An exploration of how homelessness causes mental health problem among single homeless adults in London

This research explores the relationship between homelessness and mental health among single homeless adults in London. The research aims to identify the prevalence of homelessness and investigate the risk of homelessness among those with mental health problems. The findings will contribute to understanding the impact of homelessness on mental health and provide recommendations for addressing the issue.

Running head: RESEARCH PROPOSAL
Research Proposal
Student’s name:
Name of the university:
Author’s note:

1RESEARCH PROPOSAL
Table of Contents
1. Title..............................................................................................................................................2
2. Research question........................................................................................................................2
3. Introduction..................................................................................................................................2
4. Literature review..........................................................................................................................3
5. Aims and Objectives....................................................................................................................7
6. Ethical considerations..................................................................................................................8
7. Method of data collection............................................................................................................9
8. Anticipated research outcomes..................................................................................................11
9. Identification of the strengths and weaknesses of the research proposal..................................12
10. Work plan/Gantt chart.............................................................................................................13
Reference List................................................................................................................................14
Appendices....................................................................................................................................17
Appendix 2.....................................................................................................................................19

2RESEARCH PROPOSAL
1. Title
An exploration of how homelessness causes mental health problem among single homeless
adults in London
2. Research question
Homelessness can be caused due to the lack of affordable housing, unemployment,
poverty and life events. Lack of money is the main reason for homelessness and people
sometimes cannot afford the home rent as well. In London, almost 4500 people slept on the road
on any given night in autumn of 2017 and this figure has been doubled since 2010 (Paul et al.
2018). It has been almost noticed that number of individuals sleeping in London has hit record
after an approximate 73% increase in the last three years (Theguardian.com 2018). In addition, it
is observed that homeless people are suffering mental health issue as the homeless people behave
abnormally with the common people on road.
Therefore, the primary research question of the research is:
How does homelessness contribute to mental health problem among single homeless people in
London?
3. Introduction
The relationship between homelessness and mental health is more like a cause-and-effect
relationship. In the article named ‘The Homeless Mentally ill' appeared first in Harvard Mental
Health Letter (2005) and this article; author claimed that almost one-third of all homeless people
in America has a serious mental problem such as bipolar disorder, schizophrenia and major

3RESEARCH PROPOSAL
mental depression. The relationship between the homelessness and mental health is like circular
in fashion as each one contributes on other; sometimes, mutual contribution spins out of control
(Gulati et al. 2018). According to Urbanoski et al. (2018), homelessness is traumatic for the
individuals and it leads to the depression to the people and it often develops the stress leading
mental illness. Moreover, London is developed in the economy; however, one-fifth of the
homeless people suffer from the mental illness while 14% of them are women. Homeless people
in London sometimes have to sleep under the open sky and sometimes, the homeless people
sleep in cars, tents, buses and even trains. Additionally, the report stated that sleeping without the
roof causes the victims of violence for the people and it makes 17 times more likely to suffer
verbal and physical abuse compared to common public (Essali et al. 2012).
This study aims to conduct a research on the subject matter of homelessness contributes
to a mental health problem in London. Lambeth, a borough of London observes major homeless
issues. There are some homeless shelters which provide places to live for the homeless distressed
people. This research is aiming to provide aim and objectives which will be addressed in the
final research. A literature review is provided setting the background of the research based on the
previous research studies. Data collection process and the process of data analysis are also given
in the research methodology section. In the final section, anticipated findings of the research are
provided identifying the strengths and weaknesses of the research. The findings of the study
would benefit the public health issue in London as the findings will be highlighted the core
relationship between homelessness and mental health of people.
4. Literature review
The relationship between homelessness and mental health

