homelessness health needs assessment: york april 2018 contents ======== what is homelessness? 4 what does the national r

Homelessness Health Needs Assessment: York
April 2018
What is homelessness? 4
What does the national research say about health and homelessness? 7
Children 7
Young People 7
Working Age Adults 7
Older Adults 7
Rough Sleepers 8
Criminal Justice 8
Substance misuse 8
Domestic Abuse 9
York Needs Assessment Methodology 10
Stakeholders views of health and homelessness in York 11
The biggest issues affecting health: 11
The services and support available: 13
Service user survey responses 16
Prison and youth offending: 16
Local authority care: 17
Overall self-reported health 18
Physical health 18
Mental health 19
Drug, alcohol, and smoking 20
Health service use 21
High levels of health service use: 22
Self-care 23
Views of Health 23
Challenges for the City 24
Executive Summary
People who are homeless represent a small proportion of the total
population of York, but have a disproportionately high prevalence of
physical and mental ill health and have a significant and high need
for statutory and voluntary sector health and social care services.
This report looks at the views of service users and professionals in
York and identified a selection of key challenges for the city.
People who experience homelessness are often the more marginalised
members of our society. Therefore, the presence of homelessness and
its associated poor health outcomes may be seen as a marker of
equality within society. There are both structural and environment
factors, and personal or family factors that contribute to
The poor health outcomes experienced by people who are homeless may in
part be caused by the stress and disruption that comes with being
homeless. However, in many instances the poor health outcomes are not
directly caused by a person’s homelessness, but rather the experiences
and vulnerabilities that lead to an individual becoming homeless in
the first place.
The views and perceptions of people who are homeless or at risk of
homelessness in York, and the professional views of those who work in
organisations who support them, were central to this needs assessment.
The final part of this report identifies a series of ‘Challenges for
the City’ in relating to the health and wellbeing of people who are
homeless in York. It is acknowledged that for many of these challenges
there is already work ongoing, and that these challenges compliment
the actions identified in the York homelessness strategy 2018-2023.
People who are homeless represent only a small proportion of the total
population of York. This group also has a disproportionately high
prevalence of physical and mental ill health and have a significant
and high need for statutory and voluntary sector health and social
care services. This report looks at the views of service users and
professionals in York and identified a selection of key challenges for
the city.
What is homelessness?
The link between housing and health is set out in ‘Improving Health
and Care through the home: national memorandum of understanding’ 20181.
“Poor housing, unsuitable housing and precarious housing circumstances
affect our physical and mental health. ... .... The home is a driver
of health inequalities, and those living in poverty are more likely to
live in poorer housing, precarious housing circumstances or lack
accommodation altogether.”
Sometimes homelessness is thought of as living in a doorway. This is
just one example of a broader issue of homelessness. In York,
homelessness can look like many things:
Rooflessness: living without a shelter of any kind, sometimes
known as sleeping rough
Houselessness: living in a temporary institution or shelter
Insecure housing: living with insecure tenancies, the threat of
eviction, or with domestic violence
Inadequate Housing: living on illegal campsites, in unfit housing,
or in extreme overcrowding
This needs assessment includes adults who are on their own or as part
of a family unit, or young people who are on their own. The assessment
does not consider children who are part of family units. This was in
part because of the logistical challenges of gaining consent and
access to children who are living in temporary accommodation. However
there is a body of national evidence that clearly identifies that
children who live in temporary or insecure accommodation have poorer
health and wellbeing outcomes than other children. There is no reason
to expect that the experiences of children in York are any different.
Understanding homelessness
It was once commonly said that homelessness can affect anyone. Whilst
this may still be true, some people are at greater risk of
homelessness than others.
Homelessness often results from a combination of events such as
relationship breakdown, debt, adverse experiences in childhood, and
through ill health. Homelessness and ill health are intrinsically
linked and professionals in both sectors have a role to play in
tackling the issues together.
Local Government Association, 2017 2
People who experience homelessness are often the more marginalised
members of our society. Therefore, the presence of homelessness and
its associated poor health outcomes may be seen as a marker of
equality within society. There are both structural and environment
factors, and personal or family factors3 that contribute to
Structural factors include the availability and affordability of
housing, poverty or unemployment, as well as the changing family
structure in our society meaning that families become more fragmented.
