Knowing where to turn – peer research reveals the reality of accessing mental health support for people experiencing homelessness

We wanted to better understand the experiences of people who are homeless when they try to access mental health services and importantly, what people experiencing homelessness and mental ill health would like to see from mental health services going forward.

We believe it is crucial that people experiencing homelessness are central to developing the solutions to the issues that they face. This research was led by peer researchers who codesigned the research approach, conducted the fieldwork and shaped the analysis of the research findings.

Nowhere to turn

People described many barriers to accessing the mental health support that they needed. Several people did not know where to access support or how to engage with services. The appropriate support to navigate services was key to being able to access the right service. Those who did not have access to support networks described feeling “lost”, “in grey areas” or having very minimal information about where to go if they needed help.

Others felt unable to reach out for support when they needed it due to the stigma surrounding homelessness and mental ill health. This stigma often led to feelings of shame and embarrassment, meaning many people described not having a safe space to talk through the mental health challenges that they were facing. Feelings of stigma were perpetuated by interactions with healthcare professionals when people described feeling judged when reaching out for help. This was especially the case for those who were also using drug and alcohol services or using substances to cope with their mental ill health.

Additionally people told us how they were unable to prioritise their mental health when they urgently needed to find safe and secure accommodation. This lack of suitable accommodation worsened mental health issues, while simultaneously making it harder for people to focus on accessing mental health support.

Turned down

When reaching out to mental health services, many people struggled to meet the threshold needed for appropriate support to be available and experienced significant waiting times for support to commence. The GP was often the first point of contact when people experienced poor mental health, but this led to dissatisfaction. People felt that GPs were unable to provide support promptly and did not have the time and expertise to appropriately deal with their mental health issues.

The issue of timeliness was a common theme across several services, with many people feeling services weren’t able to act or offer any support until it was too late and that support was only available when a person’s mental health had significantly deteriorated. For some, despite ongoing mental ill health, a mental health crisis was the first time they were able to access support. For others, transitions between different services and localities often meant people had to re-refer themselves or begin the process of accessing help entirely.

What needs to change

We worked with our network of peers to develop several areas where change is needed to ensure people experiencing homelessness and mental ill health have access to the crucial support that they need. We recommend:

• Ensure everyone can access a safe, suitable and secure home – The UK Government and Local Authorities must ensure everyone can access a safe, suitable and secure home, with the income and support they need to maintain their tenancy.
• Address the stigma of mental health issues and homelessness – Healthcare services and commissioners must address stigma through training and support for staff and by incentivising person-centred working.
• Prioritise peer involvement in the design and delivery of mental health services – Peer involvement must be prioritised in work by Government, Integrated Care Boards (ICBs) and local services when they plan, design and commission support.
• Remove barriers for people using drugs and alcohol – Commissioners and support services must remove barriers for people using drugs and alcohol while experiencing both homelessness and mental ill health.
• Ensure people experiencing homelessness can access support with their mental health – The UK Government, ICBs and local areas must all ensure that people experiencing homelessness can access support with their mental health, addressing critical shortages in support and ensuring local systems and pathways work together smoothly.

Next steps

There is significant work to be done to tackle the inequalities faced by people experiencing both homelessness and mental ill health – the launch of this research and recommendations are just the beginning. Soon we’ll be launching a peer-led campaign tackling the stigma surrounding homelessness and mental ill health, to ensure that everyone can access the support they need.

You can read our full report and detailed recommendations here.

Make sure you hear about the campaign when it launches by signing up to the #HealthNow newsletter here.

Biography

Jo Brown is a Research Manager at Groundswell, a charity who work with people with experience of homelessness, offering opportunities to contribute to society and create solutions to homelessness. She previously worked as Research Officer for a local Healthwatch organisation and completed her PhD in Social Policy which explored disabled people’s experiences of welfare conditionality.