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As stated by Snow (2013), there is a contrast in European technologically and
economically advanced society on misery and the size of the homeless population. The authors
further remarked that homeless people present in the general population and they achieve the
prominence during the rimes of stress and economic stress. The new visibility of the homeless
people on the streets can prompt a deal of public speculation in European regions and in the
United States. The number of homeless people has been increased in European regions and the
reasons are high employment, change in the structure of the families, decrease in the public
support programme and unavailability of the low-cost housing (Urbanoski et al. 2018). The
relationship between the homelessness and mental health is cyclic in nature as poor mental health
can lead to the homelessness as well. As opined by Bhugra (2017), poverty, personal
vulnerability and disaffiliation are factors of homelessness of the people as homeless people face
the issues of sustainable employment and little income. Lack of mental balance leads to the
delusional thinking and it leads to withdrawal from the friends, people and family persons.
The stress of the people during the homelessness leads to exacerbating previous mental
agony and it leads to the more fear, anxiety, sleeplessness and depression. The experience of
homelessness along with mental illness can be hazardous for the people as the individuals can
face the issue of physical hazards (Greenberg and Rosenheck 2016). In this situation, the people
want the supportive atmosphere, fulfilling the basic needs and having the accessible care. On the
other side, safe accommodation and affordable housing bring security and safety to the people's
lives and this advantage gives gateway to access health service along with enhancing the social
and community inclusion. It is very important to simply put a good home for the physical health
along with mental peace. Homelessness condition leads to the poor mental condition and it
makes harder for the people to handle the mental pressure during the condition of homeless. As

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found out by Herbers et al. (2017), in the year 2015, almost 33% of the single homeless people
reported to have a mental health problem and rate of depression was high in the UK. Among the
homeless people; psychological issues like substance misuse, trauma and social exclusion are
very common and these things can lead to the mental problems.
Social stigma and risks of homelessness
Homelessness is one of the stigmatised situations of the society and people without roof
experiences the components of the stigma associated with this. Financial condition and societal
factors are associated with the homelessness and these people are officially marked, segregated
and labelled to unwanted characteristics (Perry and Craig 2015). Homelessness leads to sheer
mental pressure to the people as they have no place to take shelter and most common stereotypes
concerning with mental health are mainly two types; these people are generally viewed as
responsible for their own conditions and these people are viewed as unpredictable and dangerous
for the common people leading to avoidance and fear. Stereotypes result to often perceive the
public with homelessness as mentally ill and untouchable. The common people cannot think that
homeless people are mentally ill and they cannot make decisions for their own (Narendorf 2017).
Homelessness of the people leads to the schizophrenia and these people can be dangerous for the
common public. On the other side, media provides inaccurate illustration and exaggerate
violence portraying the mental illness of the homeless people. Sometimes, common people tend
to exaggerate the relationship between the mental illness and dangerousness associated with this.
Types of intervention homelessness and mental health issue
According to Greenberg and Rosenheck (2016), increased prevalence of psychotic illness
among the homeless people may need a special model of social and psychiatric care. Individual

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vulnerabilities and structural change is the main reason of the homelessness. Homeless people
do not have relation with the friends and family for long time. As stated by Bramley and
Fitzpatrick (2018), healthcare prevention for the people who are homeless is definitely a
challenge for the public health monitoring. The governmental agencies address barriers to
develop the mental health of the homeless population which can lead to the lasting gain of the
people. For the homeless people; integrating treatment is needed with housing interventions and
substance dependence. The intervention of the people is aimed at the people who are homeless
with severe mental illness. These types of people can be given housing programmes,
rehabilitation along with life skills, crisis intervention so that they can get the services. As opined
by Reeve (2017), the government agencies describe the intervention policy as the employment
training to the homeless people and if the people are mentally misbalanced, they can be given
access to the medical care and psychiatric care as well. It has been observed that normal
community mental health cannot be sufficient for homeless mentally disabled people. If the
homeless mental health people are given with traditional mental health care; this service delivery
does not match their housing needs and welfare.
Homelessness contributes to a mental health issue in London
The interconnection between the mental illness and the homeless is multifaceted. In the
case of mental health problem, biological risk can increase the likelihood of the mental health
and subsequent homelessness. If the mentally ill people get their own home; the people have to
face again their triggers and stressors where they experience trauma, abuse and it can reduce
their function and it increases the risk of homelessness again (McIntosh et al. 2016). In London,
the number of sleepers in the open road has been increased by 15% in just one year (from 2016-
2017) (Healthyplace.com 2018). National Audit Office (NAO) in London revealed the data