In York, unemployment is lower than the national average, but wages
are relatively low, insecure employment appears high4. Additionally,
rental costs in York are higher than other parts of the country5.
Personal and family factors include longstanding family disputes,
physical or emotional abuse in the home, poor physical or mental
heath, a history of drug or alcohol misuse, low levels of formal
education, debt, limited social support networks6 or being a refugee.
Additionally, bereavement or relationship breakdown may be the sudden
event that triggers homelessness7.
Overall, York has fewer people with long term health conditions than
other parts of the country, but the prevalence of poor mental health
is relatively high. York’s population is better educated than the
national average8, but there are still people with few qualifications.
Social support is difficult to measure but the most recent public
surveys indicate that at least some people would like more social
contact or social belonging than they currently have9.
The causes and risks of homelessness both nationally and in York are
robustly discussed in the 2018 York Homelessness Strategy.
This needs assessment
The health inequalities associated with homelessness are often complex
and long standing; as a result, they are not quickly mediated.
However, during a period of homelessness or housing insecurity,
individuals and families typically have a greater degree of contact
with services than they might otherwise do.
“For most people who are at risk of, or experiencing, homelessness
there isn’t a single intervention that can tackle this on its own, at
population or at an individual level.”
Public Health England (2016) Applying all out health
The poor health outcomes experienced by people who are homeless may in
part be caused by the stress and disruption that comes with being
homeless. However, in many instances the poor health outcomes are not
directly caused by a person’s homelessness, but rather the experiences
and vulnerabilities that lead to an individual becoming homeless in
the first place.
What does the national research say about health and homelessness?
This section briefly describes the national picture of health and
wellbeing for people who are homeless in the UK. The data for this
section was taken from LGA: ‘Impact on health of homelessness, a guide
for local authorities’.
When families with children are at risk of homelessness they should
receive priority support. Usually, this means that families are
offered temporary accommodation. Despite this priority support,
Shelter reported in 2006 that children in temporary accommodation are
more likely to experience a range of negative health outcomes.
Young People
Young people who are homeless and not part of a family unit are a
particularly vulnerable group. The LGA report that it is not uncommon
for these young people to have experienced abuse when they were living
at home, to have experienced a relationship breakdown with their
family members, to have been excluded from school, to have few or no
qualifications, to have committed minor crimes, to lack social and
relationship skills, to have mental health conditions, or to misuse
alcohol or drugs. Nationally, these young people are at risk of
further exploitation whilst homeless; trafficking, criminal activity,
or being coerced into sexual relationships in exchange for somewhere
to stay.
Working Age Adults
Economic hardship; either though unemployment, under employment,
insecure employment, or debt, can increase a person’s vulnerability to
homelessness. However, these factors alone are not usually sufficient
to cause homelessness. The disruption of insecure accommodation can
also present barriers to maintaining employment.
Older Adults
Older adults are not traditionally thought of as a group at risk of
homelessness, however the LGA report that some older adults do become
homeless and that this is a growing concern in the UK. Often for these
people there are underlying health and wellbeing issues such as
addiction or debt, or social factors such as estrangement from family
members, and then a significant event such as relationship breakdown,
bereavement or accommodation being sold that results in the person
becoming homeless. Poverty is more common among retired people than
working age adults, and this further increases the risk of
homelessness in this age group.
Rough Sleepers
The LGA report than the majority of rough sleepers will only be on the
street for a short period, usually after a particular incident in
their lives. However, for a smaller group of people, rough sleeping
will become a sustained and enduring characteristic of their lives.
These people are likely to experience poor health throughout their
lives, and have a drastically shortened life expectancy.
Nationally, people who sleep rough are at significant risk of suicide,
of poor mental health, of drug or alcohol addition, of infectious
diseases such as TB, HIV or Hepatitis C, of overall poor physical
health and in particular poor oral health. They are also more likely
to be victims of crime such as assault than the general population.
Criminal Justice
The LGA report that nearly half of all people who have been in prison
report living in their accommodation for less than a year before
starting their sentence. A proportion of these individuals will have
also experienced homelessness.
