The Impact of Homelessness on the Health of Single Adults in London

The Impact of Homelessness on the Health of Single Adults in
London
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Impact of Homelessness on the Health of Single Adults in London 2
Abstract
There are vast evidences on the issue of homelessness in single adults however the data is limited
about the real time experiences of homeless people. This research analyzes the experiences of the
single homeless adults. The study conducts literature review of reliable sources of information to
find the answer to the research question. The review implies that there is increasing need to develop
collaborative practices to support the homeless people.
The aim of the study is to analyze the impact of homelessness on the health of single adults in
London. The study produces significant statistics from wide sources of government and social
service organisations to presents the most recent information about the prevalent condition of
homeless people. The study illustrates all the aspects on this topic including the socio economic
factors, employment, education, physical and mental health, skeletal and neurological impact and
the legal provisions to support the homeless adults in London.
Homelessness has adversely affected the health, causing serious levels of stress in people. It causes
ill health conditions. For instance, the ill health may lead to relationship breakdown or the loss of
job which may trigger homelessness. It is observed that the health of homeless people is poorer than
the general people.
The project uses literature review to find the answer to the research question, to identify the
association between different factors and to recommend potential solutions to the problem.

Impact of Homelessness on the Health of Single Adults in London 3
TABLE OF CONTENT
ACKNOWLEDGMENT ......................................................................................4
1. INTRODUCTION............................................................................................4
1.1 Background .....................................................................................................4
1.2 Rationale..........................................................................................................4
1.3 Overall Aim.....................................................................................................4
1.4 Objectives of the study....................................................................................5
2. METHODOLOGY.........................................................................................6
2.1 Introduction.....................................................................................................6
2.2 Study Design...................................................................................................7
2.3 Literature Search Strategy...............................................................................7
2.4 Ethical Considerations......................................................................................7
2.5 Summary...........................................................................................................8
3. LITERATURE REVIEW, FINDINGS & DISCUSSION
3.1 Introduction .....................................................................................................9
3.2 Findings & Discussion.......................................................................................9
3.3 Impact of Methodological Approach................................................................10
3.4 Summary...........................................................................................................10
4. CONCLUSION & RECOMMENDATIONS
4.1 Brief Summary of Findings.................................................................................12
4.2 Conclusion...........................................................................................................13
4.3 Recommendations...............................................................................................13
4.4 Critical Reflection of Methodology....................................................................14

Impact of Homelessness on the Health of Single Adults in London 4
ACKNOWLEDGEMENT
I wish to thank Mr.............................................., for providing me an opportunity to do this research
project over the topic “Impact of Homelessness on the health of Single Adults in London”.
I sincerely express my gratitude to Mr.......................................... for their encouragement and
guidance in completing this research. I am extremely thankful for the other staff members who
helped me in by offering their valuable opinion about the topic and research methodology.
Without your healp and support this project would not be possible to accomplish.

Impact of Homelessness on the Health of Single Adults in London 5
CHAPTER 1: INTRODUCTION
1.1 Background
London has a culture of sharp inequalities and contrasts. The expensive housing market of London
primarily contributes to disadvantage and poverty. According to Poverty Profile of London, the
main issues are: extremely high cost of property in London in both buying and renting, shortage of
new affordable houses, overcrowding and higher possessions by the landlords than in other parts in
England.
The high cost of housing is making the experience of homelessness quite randomly distributed in
the population. Around 21% of the people of 18 to 44 years of age agree that they delay planning a
family due to lack of affordable housing in London. About 28% of people have reduced the money
they spend on foods to pay off their cost of housing. Around 12% of the people report that high cost
of housing influence their ability to move for work. Such results show that the high cost of housing
is responsible for the homelessness and influences the way of living. The average cost of property
in London is 473,822 dollars. Assuming the initial deposit of 26%, and loan amount of thrice the
salary, somebody in England should earn a minimum amount of 303,074 dollars. Since April 2018,
there has been an increase in house price by 0.1% (Lenge, 2018).
The homelessness has adversely affected the health, causing serious levels of stress in people. It
cause ill health conditions. For instance the ill health may lead to relationship breakdown or the loss
of job which may trigger homelessness. It is observed that the health of homeless people is poorer
than the general people. They suffer from several health inequalities. The longer the time of
homelessness, the more the person is vulnerable to high risk factors of ill health. According to ONS
statistics, the average age of death among homeless people is 32 years less than the general people.

