The link between mental health, trauma, and homelessness

We all have mental health. Whether it is good or poor, no one is completely free of their mental health being at risk. However, for homeless people, poor mental health is both a cause and a consequence. According to statistics from UK charity Crisis UK, 45 per cent of people experiencing homelessness have been diagnosed with a mental health issue. This rises to eight in 10 people who are sleeping rough.

Due to the traumas that often lead to a person becoming homeless, it is easy to understand why mental health issues and homelessness are intrinsically linked and why there is a higher rate of mental health problems among people without a home compared with the general population.

The onset of mental health issues can trigger, or be part of, a series of events that can lead to someone being forced into homelessness. For example, a person may suffer from depression and become unable to work. Losing their job could mean they are unable to afford to pay their mortgage, resulting in them losing their home and ending up sleeping rough.

Alternatively, someone may lose their job because of redundancy and can’t afford to pay the mortgage. This housing insecurity and the threat of homelessness are stressful, exacerbating or causing mental health problems. Mental health issues are deeply connected to the trauma and adversity people who are homeless face*.

Yet without a safe and stable home, it can be difficult for people to address mental health issues and come off the streets. This is what we refer to at Keystage Housing as ‘the revolving door of homelessness’.

Toni Nye, Director of Keystage Housing, said: “For a person experiencing homelessness, mental health issues don’t start on the day someone loses their home. Generally, their mental health has been poor in the lead-up.

“We often see people with acute mental health difficulties, becoming homeless because they reach a crisis point, even when services are knowledgeable surrounding their mental health support needs. This is often when our services step in to help.”

Often, when a person comes to Keystage they have a trauma or mental health need that has been unsupported or undiagnosed. They may have been unwell with mental health for years, and their homelessness exacerbates this.

In some cases, this can sometimes lead to substance misuse and addiction making navigating support services difficult because services state they cannot work to support a person’s mental health recovery where they have a dependency on drugs or alcohol.

“It can be a vicious cycle,” explained Toni, adding: “ At Keystage Housing we aim to support individuals to navigate all these services bringing all the services to work together and this is something that we are navigating every day and it is a challenge.

“Often a person will have complex needs that are unmet, although this is in every case. But becoming homeless is a trauma for anyone that experiences this, and we should do all we can together to prevent further trauma and deteriorations in people’s health and well-being”

The importance of using a trauma-informed practice

At Keystage Housing, we wholly welcome the recent publication of new guidance published by the government in defining trauma-informed practice.

Trauma-informed approaches have become increasingly cited in policy and adopted in practice as a means for reducing the negative impact of trauma experiences and supporting mental and physical health outcomes, building on evidence developed over several decades.

However, according to the government guidance, there has been a “lack of consensus with the health and social care sector on how trauma-informed practice is defined, what its key principles are and how it can be built into services and systems”**. Its publication seeks to address this gap by providing a working definition of trauma-informed practice for those working in the health and care sector.

At Keystage, we already work in a trauma-informed way and the publication of this guidance is a positive step to support others in the health and care sector to work in the same way.  

“It shows a commitment from the Government, to support the understanding a person’s trauma,” said Toni, adding: “We wholly work in a trauma-informed way. This threads through everything we do and we see the outcomes people achieve through feeling and being understood. We celebrate that this step towards the embedding of this approach.”

So, what does it mean to work in a trauma-informed way?

Lee Coyle, Assistant Director of Operations for Keystage Housing, explained that working in a non-trauma-informed way often leads to people becoming evicted from their homes and exacerbates mental health, often leading to a person being re-traumatised

“That person is on a revolving door of homelessness and they will come back whether it be to our service or another,” he said.

Instead, we acknowledge an individual’s trauma, recognising that it is part of the cycle and bringing together different services to tackle the issues such as drug and alcohol misuse.

This means that sometimes, people are given a second chance if they come back to us.

Toni said: “ We expect that people’s lives can change, we aim to support them to do just this; change their lives. With this approach in mind, we can offer people who may not have had a successful placement previously the opportunity to open the door to services and aim to prevent that revolving door of homelessness. We don’t ignore what happened before but it’s about offering the person the support they need, in the right environment and bringing services together around the person.”

Lee added: “Trauma-informed practice acknowledges the need to see beyond an individual’s presenting behaviours and to ask, ‘What does this person need?’ rather than ‘What is wrong with this person?’

*Crisis UK https://www.crisis.org.uk/ending-homelessness/health-and-wellbeing/mental-health/

** https://www.gov.uk/government/publications/working-definition-of-trauma-informed-practice/working-definition-of-trauma-informed-practice