A prison sentence can offer increased access to services and support,
meaning that people will receive treatment for physical and mental
health conditions whilst they are in prison. However, continuing this
treatment after release from prison can be challenging, particularly
if the person is not registered with a GP or is moving between
temporary addresses.
Substance misuse
The LGA report that people who misuse drugs or alcohol are at a
greater risk of experiencing homelessness. Unemployment, debt, and
alienation from family members and friends, are factors which can
increase the risk of experiencing homelessness. A drug or alcohol
addiction may also present a barrier to accessing some support
services because the services are not equipped to support people with
addiction or because addiction can make people less open to accessing
help and services.
There is also some evidence that people who experienced living in
insecure accommodation as young children are more likely to use drugs
in later life.
Domestic Abuse
Domestic abuse can happen to anyone, but some groups of people are
more at risk; this includes young adults and people with illnesses and
disabilities, women when they are pregnant, women who are recently
separated, gay or bisexual men, or people who are transgender.
Domestic violence does not automatically increase the risk of
homelessness. However, fleeing domestic violence can be a trigger for
homelessness. This can be exacerbated where there has been financial
abuse or when a person has been isolated from their family or friends
as part of the abuse.
York Needs Assessment Methodology
The views and perceptions of people who are homeless or at risk of
homelessness in York, and the professional views of those who work in
organisations who support them, were central to this needs assessment.
A paper survey was used to gather the views of people in York who are
homeless or at risk of homelessness. Professionals were asked to
distribute the questionnaire among the people they support, and to
support the survey completion when this was appropriate. A prize draw
was used as an incentive.
The content of the questionnaire was taken from a resource which was
jointly devised by Public Health England and Homeless Link for the
purpose of needs assessments. Minor adjustments were made to better
suit the local context.
This approach was intended to remove some of the barriers to
engagement; for example to include people with limited written English
or limited access to the internet. However the limitation of this
approach is that the survey can only reach people who are known to
professionals working in York.
Over 30 organisations and teams were contacted; this included both
organisations and teams who work exclusively with people who are
homeless, as well as organisations who only support this population
group as a part of their role.
The data in this needs assessment was collected through November 2017,
and was a snapshot of service users and stakeholders views at this
Stakeholders views of health and homelessness in York
This section reports on the views of professionals and stakeholder
organisations that work alongside people who are homeless in York. A
total of 30 organisations or teams were contacted, and 23 full
responses were received. Additionally, two organisations or teams
responded to say that they did not have any regular contact with
people who are homeless in York.
The biggest issues affecting health:
The scope of the health and wellbeing topics that can be discussed in
relation to homelessness is vast. York professionals were asked to
describe the biggest health and wellbeing issues that affect homeless
people in York. This question was deliberately worded to identify gaps
and issues.
The following topics were commonly discussed:
Lack of stable accommodation, preventing support for other health
and wellbeing needs.
Timely access to appropriate services
Mental ill health and self-esteem
Substance misuse
Poverty and debt
Exploitation and violence
Social isolation and stigma
Unemployment and access to financial benefits
Malnutrition and diet
Disengagement and lack of trust
Climate and its affect on rough sleepers
On mental health ... Mental health was the most commonly mentioned
topic, and was discussed by most professionals. Clinical mental ill
health, in particular anxiety conditions, personality disorders, and
self-harm, was widely discussed. Generally, this was discussed in
relation to mental health conditions that existed before the person
became homeless. Alongside this, poor mental wellbeing, for example
stress and isolation, were viewed as common issues for the individuals
and families who were homeless or at risk of homelessness. The lack of
social support from family or friends was also mentioned by teams who
support isolated individuals such as young adults who are care
On addiction ... Addiction or substance misuse was discussed as a
prevalent issue for the homeless population. Some professionals
focused on the immediate physical health complications that are
associated with substance misuse, such as non-healing wounds,
infections at injection sites, or conditions such as liver cirrhosis.
Others identified the impact addiction can have on a persons’ mental
wellbeing and engagement with health or homelessness services. The
issue of overdose was also mentioned by stakeholders.
On dual diagnosis ... The lack of support for people with a mental
health and substance misuse ‘dual diagnosis’ was discussed as an issue
by several teams.