Impact of Homelessness on the Health of Single Adults in London 6
According to a survey, one in every 200 people in London is homeless. The research explores
various factors affecting the homelessness in single adults in UK and its impact on their health.
1.2 Rationale
The purpose of this writing is to elaborate different perspectives of homelessness in the single adult
populations and the various factors leading to homelessness in their life. The paper also explores the
impact of this phenomenon on the health of homeless people comparing it with the general
populations. The scope of this paper relies till the single adults of London. The study includes the
populations aged 18 to 45 years of age living in London. The paper investigates the literature
review from 2011 to 2019.
1.3 Overall Aim
The study aims to explore the impact of helplessness on the health of single adults in London. The
number of homeless people has significantly increased from 2007 to 2019, which raises a serious
burden of preventable health illness on the healthcare system of UK.
Therefore it requires intense study to identify the factors responsible for homelessness and to frame
the strategies to improve the condition. The research will help the healthcare professionals in
understanding the primary association of homelessness and related aspects. The paper will address
the situation through detailed literature review of earlier researches and journals written on this
topic.
1.4 Objective of Study
 The study performs secondary research to analyze the factors responsible for homelessness
in single adults in London.
 The study highlights the developing trends which would most likely affect the homeless
people across London.
 The study finds association between different factors affecting the health and welfare of
homeless adults in London.
 The study evaluates the existing strategies implemented by the government and non-
governmental organisations in this regard in London
 The study would recommend possible solutions to improve the condition.

Impact of Homelessness on the Health of Single Adults in London 7
CHAPTER 2: METHODOLOGY
2.1 Introduction
The research involved extensive integrated evidence based review of primary and secondary
literatures to access, identify, and appraise the content related to topic. A qualitative evidence based
research was performed for the collected information. The government research reports, journal
articles, government policy documents and the research publications from authentic organisations
along with grey literature were used as sources of information. The study collected the data from
these academic sources to form evidence for the research.
2.2 Study Design
The study involved extensive research of related documents on the topic to collect evidences over
the problem and to explore the in depth analysis of facts and figures. The study did not involve any
personal meetings or interviews with the subjects for any organisation. Therefore there was no need
to avail informed consent. The databases CINAHL, PubMed, and Cochrane were searched along
with grey literature through Google search to collect the data using keyword search and Boolean
algebra. All the factors affecting the homelessness among single adults were explored to involve
wide range of resources from London. The literature from 2013 to 2019 was only included in the
study.
The database search retrieved 165 articles. After screening of the abstract and titles, 110 articles
were eliminated due to multiple reasons. They were not published by valid peer reviewed sources of
information. Few were inadequate in exploring the problem effectively. Few of them were not
focused on the topic ‘homelessness for single adults’ in London. This validation and thorough

Impact of Homelessness on the Health of Single Adults in London 8
evaluation of full text resulted in just 6 eligible articles and were included in the final evidence
based review.
2.3 Literature Search Strategy
The search strategy involved the keywords like “Homeless”, “London”,”Heath”,” Single Adults”,
“Homelessness” using AND, OR Boolean operands. The literature search was confined only to the
London while the other cities were excluded from the study. The content published only in English
language was included in the study to avoid unnecessary translation costs. The study involved the
adults aged 18 years or more living alone in London in rented accommodations or other places.
People aged less than 18 years were excluded from the study. The single adults involved the adults
who are college students, bachelors, divorced, widow, old age single adults, refugees, LGBT,
people from minor ethic groups and asylums.
2.4 Ethical Considerations
This review was evidence based literature review so did not involve any ethical consultations or
informed consent for the participants. The subjects were not met individually to collect their
responses. All the data was collected only through literature published between 2013 and 2019.
2.5 Summary
The study involves evidence based exploration and analysis of reliable sources of information from
London. The research will help the organisations and government bodies to bring strategic changes
in policies and regulations for the homeless single adults living in London.

