Mental Health Needs of Homeless Youths: Awareness and Engagement with Services in the UK

Understanding the mental health needs of homeless youths aged 16-24 and their engagement with mental health services in the UK. The research questions focus on the level of awareness and engagement of homeless youths with mental health services. The study uses a PRISMA flow diagram and the CASP tool to assess the methodological validity of the selected articles. The research findings can inform the development of targeted services for homeless youths with mental health needs in the UK.

Mental Health Needs of Homeless Youths(aged-16-24) and their engagement with Mental Health Service
Provisions.
Research Questions
What do young homeless people aged (16-24) know about mental health services that are available through the
public (NHS) and Voluntary Sectors?
How do the homeless youths engage with mental health services?
Abstract
There is a significant literature which explores the links between youth homelessness and mental illness. Given
the rise in homelessness in developed countries including UK, it is important to understand the needs of this
group as they can be the most vulnerable to mental health illnesses. The causes of youth homelessness can be
varied and interdependent, with a large proportion of these young people, due to suffering from domestic
violence, sexual or emotional abuse, addiction to drugs or alcohol, release from prison and leaving care. This
research aims at understanding the targeted services provided to these youths to determine their level of
awareness and engagement with specific reference to Mental health services
Secondary data can provide a baseline by which researchers can gather significant information on a given
research topic. Secondary data analysis can be defined as the analysis of data or information already present or
collected from other sources such as Journals, Government policy papers, working papers and reports by other
institutions. When using large databases or library catalogue such as Nelson, l will choose the search string
carefully. The common approach is to use Boolean operators. Boolean operators, include terms like AND, OR
and NOT, can increase the chances of identifying the results. The key search terms used in this research may
include: (Mental Health OR Mental illness) AND (Homeless OR Youths) AND (Youth OR Young People OR
Young Adults) The articles will be selected using the PRISMA flow diagram and the methodological validity
assessed using the CASP (Critical Skills Appraisal Programme) tool. An analysis of the study themes and sub-
themes will be carried out to answer the proposed research questions.
Methodology
This research will be done using secondary data. Secondary data refers to information that was collected by
someone else other than the researcher. The source of the secondary data can be journal articles, information
collected through government departments, census, or data collected from academic books. All these records
and data were collected for some other research. In the present research work, the literature was obtained from
different searches conducted through the catalogue and database of University of Northampton, Other than
that, several journal articles were obtained through Google Scholar. The search term used for the research was
youth homelessness strategies for mental health and youth homelessness policies awareness. The results
obtained from the research were research articles based on the issue of homelessness and major issues of
homelessness. However, the research subject was mental health needs of homeless youths and the engagement

of youths with the homeless or mental health services. Therefore, due to the results, it was necessary to hand
pick articles for literature review. The research articles were selected by reading the abstract of the research.
Database Search
Google Books
Search Term*Youth homelessness strategies for mental health in UK*
Number of Hits= 8,160 hits
Relevant books: 4
The abstract of all the books was studied for the research, and total 4 books were selected for further research.
They are, “homelessness and social policy”, “Understanding housing policy”, “Mental Health and Emerging
Adulthood among Homeless young people”.
Google Scholar
Number of hits= 80,000 hits Any Year
Advanced search (journal articles from year 2012-2018)= 16,900
Relevant articles: Keyword: *Mental health needs of the youth and the engagement of the youth with the
homelessness services in UK*
Number of Hits: 17,100
Advanced Search: 7, 850 hits (Journal Articles from year 2014-2018)
Nelson
Name of Database: Nelson University Online database
Keyword: homelessness policies awareness UK
Number of hits: 10,656
Extended research: The inclusion and the exclusion criteria included the date of publication (2005
onwards) and relevance of abstracts
Extended research
Number of Hits: 5,342
Peer reviewed articles: 4,154 articles
The selected articles are