On specialist accommodation ... The more specialised teams in adult
social care discussed the availability of appropriate housing for
people with specialist needs; such as those with brain injury, alcohol
addiction, and Asperger’s syndrome. They highlight that these people
tend to have multiple and complex needs, and as a result have less
opportunity to access community and voluntary sector support systems.
On daily pressures ... Some teams and professionals work specifically
with people who are not yet homeless, but who for a range of reasons
are at significant risk of experiencing homelessness. These teams talk
about the wider health and wellbeing challenges. For example;
relationship breakdown within the family, financial pressures
including debt and challenges with benefit payments, and substance
misuse. They highlight that this may be greater still for single
adults as families with children will typically receive priority
On finance ... Individuals financial pressures were discussed. This
included debt and delays in receiving the universal credit and other
benefit payments. Some supported housing schemes have seen that people
who were ‘previously stable’ are pushed towards relying on food banks
or similar because of delays in universal credit payments. Conversely,
these errors can result in some people receiving large back payments
which can put vulnerable people at risk of exploitation.
On self care ... Poor diet and poor self care was also mentioned as a
general theme. In particular this was discussed in relation to people
who were sleeping rough. Additionally young people were also
discussed, as they may not yet have developed the life skills needed
to meet their physical needs, such as shopping and cooking to maintain
a healthy diet or registering with dental or GP services.
Additionally, people who are ‘sofa surfing’ may find this challenging
due to the limited autonomy of their circumstances. This may extend to
offending, drug taking, or sexual activity to please or appease their
The services and support available:
It was widely reported among stakeholders in York that the specialist
homeless support and prevention work was substantial and good quality.
In particular the ‘bed ahead’ system, the ‘making every adult matter’
teams, and the hospital discharge services were regarded as securing
better access to health and social care for individuals.
On demand and capacity ... Limited capacity and the pressures on all
teams were widely recognised and discussed. Several stakeholders
commented that the services which try to respond to the needs of
homeless people in York are often full, and that the pressures on
these services are rising. Another felt that York would benefit from
strengthening the specialist support available for homeless people
with complex needs or additional vulnerabilities. There were also some
concerns in relation to the requirement to prove homeless status
before being able to access support. This was seen as a particularly
challenging process for people leaving secure institutions such as
On disengagement ... The concept of service user disengagement with
support services was discussed by multiple organisations, in
particular statutory services. This included both people who did not
access any support and people who had limited or ad-hoc involvement
with services, for example by missing multiple appointments. The
stakeholders noted that significant mental ill health or addiction is
often linked to disengagement with services. In some instances this
can unfortunately lead to a person being excluded from a service when
a person is causing disruption to others. It was also highlighted that
some people who sleep rough do so because they do not want to
associate with other people who are homeless, and in particular
because they do not want to associate with people who inject drugs.
It was also noted that some homeless people are reluctant to spend
extended periods in hospitals or other health settings, often because
of an unmanaged mental health condition or a drug or alcohol
addiction. To counter this, there were several examples of staff
extending services and working flexibly to try and support people who
have disengaged. For example, medical staff visiting people on the
street when they were deeply unwilling to attend a health centre.
On access to primary care services ... Lack of access to specific
services, notably primary care services and specialist mental health
services, was discussed frequently by stakeholders. For primary care
the main barrier was perceived to be difficulties in registering with
a practice, although concerns were also raised about the level of
flexibility for those who miss appointment slots. Both of these
barriers were perceived to be amplified substantially when a person
doesn’t have a fixed address or phone number. GPs themselves recognise
these limitations within their service to meet the needs of some
homeless people. In particular they highlight that the 10-minute
appointment system is not suited to people who find it challenging to
book or attend appointments and so often present only when in crisis.
GPs recognise that occasionally this means some homeless people in
York get a reduced or rushed service in primary care. GP practices
also highlight that they can feel they are working in isolation from
social care, benefits teams, mental health workers, and the probation
services in York.
On access of mental health services ... Access to specialist mental
health services was widely discussed as an issue. It was generally
held that these services are under strain, and there was a perception
that homeless people have reduced access to an already stretched
service. The support for people with complex needs was identified as a
particular gap; this included support for people with personality
disorders, with autism spectrum conditions, and with substance misuse
or addiction (dual diagnosis).