Impact of Homelessness on the Health of Single Adults in London 9
CHAPTER 3: LITERATURE REVIEW, FINDINGS & DISCUSSION
3.1 Introduction
According to a survey by YouGove and Shelter, the people in London cut back the cost of essential
food and clothes to pay the housing cost (Dix, 2016, p.7). There has been an increase in people
living in rented houses. As per the reports of Resolution Foundation in 2016, the ownership of
homes in London is 63.4% (Dix, 2016, p.18). London has one of the lowest home ownership after
England and Manchester. The report of London Fairness Commission stated that in 1 in 4 people
lives in rented accommodations and the number is rising continuously (Dix, 2016, p.23).
3.2 Findings
The literature search retrieved 6 articles as listed below:
S.No
.
Reference The
Intervention
Summary of Article
1 Leng,G.(2018). Impact of Homelessness
on Health. Local Government
Association.
Evidence Based
Literature
Review
Councils, and Government
Health and Wellbeing
Boards can end
homelessness.
2 Dix (2016). Literature Review. City
Bridge Trust.
Interview Study interviewed subjects
from Community and
Children Services, Open
spaces, Heart of city,
Economic Development
Unit, and NHS to collect
facts. Social Isolation and
Loneliness in Single adults
adversely affects physical
and mental health.
3 Whiteford, M., Whiteford, M., Simpson,
G. and Simpson, G., (2016). “There is
still a perception that homelessness is a
housing problem”
Semi Structured
Interviews
Scale and Scope of national or
regional homelessness
preventive strategies; intra
national variations in public
health responses to
homelessness in london
4 Evans, W.N., Sullivan, J.X. and
Wallskog, M., (2016). The impact of
homelessness prevention programs on
homelessness.
Retrospective
Analysis
Evaluates the funding sources
and impact of homelessness
preventive strategies in
London.

Impact of Homelessness on the Health of Single Adults in London 10
5 Clarke,J. (2017). Accommodating illness:
The experience of suffering in a
physically unwell homeless population
6 Scanlon,K. Whitehead,C. and Blanc,F.
(2018). A sustainable increase in London
Housing Supply.
Evaluation of
policies
Effective initiatives are
being undertaken by
improving the structure and
functioning of construction
company, improving
effective planning and
fostering greater uncertainty
and innovation.
3.3 Discussion
According to Leng (2018), 80% of the single adults in London are homeless and want to work
however just 10% of them are in paid jobs. The stressful lifestyle and anxiety due to homelessness
not only affects the existing employment but also gives rise to several chronic diseases like
hypertension, diabetes, asthma, mental health problems. The acute problems like pneumonia,
injuries and infection become difficult to control when the people find no place to recuperate and
relax. Homelessness compels a person to live at streets and shelters where there are high risks of
communicable diseases and violence. Lack of security, privacy and crowded living conditions
increases the risk of mental, physical and sexual violence.
The women aged 16-24 years experiencing domestic violence or separated or pregnant are more
likely to get homeless (Leng, 2018, p.17). The early experience of homelessness in young adults
leads to strenuous relationships, addiction to drugs or alcohol and issues in sustaining the job. These
factors ultimately result into elevated mortality rates. According to National Drug Treatment
Monitoring System, the single adults living at streets and having rough sleep face dual needs
(substance misuse and mental health). There is a significant relationship between the substance
misuse, homelessness and the criminal justice system.
Data from London reports that in 2018, around 70% of the single homeless adults also had mental
problems and more than 33% tried to self harm (Leng, 2018.p.17). Among the most vulnerable
individuals at risk for homelessness are those who ran away from care, people from black and
minority ethnic (BME) backgrounds, LGBT adults, young people from rural areas, asylum seekers,
refugees and the adults undergoing Criminal Justice System (Leng, 2018.P.11)
Table 1. Experiences of Homelessness in London by Age

