors.
• More research into the intersection between disability and homelessness is needed to better understand the cost to individuals and society, the scale of the problem and identify potential solutions. This research needs to be made available in digestible formats to frontline services and housing teams, as well as disability organisations.

Our approach to these interviews is to be led by the participants self-identification and choice of language when discussing their experiences. While we would carefully consider our use of language to be inclusive when discussing disability as an organisation, we think it is important to include our participants' own choice of words when describing their situations. The names used throughout are pseudonyms chosen by our participants.