Other specific issues mentioned by multiple stakeholders included;
long waiting times for the support that is available, a lack of
support for young people and a lack of mental health training for the
staff and volunteers who work in hostels. In contrast one stakeholder
felt that some forms of mental health treatment were too readily
accessible, in particular the prescription of anti-depressant
medication by GPs.
On the importance of an address ... Multiple stakeholders discussed
the challenges that come with not having a fixed address. Stakeholders
mentioned perceived barriers to accessing primary care services,
dental services, benefit and pension payments. It was not apparent in
the stakeholders’ responses whether they were aware that several GP
practices will allow people with ‘no fixed abode’ to register using
alternative addresses. Additionally, none of the stakeholders other
than the Salvation Army mentioned that the Salvation Army will allow
people to use their office address provided the person is engaging
with their services.
On development opportunities ... Stakeholders suggested that mental
health services for homeless people in York could be enhanced through
making available accommodation for homeless people with on-sight
mental health support, and also through making available more informal
‘drop-in’ type mental health support. Accommodation with on-site
mental health support had recently been present in one hostel and was
considered a valuable resource by the stakeholders who mentioned it.
Despite the numerous gaps, stakeholders were keen to identify the
range of quality support that is available, including the preventative
support, and quality of partnership working.
Service user survey responses
This section describes the views of people who use homeless services
in York. The survey was offered to as many people as possible who were
in contact with housing services towards the end of 2017. This totals
around 300 people, and includes people who are staying in hostels,
emergency accommodation or other supported housing, as well as the
approximately 20 people who were street homeless. Of these
approximately 300 people, 82 people responded.
Who responded ...
64% of the respondents were male,
The average age was 32 years old, (range 17 to 63)
11% said they were gay, lesbian, or bisexual
90% were White British and 95% were UK nationals.
In the previous night, 66 slept in a hostel or supported
accommodation, 6 slept on the street/tent/other unofficial
accommodation, and 4 slept in accommodation they rented.
55% reported having a disability or long term health condition
30% had experienced domestic violence
5 were in education, and 7 were in paid employment or self
At some point in their lives...
More than half (47 people) had slept rough,
The majority (60 people) had been homeless
The majority of individuals (59 people) had ‘sofa surfed’
The first period of homelessness was typically in their early 20’s,
however this varied from young childhood to nearing retirement.
Prison and youth offending:
Among the people who responded to the survey, 33% (27 people) had
been in prison. Of these, 22 reported being homeless at some point
in their lives, and almost all were in hostels or other sheltered
accommodation the previous night (the remaining few were rough
Additionally, 17 people had spent time in a secure unit or youth
offending institution, there was an overlap between the two, with
13 people having spent time in both prison and a youth offending
Of the 27 people who had been in prison, many reported poor mental
or physical health. 21 reported having depression and 20 reported
having had anxiety in the previous year. Additionally, 8 reported
having had Hepatitis C at some point in their lives.
Local authority care:
Crisis estimate that 1 in 4 people sleeping on the street will have
been in care at some point in their younger lives.
Of the people who responded to the survey, 23 said they had spent
time in care as children or young people
Of these 21 reported spending the previous night in a hostel or
supported accommodation
The majority of the individuals reported at least one physical
health condition within the last year, these were very wide
ranging, but most common were dental and liver problems.
Mental health conditions were also commonly reported by this
group, most commonly was depression (14 people), anxiety (14
people) and psychosis (11 people).
Overall self-reported health
The EQ5D measures a person’s overall level of physical and mental
health. People rate their health across five areas (mobility,
self-care, usual activities, pain and discomfort, and anxiety and
depression) and are asked to judge if they have no limitations,
some/moderate limitations, or extreme ill health/unable to complete
activity unaided.
The minimum score of ‘5’ indicates overall good health, however the
maximum score ‘15’ indicates the person is not able to meet their
needs unaided or has very poor overall health.
26 people scored 5 or 6; mainly good health
26 people scored 7 or 8; moderately poor health in some areas
13 people scored 9 or 10; moderately poor health in most areas
5 people scored 11 or 12; moderate/significant poor health in most
When rating their overall health between 0 (worst imaginable health)
and 100 (best imaginable health), most people rated their health
between 50-80.