Impact of Homelessness on the Health of Single Adults in London 11
Age % of single adults homeless since last 10 years
16-29 13.7
30-44 6.0
45-54 2.5
55-65 2.2
65+ 0.9
Total 25.3
Source: (Scanlon, Whitehead and Blanc,2018)
.Table 2. Homelessness by Ethnicity in London
Ethnic Origin % of single adults homeless since last 10 years
Whites 4.2
Blacks 13.4
Indian 2.4
Bangladeshi/ Pakistani 3.8
Others 4.6
Source: (Scanlon, Whitehead and Blanc,2018)
Table 3. Types of Homelessness in London
Homelessness Type % of single adults homeless since last 10 years
Hostels 23
Rough Sleep 5
Day to day based care of friend 28
Insecure Accomodation (Rented) 12
Residing with friend/ Relative , and
need home
63
Source: (Scanlon, Whitehead and Blanc,2018)

Impact of Homelessness on the Health of Single Adults in London 12
Table 4. Decisions taken by the Housing Legislations in London for households eligible for housing
assistance
Households found Number of Eligible Applications %
On Priority
Unintentionally homeless
250, 130 43
On Priority Intentionally
Homeless
8000 3
Homeless but not on
priority need
76500 19
Not Homeless 88750 35
Total Decisions 423380 100
Source: (Scanlon, Whitehead and Blanc,2018)
According to local authorities in London, there were 47 street counts for the people sleeping rough
(Whiteford, 2016).
Scale of Single Homelessness
The practitioners and the policymakers should have a clear picture about the estimates of single
homeless adults in London due to various reasons. It will bring forth the extent of the problem, may
highlight the possible trends overtime, and may contribute to effective implementation of policies
and frameworks. The counting of homeless residents need to specify whether the measured numbers
relate to stock, prevalence or flow. The stock refers to the people who have been homeless at any
duration of time. The flow shows the number of people who became homeless due to any reason
and the prevalence shows the persistent homelessness since long time. The statistics of London or
UK have exhibited homelessness in stock and not in prevalence or flow. The number of individuals
constituting the stock is exceptionally higher than the flow.
Analysis of Scanlon, Whitehead and Blanc (2018) showed that 25% of the single adults are
homeless since 10 years in London (Table 1). The homelessness is prevalent in youth aged 16 to 29
years (Table 1). The statistics of Table 2 exhibit that the prevalence of homeless adults is highest in
Blacks than in whites or other groups. Moreover, the number of youth living with friends or
relatives and need a home are highest fraction who is homeless since the last 10 years.

Impact of Homelessness on the Health of Single Adults in London 13
According to a survey as reported in Leng (2018), only 3 out of 10 people who experienced
homelessness had ever lived in hostels or had rough sleep. Most of the people who reported that
they have been homeless since 10 years have been experiencing ‘hidden homelessness’. They have
been living at their friends or at relative’s houses or rented accommodations.
In London, the statistics for which the local authorities had taken decisions reduced from 566,534 in
2012 to 465,230 in 2017. The total number of applications submitted to legislative bodies for the
homelessness was 423,380 in 2017. The rate of homelessness acceptance was 8.4 % per 1000
people in London in 2017 which is the highest when compared to England (3.5%) and West
Midlands (6.9%) (Fitzpatrick, Kemp and Klinker, n.d.)
Causes of Single Homelessness
The supply and demand of houses in the UK market has undergone significant changes which
imposed disadvantage on the single adults. The demand has elevated due to high rise in the number
of single people living in London, mostly due to high rates of divorce or ageing people. Moreover a
huge number of unmarried adults live alone. According to an estimate there were 3.5 million single
individuals in London in 2016 (Fitzpatrick, Kemp and Klinker, n.d.). It implies a requirement of
more than 1lakh additional houses every year in London.
Supply of Housing
The net housing supply for the year 2016-17 in London was recorded to be 45,505 which involved
41371 conventional houses, 4526 non conventional accommodations and an elevation in the
number of long term empty houses by 392. Funded by Greater London Authority, there were
12,555 affordable houses began in 2017 out of which just 5355 got completed (Data Press, 2019).
Therefore the London Housing Strategy initiates the structuring and construction of affordable
houses however just limited number of houses gets completed.