Name of writer Title of article
Fallaize, R., Seale, J., Mortin, C., Armstrong, L., &
Lovegrove, J. (2017).
Dietary intake, nutritional status and mental wellbeing
of homeless adults in Reading, UK.
Dorney-Smith, S., Hewett, N., & Burridge, S. (2016). Homeless medical respite in the UK: A needs
assessment for South London.
H WHITEFORD, M. and SIMPSON, G., 2016. "There is still a perception that homelessness is a
housing problem": devolution, homelessness and
health in the UK.
Other research articles were also shortlisted through online research on web portals. When these journal articles
were explored, several subthemes were identified, which were later used to develop the subheadings of the
research.
The researcher will view the abstract of the research and determine, if the journal articles are relevant to the
research sections of the dissertation. These articles were selected for the research as they had relevant
information regarding the healthcare policies to address the mental health issue in the UK. The research papers
were not selected before the year 2000. When the research term, homelessness in youth is selected, more than
40 hits occurred. Therefore, the result was refined by using key terms, strategy homelessness in the
organization. Several books occurred in the search results; however, these books were not recent and;
therefore, did not contain relevant information.
In recent years, several research articles have been published regarding homelessness. It is due to the fact that
the scholars have identified homelessness as a serious social issue. Several researchers have explored
homelessness with a local perspective. Going through journal articles, it was identified that there is a growing
number of homelessness in London, due to high rates in property prices. Several research articles have explored
the subject and proposed strategies, which can be used to address the social problem. The researcher has
identified these strategies and used them in critical literature review section. Secondary data will be collected
from Journal articles such as Google scholar, Google books and Nelson Northampton University Electronic
Library Online Search. Different keywords were used for exploring different journal articles. It is important for
youths to be aware of homelessness policies and to remain engaged with them. Another keyword used for the
research is the strategies of the government to deal with homelessness.

Literature Review
Author Title of article or journal
Fox, A. M., Mulvey, P., Katz, C. M., & Shafer, M. S.
(2016)
Untangling the relationship between mental health
and homelessness among a sample of arrestees
Kazloff et al. (2016). "Housing First" for Homeless Youth With Mental
Illness.
Keuroghlian, A.S., Shtasel, D., & Bassuk, E.L. (2015 Out on the Street: A Public Health and Policy Agenda
for Lesbian, Gay, Bisexual, and Transgender Youth
Who Are Homeless
Rhoades, H., Winetrobe, H., & Rice, E. (2016) Pet Ownership among Homeless Youth: Associations
with Mental Health, Service Utilization and Housing
Status
Saddiccha, S., Linden, I., & Reinhadt, K. (2014). Physical and Mental Health Issues among Homeless
Youth in British Columbia, Canada: Are they
Different from Older Homeless Adults?
Author Title of article or Journal
Abramovich, I. A. (2012) No safe place to go-LGBTQ youth homelessness in
Canada: Reviewing the literature
Burns et al. (2015) Mental Health Disorders in Young Urban Sexual
Minority Men
Choi, S. K., Wilson, B. D., Shelton, J., & Gates, G. J.
(2015)
Serving our youth 2015: The needs and experiences of
lesbian, gay, bisexual, transgender, and questioning
youth experiencing homelessness.
Bender, K., Brown, S.M., Thompson, S.J., Ferguson,
K.M., and Langenderfer, L. (2014)
Multiple Victimizations Before and After Leaving
Home Associated With PTSD, Depression, and
Substance Use Disorder Among Homeless Youth
Edidin, J. P., Ganim, Z., Hunter, S. J., & Karnik, N. S.
(2012)
The mental and physical health of homeless youth: a
literature review.