Physical health
People were asked to look through a list of common physical health
conditions and record if they have ever had this condition, and
whether they have this condition ‘now or recently’ i.e. at the moment
or within the last year, or ‘in the past’ i.e. more than a year ago.
The most commonly reported conditions within the last year were as
Joint aches or problems with bones and muscles
Dental or teeth problems
Difficulty seeing or other eye problems
Other skin or wound infection
Problems with feet
High blood pressure
Within the last year...
25 people reported no physical health conditions
17 people reported only having on health condition
12 people reported having five or more health conditions
People who reported having no health conditions within the last year
were more likely to be currently living in rented accommodation and
not to have been homeless at any point in their lives.
Treatment for physical health conditions
Of those who had received treatment for a physical condition, the
majority were happy with the treatment (20 of 25), but another 9 had
not received any treatment for a physical health condition but felt in
need. Barriers to treatment included not knowing how/who to ask for
the treatment, difficulty travelling, missed appointments, and fear of
the appointment.
Mental health
It is commonly quoted that among the general population, 1 in 4 people
will experience a mental illness at some point in their lives and that
1 in 10 adults are experiencing a mental illness at any given time.
Of the York cohort who responded to the survey, 33 of the 83 reported
having been diagnosed with at least one mental health condition now or
within the last 12 months. A small number reported having multiple
The most commonly reported conditions within the last year were as
Number of people
Anxiety disorder or phobia
Suicidal Thoughts
Psychosis (schizophrenia or bipolar disorder)
Dual Diagnosis
Post traumatic stress disorder
Of those who had received treatment for a mental health condition the
majority were happy with the treatment (30 of 47), and another 8 had
not received any treatment but felt it was needed. Typically this
included community mental health support and a mixture of talking
therapy, prescribed medications and practical support. Barriers to
treatment included long waiting lists or limited appointment slots.
Drug, alcohol, and smoking
Self medication
30 respondents reported that they use some form or alcohol or
drugs to ‘self-medicate’ or otherwise cope with their mental
Dual Diagnosis
10 people reported a ‘dual diagnosis’ of a mental health condition
and an addiction
Drug misuse
14 people said they had a drug addiction, a further 16 said they
were in recovery
most commonly people received specialist community support,
although talking therapies and support from primary care were also
17 of the 24 people who reported receiving some support for a drug
addiction said the service(s) they were receiving met their need
Alcohol misuse
7 people said they had an alcohol addiction, a further 9 said they
were in recovery
There were also people who indicated they drank substantially
beyond the recommended upper limit for alcohol consumption, or who
drank most days, and who did not indicate they had a problem with
the most common support was advice from primary care
8 of the 12 people who were receiving some support for an alcohol
addiction said the service(s) they were receiving met their need
53 of the 83 respondents currently smoke, and another 10 smoke
e-cigarettes exclusively
Of all smokers, 20 said they would like to stop smoking completely
Of these, 15 did not remember being offered support by a health
Health service use
Primary care
All but one person was registered with a GP practice
None of the respondents had been refused registration with a GP in
the last 12 months
On average, people visited their GP three times in the last 12
months, although a small number of people had visited their GP
well over 20 times.
38 people were registered with a dentist in York
8 had been refused to register with a dentist in the last 12
months, and the comments indicate this was largely due to
Prescription medicating
55 people reported they were currently prescribed at least one
prescription medication
Emergency ambulance use
30 people had used an ambulance in the last 12 months; most had
only used the ambulance once.
Two people reported using ambulances very frequently.
A+E admission
Nearly half of people (35) had not been to A+E at any point in the
last 12 months, a further 14 had only attended once.
A small number report using A+E frequently; more than six times in
the last year.
Hospital admission
31 people had been admitted to hospital within the last 12 months
14 of these people had been admitted just the once,
A small minority report frequent admissions.
Most commonly, people said they were admitted for ongoing physical
or mental health conditions.