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where it is shown the numbers of sleepers have been increased by 34% since the Conservative
Power took the power (Ward et al. 2015). Some of the homeless families approached the
councils and they had got the temporary accommodation. Amidst the prosperous condition in
London, more people find themselves helpless and they are forced to sleep in dangerous as well
as freezing condition. Murphy et al. (2017) observed that the Government of the UK pledges to
handle rough sleeping and it includes the homelessness along with the mental health of the
people. The authors further stated that the Government has ample numbers of shelters for the
homeless people, the worst pain is the housing crisis.
Gap in literature
Most of the previous researches focused on the interrelationship between homelessness
and mental health issues. The scholarly articles mainly mentioned the cause-effect relationship
between mental health and homelessness of the people and the authors mainly stated that these
two factors are cyclical in nature. However, the question of this particular research is to highlight
how homelessness attributes mental health of the people. The researchers found out the financial
and social factors behind the homelessness of the people which lead to the mental health of the
people. However, it is not evidenced by risks of homelessness; many of the homeless people
with the mental illness accept the services and treatment.
5. Aims and Objectives
The aim of the research is to demonstrate how homelessness contributes to mental health
problems among single homeless adults in London.
Research objectives are:

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 To investigate the prevalence of homelessness among single homeless adult in London
 To investigate the risk of homelessness among those with mental health problems
 To investigate government housing policies in addressing homelessness and health
6. Ethical considerations
This research will focus on the homelessness and its contribution towards mental health
issue. This particular research will be based on secondary data. The researcher will take
permission from the university before starting the research. The researcher will also follow the
ethical considerations as well by using the correct data like documentary records, archives and
case notes. This particular research follows the social research approach as the targets of the
research are the homeless people. The researcher will interpret and use secondary data and the
researcher will not be biased taking the research data from the secondary sources. The researcher
will use only relevant and up to date journal articles. The researcher will follow the Data
Protection Act 1998 where the researcher will destroy the data after completing the research.
Under the terms of Data Protection Act 1998, the researcher will ask if the authors are willing for
their data to be archived and make them available for the final research (Watcher et al. 2017). In
secondary research data; the researcher will put proper citations along with correct references.
Sometimes, the researcher may face the ambiguity as two secondary data sources may give two
different types of information; in this scenario; the researcher will further research to put the
information. Data of the researcher must be de-identified before the researcher release and use of
data should not result in any damage. Informed consent of the second data includes the terms of
sharing from public agencies and archives. Sometimes, secondary data is involved in strong
anonymisation.

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7. Method of data collection
Method of investigations
In this research, the researcher will select the interpretive philosophy. Interpretivism
research philosophy assumes that access to reality can only be possible through social
construction, instrument and shared meaning. Development of the interpretivism is based on
positivism in social science.
The researcher will select the deductive approach as this approach aims to test the
theory. Deductive approach is used which starts with problem statement and the end result is
based on the either confirmation of the hypothesis or rejection (Ledford and Gast 2018). In this
research, observations regarding homelessness contribute to the mental health issues will be
discussed and it will start with the social theory.
The researcher will select an exploratory research design as it will help the researcher to
identify the problem statement. Exploratory research design mainly helps the researcher to
address the subject topic which has not been addressed by the previous researchers. The
researcher will explore the research topic through conclusive answers.
Data collection process
There are mainly two types of data collection process, primary data collection and
secondary data collection.
In this research, secondary data sources will be considered in order to conduct the
research. The researcher will obtain the secondary data from UK government publications,
report, technical and trade journals, public records, online articles, books, journals, reports of

10RESEARCH PROPOSAL
various governmental agencies, statistical and historical documents. The researcher will follow
the articles and news published by agencies through Mental Health and Homeless departments.
The researcher will also follow information related to National Health Services (NHS).
The researcher will assess the reliability of the secondary data through an understanding
of the premium articles with credible journal sources. The researcher will assess the data
accuracy as it refers to the data value stored for the object. In order to be all the data to be
accurate; the value of the data must be right and it should be represented in an unambiguous and
consistent form (Palinkas et al. 2015). The researcher will use secondary data sources as it will
provide help to gain the data accurate on homelessness which influences the mental health issue
in London. However, it would be a bit difficult for the researcher to collect the exact data based
on London's homelessness. Secondary data will be helpful for this research as the researcher
cannot collect the primary data from the mental health of people who are homeless. In this
scenario, secondary data can provide accurate information as it will be economical and it will be
time-saving for the researcher. As stated by Mackey and Gass (2015), secondary data helps to
improve the understanding of the problem statement and it mainly gives the comparison for the
data which is gathered by the researcher.
Sampling
In this research, the researcher will use a list of external secondary data sources which
can be extensive. The researcher will use the sample of various health data, social surveys,
statistics, population censuses, government data and online articles. The researcher will use
approximate 40 articles including government data, statistical papers and website materials.
Therefore, the sample size is 40.