Introduction
Youth homelessness is on the rise, which has also increased issues associated with young homeless youths. As
per the authors, youth refers to a young person between the age group of 14-40, who are homeless and do not
have a place to stay (Saddichha, Linden, & Krausz, 2014). According to United Nations (2008) ‘youth’ is
someone aged 15-24 years old and they defined the word ‘youth’ as a process of change from depending as a
child to adulthood, independence and someone leaving compulsory education and looking for work.
Homeless youths have a high number of physical and psychiatric illnesses. Homelessness is a serious issue that
affects single men and women with effects of psychological well-being problems. The literature highlights that
there are several pathways to homelessness; however, youths are at high risk as victims of homelessness.
Females are particularly at high risk of violence and trauma. Being homeless can create a lifetime of existing
psychiatric disorders, which includes depression, anxiety, post-traumatic substance abuse and psychosis
(Saddichha, Linden & Krausz, 2014). It increases suicidal idealization, and suicidal attempts. Homeless youths
are more likely to experience mental health issues such as depression and anxiety. In this essence, the present
literature review will shed light on the mental health needs of homeless youth.
Youth Homelessness
In the views of (Bender et al,2014) the root causes of homelessness are youths leaving their family homes
because of maltreatment and they are also escaping their homes to avoid abuse and discrimination on the street.
Childhood victimization results in youth’s psychological disorders. Many youths in United States of America
have been screened positive for physical and sexual abuse. Experiences from childhood victimization can cause
post-traumatic stress, depressive disorder and substance abuse disorder. Different forms of childhood abuse
such as physical, sexual, emotional, psychological and verbal can result to psychological symptoms. There is a
significant number of homelessness experiences, which can increase mental illness and depression (Guirguis-
Younger, 2014). Therefore, it is important that the government introduce trauma-informed screening, services
and treatment for homeless youths.
Awareness of Government Policies regarding Homelessness
Edidin, Ganim, Hunter & Karnik, (2012) stated that most medical treatment programs for homeless people
contain four major elements; Communication is the major element in developing policies for homeless people
with mental health needs. In the views of Fallaize, Seale, Mortin, Armstrong & Lovegrove (2017) agencies
involved in developing solutions to healthcare problems should be informed regularly about the developments
and changes in policies. As per the article, malnutrition is a significant issue in the homeless population, which
can negatively impact on the mental well-being. Healthcare professionals should have proper co-ordination
with policy makers. There should be proper co-ordination between mental health teams, housing, social
services and voluntary organization officials. Service providers should create more supporting services for
every individual instead of users being forced to use the service.
In the perspective of Keuroghlian, Shtasel and Bassuk, (2014) LGBT youth community is more prone to mental
illness due to issues faced by this community; therefore, this community has high rates of mental health
poblems, substance abuse problems and suicidal acts. As a result, people falling in this category have a history