Impact of Homelessness on the Health of Single Adults in London 14
Fig. Average prices of housing in London. (Source: Scanlon, Whitehead and Blanc,2018)
Though the government has promoted the expansion of owner occupations by initiating tax reforms,
this option is not realistic for the single adults dwelling on low income sources in London. The
private rented accommodations are insecure and expensive for the single adults than the social
rented accommodations. They are of poor quality in maintenance and infrastructure. Moreover the
single adults face lot of problems in this sector due to financial barriers and restrictions in housing
benefits. In such conditions the housing associations play an important role in providing
accommodation to the single adults in London. Though they also demand high rent due to reduced
subsidies by the government.
Predictors of Single Homelessness
Most prominent risk factors for the single homelessness are poverty and unemployment. The other
factors being family breakdown, a background of local authority care, experience of prison or
offending behaviour, physical or sexual abuse in adolescents and children, shortage of any social
support services, debts, substance misuse, lack of good educational qualification, nuisance to the
neighbours, poor mental and physical health or discharge from armed services.
According to Whiteford, Whiteford, Simpson and Simpson (2016), a number of preventive
interventions have been taken to reduce the homelessness in London:
Such as: There are mentoring and support services to reduce social isolation, there are supports for
the rented people undergoing mental or health issues, there is education provided at the schools and
colleges about homelessness, there are supportive care facilities to assist the youths leaving home,
resettlement programs are there for the people leaving prisons, there are rent deposits guarantee

Impact of Homelessness on the Health of Single Adults in London 15
schemes, and mortgage rescue schemes. Additionally many affordable housing schemes are also
been started by Ministry of Housing, Community and Local Government (MHCLG) and Greater
London Authority (DataPress, 2019)
According to Seria-Walker (2018), the highest number of rough sleepers are found in London
(23%) of the total number in England. Out of those, 12% are women, 7% are less than 25 year of
age, 5% are migrants, and 17% are EU natives from outside of UK.
.The data can be further illustrated as recorded by the outreach teams as follows:
 2584 single adults undergo rough sleeping in London (April-June 2017 statistics)
 Out of these, 362 residing over the streets, 1030 intermittent rough sleepers, 1206 new or
first time rough sleepers.
 1352 are from the origin of UK, 522 from EU, 168 from Poland and 198 from Romania.
 1374 had more than one support need like mental health, drugs, alcohol etc.
Health Detriments
Homeless adults are vulnerable to several life threatening conditions like HIV, TB, depression, skin
infections, malnutrition and unintentional injuries (Labani, 2018). The people residing at
compromised accommodations like damp, cold, overcrowded locations are at higher risk of
incepting poor nutrition, lack of personal hygiene, enforced lifestyle and negligence of diseased
condition. Their lifespan has also been found to be lower than the general populations. Shortage of
consistency in treatment and regular follow ups even deteriorates the chronic condition (Labani,
2018). The health conditions may get untreated and unrecognized even after being detected
resulting into elevated rate of morbidity and premature death.