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Inclusion and exclusion criteria
Inclusion criteria are the features which are prospective subjects to be included in the
research study. In this research, the inclusion criteria of the sampling of the secondary data
source are that all the credible and collected data sources must be published after 2010.
Therefore, the researcher will have credible and recent data which can be used as secondary data.
Secondary data which have been published after 2010 will be taken as sampling. Exclusion
criteria are those features which disqualify prospective subjects from inclusion in the study. The
exclusion criteria of the sample are the ones which are not based on European context.
Therefore, all the articles and secondary data must be based on the European context which helps
the researcher to get the accurate data.
Method of data analysis
Collected data through secondary data sources will be analysed through thematic data
analysis. Secondary data are mainly qualitative research data and qualitative data are mainly
subjective in form. Thematic analysis is the common form of qualitative research. Thematic
analysis mainly pinpoints, records and examines patterns within the data. The researcher will
segregate the findings into five themes based on the across the data set.
8. Anticipated research outcomes
After the literature review, it is clear that major depression, psychotic illness and drug
prevalence is quite common among the homeless people. After exploring potential secondary
data, it may be found that homeless people in London, mainly the Lambeth area are more likely
to sleep homeless shelter at night and under the open sky. These people more likely to have
drugs and alcohol and people face psychotic illness due to the mental pressure and ill-treatment

12RESEARCH PROPOSAL
from the family, friends and common people are very normal for them. However, the true
magnitude of the issue is very difficult to understand as different approaches are taken by the
Government in the UK. There are many factors which may lead to the homelessness, substance
abuse, unemployment and domestic violence; mental illness is untreated among the homeless.
This research will strive to explore the implications of the health services for the mental illness
among the homeless people. The traditional model of service delivery will not be able to treat the
mental health of the homeless people in London.
9. Identification of the strengths and weaknesses of the research proposal
The major strength of the research is that this particular research is going to explore the
health implication of the homeless people and this research area demands analysis to find out the
reasons behind the homelessness and mental illness among single people in London. The
strength of the research is that this particular research focuses narrowly on London which will
increase the impact of the research. This research will technically explore the complex
interrelationship between homelessness and mental illness from the secondary data sources by
public health departments and social justice bodies. This research will bring out the prevalence
of the mental illness among the homeless people. In addition, psychiatric diagnosis is becoming
more discriminating and it has its link between illness and homelessness. The strength of this
study is to identify the factors like housing, employment, education, social support, access to
health and family cohesion related to mental health and homelessness.
This research is based on the secondary data; therefore, the research will be solely based
on what other researches told in recent and previous time. The researcher needs to research the
government reports and agencies' statistics to show the recent condition. In addition, the

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researcher will not get first-hand data to understand the condition of London regarding
homelessness and mental health. Secondary data do not fit in the framework of marketing
research sometimes. The researcher will not get the direct responses from the public health staffs.
Sometimes, secondary data lack the accuracy.
10. Work plan/Gantt chart
(Refer to Appendix 1)

14RESEARCH PROPOSAL
Reference List
Bhugra, D. ed., 2017. Homelessness and mental health. Cambridge University Press.
Bramley, G. and Fitzpatrick, S., 2018. Homelessness in the UK: who is most at risk?. Housing
Studies, 33(1), pp.96-116.
Essali, A., Tarboush, M. and Awad, M., 2012. Specialist interventions for homeless people with
the severe mental illness. The Cochrane Library. pp.1-15
Greenberg, G.A. and Rosenheck, R.A., 2016. Jail incarceration, homelessness, and mental
health: A national study. Psychiatric services, 59(2), pp.170-177.
Gulati, G., Keating, N., O’Neill, A., Delaunois, I., Meagher, D. and Dunne, C.P., 2018. The
prevalence of major mental illness, substance misuse and homelessness in Irish prisoners:
systematic review and meta-analyses. Irish Journal of Psychological Medicine, pp.1-11.
Healthyplace.com. 2018. Mental Illness and Homelessness | HealthyPlace. [online] Available at
https://www.healthyplace.com/other-info/mental-illness-overview/mental-illness-and-
homelessness [Accessed 25 Jul. 2018].
Herbers, J.E., Cutuli, J.J., Kolarova, L., Albu, A. and Sparks, L.A., 2017. Mental health and
adaptation of children experiencing family homelessness. In Child and Family Well-Being and
Homelessness (pp. 7-26). Springer, Cham.
Ledford, J.R. and Gast, D.L., 2018. Single case research methodology: Applications in special
education and behavioural sciences. Abingdon: Routledge.