of academic difficulties and high rate of school drop-outs. In the LGBT community, major causes of
homelessness are running away from family homes, which reject them due to different sexual orientation.
Another reason is being forced out of their family homes, despite preferring to stay at home
Tyler & Cauce, (2002) discussed that due to education level and lifestyle choices, homeless people have little
awareness of healthcare services they are entitled to and they face barriers when it comes to accessing these
services. Homeless people rely on A&E, walk in clinics and other voluntary organizations. Firstly, diverse
nature of homeless people and the structure of the community is also challenging. It is important that services
are brought to homeless people rather than waiting for them to come in. There are several unique characteristics
when it comes to homeless people, this impact on the provision of treatment and the healthcare planning. Daily
activities for homeless people are quite unique as they find it difficult to maintain their medication whilst living
on the street. During treatment of schizophrenia, medications can make them too drowsy, which interfere with
the alertness against street dangers. There are multiple needs for homeless people, which include housing and
income maintenance. In the perspective of Medcalf and Georgina (2014), homelessness is a silent killer and
demands immediate attention from the government. A large number of homeless people die every year, because
of lack of treatment. The healthcare facilities should be delivered by the coordinated team, which has expertise
on the substance misuse, mental health, primary health and social care and housing.
In the views of Slesnick, Dashora, Letcher, Erdem & Serovich, (2009) homeless people abuse drug and alcohol
misuse, which makes their treatment needs different. A significant amount of homeless people ends up
developing social support structure for themselves and these networks enables them to be accepted within the
society However, there is a few homeless citizens, who are not able to develop this support structure as they
find it difficult to settle and maintain such relationships. Such people suffer from lack of connection and lack of
motivation for life (Levinson, 2004). Distrust is another issue, faced by homeless people. Several times,
homeless people face bad experiences due to medication, hospitals and which create more distrust amongst
them.
Whiteford and Simpson (2014) have stated that homelessness is not only a health issue, but a social issue. There
are several other issues associated with the homelessness such as emergency care, hospital discharge and the
intermediate care for the homeless people. Moreover, the article analyzes that the welfare reforms abs the
financial austerity has created new challenges for the homeless people in London.
A significant amount of homeless youths run away from their foster care homes as they do not like sudden
changes taking place in their life. There are several psychological conditions, such as depressive episode,
PTSD, suicide idealization which are triggered by homelessness. There are several factors mediated for the
association between homelessness and psychological disorders, namely, stressful life events, negative social
relationships and psychiatric symptoms. Rhoades, Winetrobe & Rice, (2016) mentioned that affordable and safe
housing is essential to bring stability and security to individuals. The right to housing increases social and
economic inclusion of people within the society. In simple terms, home is essential for mental, physical and
health of individuals. It is one of the fundamental right of humans and it is also mentioned within the UN
Covenant on Economic, Social and Cultural Rights which states that every individual has a right to adequate
standard of living including housing.

Engagement of Homeless Youth with Government Policies
In the same essence Burns et al, (2015) stated that several government agencies are making efforts to provide
adequate housing facilities to everyone facing homelessness challenges. Several reasons cited as causes behind
homelessness include poverty, disability and a lack of affordable housing. However, lack of housing is directly
connected with the mental health; Homelessness can increase chances of mental health issues. Homeless people
not only have high rates of mental depression, they are more likely to suffer from complex trauma, substance
misuse and social exclusion.
In the views of Kazloff et al, (2016) social welfare services within the UK have realized that homelessness is a
health issue and needed to be dealt with immediately. Youths without a house have problems in accessing
healthcare services as normally place of resident is needed, Homelessness is a public health issue; therefore, the
government as well as voluntary organizations are doing their best investing and training staff, working with
homeless youths. The staff who works with homeless individuals should be aware of emotional and
psychological needs and the well-being of homeless youths. In UK, Government has developed several
strategies for unemployed homeless youth.
In the perspective of Choi, Wilson, Shelton & Gates, (2015) there are several homeless families within the UK,
who are provided shelter through Voluntary organizations and from the local council. Local authorities are
under more pressure to provide proper housing to these families. As per the literature substance abuse amongst
homeless women it is becoming high and there are high requirements of sanitary products.
According to Abramovich, (2012), there is other outcomes of homelessness, which can severely impact on the
mental health of people. It results in low education level, long-term employment and poverty, which has direct
impact on the mental well-being of homeless people. Homelessness is a complex problem and there is no
simple provision to deal with the issue. Therefore, proper support and treatment is required for individuals.
In the perspective of Johnson & Chamberlain, (2008) it is important that the government prioritize mental
health policies and focus on social care, welfare, employment and the criminal justice system. Access to
psychological therapies is also important as a treatment for homeless people with mental illness. Several
strategies such as counselling and psychotherapy will create a positive impact for individuals affected due
homelessness. The psychodynamic therapy emphasizes the importance of relationships and different
experiences for shaping and triggering current behavior of people. It explains the high rate of mental disorders
amongst young homeless youths (Cabrera, Villarruel & Fitzgerald, 2011). It is also beneficial in treating
psychological disorders, including people with complex conditions such as personality disorders.
In the perspective of Toro, Dworsky & Fowler (2007) policy makers and service organizations should take
targeted approach when it comes to medical assistance programs for homeless people. They should not be
passive whilst waiting for homeless people to appear and use available services. The medical programs should
have high outreach teams and be able to reach out to homeless people on the streets. Along with it there should
be a range of resources for programs to run smoothly. In the successful operations of the program, there should
be adequate internal and external resources, such as reasonable funding, paid employees, number of volunteers,