Impact of Homelessness on the Health of Single Adults in London 16
Source: Youth on their own (2018)
Till now many studies have been conducted to explore this issue and there have been significant
efforts from the governmental and non-governmental organisations to help the homeless
populations avail the affordable and quality healthcare services. Even after all this, many people are
still in need of effective access to healthcare.
According to WHO, the health is a combination of physical, mental and social well being and not
only the absence of illness. It is necessary to understand the ways in which we can improve the
health of homeless people, lowering down the health inequalities (Whiteford et al. 2016). The study
affirms that the homeless children, when separated from their families face significant adverse
impact on cognitive ability, learning capabilities and delayed development of linguistic efficiency
than the children living in permanent houses (Evans et al. 2016).
Maslow’s Hierarchy of Needs

Impact of Homelessness on the Health of Single Adults in London 17
Fig. Maslow’s Hierarchy of Needs. Source: Queen Margaret University (2018)
According to this model, the people are generally motivated to achieve certain objectives. The
people first attempt to achieve the first initial level of hierarchy, then progress towards the higher
levels. The homeless individuals in most of the cases try to achieve the basic physiological needs
like food shelter, sleep and water. As these requirements are often left unmet, they seldom look
forward to seek health and safety issues. Most of the time they prioritize the issues like food, jobs
etc while leaving the health issues unattended. Thus, this population lacks the use of adequate
medical health services.
According to Health Audit Reports( 2014), the homeless single adults experience greater physical
health issues than the other. It occurs due to inaccessibility of medical health services, lack of taking
decisions about going for medical checkups, moslow’s hierarchy model and not giving importance
to health. Though 90% of the homeless people are registered with GPs in London, they suffer from
greater number of health problems than the general populations. That’s why they have lower
functional ability and reduced quality of life. The life expectancy of homeless females is 43 years
while that of males is 47, the statistics are 30 years less than the national figures.
Musculoskeletal & Neurological Problems
Homeless people often perceive acute pain in muscles and skeletal part due to trauma like being hit
by vehicles, fighting and falling. Pain in lower back is common in people sleeping rough. The
complexity of the symptoms gets severe due to unhygienic conditions, ligament tears and injuries.

Impact of Homelessness on the Health of Single Adults in London 18
Around 73.3% homeless people reported to have acute pain while 59.3 reported to have chronic
pain which persisted for a time period of minimum 6 years (Queen Margaret University, 2018). It
may be due to poor sleep, poor analgesia control and reduced levels of physical activity. 47% of the
people suffering from homelessness reported to suffer from traumatic brain injury while the number
was just 21% in usual people. The condition may adversely affect their memory, behavioural issues,
impulse control and attention. The homeless people suffering from diabetes and liver problems are
known to suffer from neuropathic pain as well. Around 7 % of the homeless people in London
suffer from respiratory issues (Queen Margaret University, 2018).
The homeless single populations are most vulnerable to have self harm wounds which get infected
and may develop high complications. According to a study by Pluck & Parks (2013), more than
68% of homeless people have undergone self harming incidents.
The people having permanent houses do not need to shift their housing places frequently and can
devote more time in managing their health, taking out time to meet the doctors by booking the
appointments and maintain the adherence to medication routine. Stable housing also lowers down
the chances of violence and further illness. Having homelessness may develop negative feelings like
anxiety, phobia, panic, depression, grief, post traumatic stress and shame. Having a permanent
house contributes to better health. It prevents new health conditions to occur and also prevents the
existing health issues from worsening.
Defining Homelessness
According to US Department of Health and Human Services, homeless person can be defined as”
A person who lacks any house, including the person whose primary residence at night is supervised
private or public facility (shelters) providing temporary accommodations, and a person who is a
resident of transition home” (Scanlon,K. Whitehead,C. and Blanc, 2018). A person who has no
permanent house, who lives in shelters, streets, abandoned buildings, missions or single room
occupancy services is also known as homeless person (Scanlon et al. 2018).
The most probable causes of homelessness may be individual or structural. The structural factors
can be attributed to inequality, poverty, affordability and housing supply, access to social security,
and unemployment or insecure employment. The individual factors of homelessness may involve
mental health issues, relationship breakdown, harassment, violence and abuse, poor physical health,
drug addiction, refugees and bereavement.