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Mackey, A. and Gass, S.M., 2015. Second language research: Methodology and design.
Abingdon: Routledge.
McIntosh, A.M., Stewart, R., John, A., Smith, D.J., Davis, K., Sudlow, C., Corvin, A.,
Nicodemus, K.K., Kingdon, D., Hassan, L. and Hotopf, M., 2016. Data science for mental
health: a UK perspective on a global challenge. The Lancet Psychiatry, 3(10), pp.993-998.
Murphy, D., Ashwick, R., Palmer, E. and Busuttil, W., 2017. Describing the profile of a
population of UK veterans seeking support for mental health difficulties. Journal of Mental
Health, pp.1-8.
Narendorf, S.C., 2017. The intersection of homelessness and mental health: A mixed methods
study of young adults who accessed psychiatric emergency services. Children and Youth
Services Review, 81, pp.54-62.
Palinkas, L.A., Horwitz, S.M., Green, C.A., Wisdom, J.P., Duan, N. and Hoagwood, K., 2015.
Purposeful sampling for qualitative data collection and analysis in mixed method implementation
research. Administration and Policy in Mental Health and Mental Health Services
Research, 42(5), pp.533-544.
Paul, S., Corneau, S., Boozary, T. and Stergiopoulos, V., 2018. Coping and resilience among
ethnoracial individuals experiencing homelessness and mental illness. International Journal of
Social Psychiatry, 64(2), pp.189-197.
Perry, J. and Craig, T.K., 2015. Homelessness and mental health. Trends in Urology & Men's
Health, 6(2), pp.19-21.

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Reeve, K., 2017. Welfare conditionality, benefit sanctions and homelessness in the UK: ending
the'something for nothing culture'or punishing the poor?. Journal of Poverty and Social
Justice, 25(1), pp.65-78.
Snow, N.L., 2013. The Stigma of Homelessness as a Function of Mental Illness Comorbidity.
The University of Drayton.
The Guardian. 2018. Mental Health and Homelessness. [online] Available at
https://www.theguardian.com/society/2018/jun/19/deaths-of-mentally-ill-rough-sleepers-in-
london-rise-sharply [Accessed 25 Jul. 2018].
Urbanski, K., Veldhuizen, S., Krausz, M., Schutz, C., Somers, J.M., Kirst, M., Fleury, M.J.,
Stergiopoulos, V., Patterson, M., Strehlau, V. and Goering, P., 2018. Effects of comorbid
substance use disorders on outcomes in a Housing First intervention for homeless people with
mental illness. Addiction, 113(1), pp.137-145.
Wachter, S., Mittelstadt, B. and Florida, L., 2017. Why a right to an explanation of automated
decision-making does not exist in the general data protection regulation. International Data
Privacy Law, 7(2), pp.76-99.
Ward, G., Perera, G. and Stewart, R., 2015. Predictors of mortality for people aged over 65 years
receiving mental health care for delirium in a South London Mental Health Trust, UK: a
retrospective survival analysis. International journal of geriatric psychiatry, 30(6), pp.639-646.

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Appendices
Appendix 1
Timeline of the research
Gantt chart
Activities Week 1
(August
1)
Week 3
(Aug 2-
Aug 16)
Week 6
(Aug
17-Sept
7)
Week 9
(Sept 8-
Sept 29)
Week
12
(Sept
30- Oct
20)
Week
14
(Oct 21-
Nov 21)
Week
16
(Nov
22- Dec
22)
Selection of the
research topic
✓
Reviewing the
literature
✓
Data collection
(Secondary)
✓
Data analysis ✓
Drawing
conclusions
✓
Recommendation ✓
Final submission ✓
Table: Gantt chart

18RESEARCH PROPOSAL
(Source: Created by the researcher)

19RESEARCH PROPOSAL
Appendix 2
Proposed dissertation structure in chapters
Chapter One: Introduction
Chapter Two: Literature Review
Chapter Three: Research Methodology
Chapter Four: Data Findings and Analysis
Chapter Five: Conclusions and Recommendations