goods and facilities. External resources can include the network of essential services and the ability of
employees to be able to access the network.
According to Folsom, Hawthorne, Lindamer, Gilmer, Bailey, Golshan, & Jeste,(2005) in the past, several
health-care program models have been developed to provide adequate services to homeless people. Shelter-
based clinics are the most common programs and are implemented frequently in most of the healthcare
programs. These programs are developed to bring services to the place of the homeless people. It identifies such
needs and on-site clinics and shelter can be developed.
In the views of Greenberg & Rosenheck, (2008), rescue mission is another model program, which is aimed at
supporting mental and physical healthcare needs of individuals. The rescue missions are co-ordinated at a
national level; however, they can be designed more effective as it has local collaboration with it. It is important
that clinics have volunteer doctors and nurses. These institutions rely heavily on private donations, cash and
pharmaceutical supplies. However, several times these institutions are associated with different religions, which
makes homeless people unwilling to visit these institutions. The public-private program is another program
model, which focus on developing solutions for the needs and the problems of homeless people. The public-
private programs have similar attributes to that of volunteer organizations (Whitbeck, 2011). These programs
are designed to address health and social service requirements of municipal shelters and their interdisciplinary
teams.
In the perspective of Fox, Mulvey, Katz & Shafer, (2016) during the treatment of homeless people, one of the
most significant challenges is the notion or presumption of the doctor or the healthcare service providers that
the patient has a home. Even when the homeless people are aware of the mental and physical health care needs,
accessing these programs can be challenging. Homeless people suffer from both financial and physical access
challenge, regarding the financial access, homeless people can be compared to the poor or the near-poor people,
it means that they face the same problems. They need to seek financial assistance, which requires eligibility and
lots of paperwork. Several legislations, which can eliminate shortages of financial access for homeless people
requires a fixed address for gaining access. However, there are certain legislations, which prevent single and
non-disabled people from gaining access to these benefits.
Regarding the physical access, there are certain obstacles such as location of hospitals, clinics, and mental
health care services are far from the places where homeless people can access. The most common medium of
accessing healthcare program is by public transportation; however, shelter services are far from transportation
services, which increase obstacles for homeless people. Whilst choosing between homelessness and a place for
a night, the shelter is the top priority for people.
Summary
It can be summarized that due to education level and lifestyle choices, homeless people do have little awareness
of healthcare services. They also face barriers in accessing these services. Walk in clinics and other voluntary
organizations access the homeless people to provide these services. Firstly, diverse nature of homeless people
and the structure of the community create challenge in the accessibility of these services. It is resulting in
services to be brought to homeless people rather than waiting for them to come in. Daily activities for homeless
people are quite unique as they find it difficult to maintain their medication whilst living on the street.

The fundamental issue in the accessibility of these services is the lack of stable residence, which has a direct
and detrimental impact on the mental and physical health of individuals. The poor health results in delay in the
treatment efforts. A broad initiative is required to increase the access to the homeless people. However, it is
difficult to implement targeted approach in the long run as people offering these services encounter other poor
and uninsured people or unregistered staff. Therefore, a targeted approach is neither ethical nor practical.
Moreover, the immediate need of providing food and shelter to people has over-ridden the need to design and
implement policies, which can offer long-term solutions. The government creates an action plan for both
national and local level for co-ordination and the continuity of different services. There are different strategies
which are used for delivering effective healthcare services to homeless people. It is important that services are
provided on a voluntary basis. Homeless individuals are entitled to their privacy and dignity. Moreover, there
should be intensive efforts for engagement of homeless people with these services. There are appropriately
skilled and trained healthcare professionals, who understand the needs of the customers and provide them with
constant services.

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