Hospital discharge
After the last admission, 21 people reported they were discharged
to suitable accommodation, 5 to unsuitable accommodation, and 5
people reported being discharged to the street
5 people reported re-admission within 30 days
Mental health ward admission
Six people had been admitted to hospital for mental health
treatment within the last 12 months
Vaccination and screening programs
25 people reported being vaccinated for hepatitis B at least once
29 had ever received a flu vaccination
70 people knew where to assess sexual health advice,
66 knew where to access free contraception
7 people thought they had received a health check
10 of 29 women had received cervical cancer screening
High levels of health service use:
Of the survey cohort, 24 have reported one of the following:
Use of GP 10+ times in the year, or
Use of emergency ambulance 5+ times in the year, or
Use of A+E 5+ times in the year, or
Hospital admission 5+ times in the year
Within the last 12 months, this group of 24 people self-reported:
387 GP appointments
121 A+E attendances
57 Emergency ambulance call outs
36 hospital admissions
5 mental health inpatient stays
Within this group, many reported mental ill health, including having
multiple health diagnosis. Half reported using alcohol to
self-medicate. Additionally, more than half reported a period of
physical ill health within the last year; several people reported
multiple physical health conditions
The majority of people reported only eating one or two meals a day
(25 people and 35 people respectively). Five people reported not
eating a single meal the previous day.
33 people reported not eating a single portion of fruit or
vegetables in the previous day. Only five people reported eating
the recommended 5 portions of fruit and vegetables in the previous
The data on exercise is split; 23 people reported never doing 30
minutes of exercise, whereas another 23 people reported doing 30
minutes of exercise on five or more days in the week.
Views of Health
Finally, people were asked to describe the things that make them feel
happy and healthy, and allow them to look after their own health.
Only a small number of people responded, but the responses indicate
that the following things were important;
Social support and contact with friends and family
Exercise and ‘getting out and about’
A sense of routine and purpose
Feeling stable and knowing that will happen next
Being able to manage long term physical and mental health
Challenges for the City
Many of York’s homeless population are in contact with multiple
services, departments and organisations. There is some evidence that
professionals find it difficult to access accurate and up to date
information about the support available.
The challenge for the city is to ensure that all organisations take
practical steps to ensure that there is a high level of awareness of
the support and services offered by that organisation and available in
There were high levels of mental ill health reported by the homeless
cohort, and this was supported by the statements from health
... The challenge for the city is to ensure adequate mental health
treatment and support is available for those with a diagnosable mental
Support for people with a ‘dual diagnosis’ of mental ill health and a
drug or alcohol addiction was perceived as complex to access. The need
for dual diagnosis support was frequently discussed by both
professionals and the homeless population in this report.
... The challenge for the city is to ensure that information on the
referral criteria and service pathway is available to professionals
working in health and social care organisations across the city.
The homeless cohort reports that they are generally able to access
universal health care services in York. However, there is evidence of
frequent health service use among a small group. This places demand on
services, and may indicate unmet need.
... The challenge for the city is to engage in evidence based
activities to meet the needs of these individuals, including
supporting and contributing to the evaluation of pilot projects.
There remains an overlap between the current homeless population in
York and people who have been in a range of institutions.
... The challenge for the city is to develop a more preventative
approach to identify and address health and housing needs.
Health professionals from across the sector discuss ‘disengagement’ as
a barrier to accessing services for a small group of people. In
particular, this was associated with long term rough sleeping and poor
... The challenge for the city is to work in a flexible manner to
ensure this customer group can access services
Of all the behavioural factors, smoking has the biggest impact on
health. The majority of the homeless cohort report smoking; and few
recall being offered support to stop. Smoking was not widely discussed
by professionals.
... The challenge for the city is to remain ambitious in offering
timely support for people to stop smoking, in particular as people
move back into stable accommodation.
A large proportion of respondents reported consuming alcohol
substantially beyond the recommended upper limit.
The challenge for the city is to support people to reduce alcohol
intake to reduce the risk of alcohol related health harms.
People reported feeling most well when they had meaningful social
contact, engaged in physical exercise, or had a sense of purpose.
The challenge for the city is to identify meaningful opportunities for
people who are homeless to build their social capital and improve
their sense of wellbeing.
1 ww.cih.org/resources/policy/HealthHousing%20MoU%20Feb18.pdf
5 https://data.yorkopendata.org/dataset/kpi-cjge178

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