Impact of Homelessness on the Health of Single Adults in London 19
It is imperative that the healthcare professionals need to understand that homelessness is a result of
complex interrelated factors like vulnerabilities and individual circumstances and needs several
levels of interventions to address. The Homelessness Reduction Act, 2018, imposes new duties on
the homeless populations to relieve them. The National Housing Federation has developed
Personalized Housing Plans, ‘Duty to refer’ legislation, homelessness strategies, enhanced
partnership and extension of ‘threatened from homelessness’ (National Housing Federation, 2018).
The Act imposes a duty over the councils to assist the homeless people or the people who are at risk
of getting homeless.
Source: Mehet and Ollason (2015)
This review is important because as per the statistics in London only 6 people in every 100
homeless people have stable employment, 72 in every 100 homeless people have mental health
issues, 56 in every 100 homeless people have long term physical health problems, and 26 in every
100 homeless individuals are addicted to drugs (Leng, 2018). As their health problems get complex,
they get involve in anti social behaviour more often. The homelessness also adversely affects the
local communities. The homeless people having complex issues have 77% chances that they may
sleep rough, 53% chances of their involvement in street drinking, 32% chances of begging and 10%
chances of their involvement in prostitution (Homeless Link, 2017).

Impact of Homelessness on the Health of Single Adults in London 20
Source: (Mehet and Ollason, 2015)
The homeless adults contribute to significant proportion of population in high need of medical
services like general people.
According to Bramley and Fitzpatrick (2016), if similar trends continue to prevail in the next years
as well, during the next year in london 1 lakh individuals will be residing in hostels, B&Bs and
other temporary shelters. The government of UK has pledged to put an end to rough sleep by the
year 2027, and has welcomed the establishment of Rough Sleeping Implementation Task Force and
Homelessness. The statistics of CHAIN system in London shows the extent of rough sleep in
London has increased to more than double in 2016 since the year 2010 (Clarke, 2017). There has
been depicted an increase in rough sleeping in London including in UK. Due to contraction of street
homelessness, including the people of Eastern and Central European origin, the rough sleep in
London has slightly lowered since 2015. The cases of homelessness have remarkable increased
from 11% in 2010 to 31% in 2015 (Clarke, 2017). In London, the most recent statistics have shown
that the number of homelessness households has doubled (Clarke, 2017).
Effectiveness of Medical Services for Homeless Populations in London
The existing arrangements for commissioning do not extend healthcare facilities to London and the
homeless adults seek different methods of care through different CCGs. Certain locations in London
seem cautious to commission specialist medical facilities for this section of people as they assume
that it would attract more homeless people. They complain that the federal medical services should
facilitate registration for these categories. This type of attitude is termed as Race to the bottom and
often denies the homeless people from quality medical care. There is high demand of
commissioning model in London to address the needs of homeless people who spend a more
chaotic and mobile life. In cases where they change the care providers, it abrupt in continuity of

Impact of Homelessness on the Health of Single Adults in London 21
care, leading to loss of trust and break down of relationship. These factors are important for the
primary care services of any human being.
Fig. Barriers to Access the Healthcare Services for Homeless People in London. Source: University of
Maragret (2018).
According to Mehet and Ollason (2015), 38% of homeless single adults have been to the
Emergency care units since last 6 months in London. This statistics is 4 times greater than the
normal people. Homeless single adults often consider the health as secondary priority. They consult
the General Practitioners for their health problems when they get acute.
Shortage of accessible medical help, leads to increased use of emergency services in form of their
sole source of medical assistance. The people who are not registered with the GPs visit the
emergency departments for the problems which are non emergency in nature. It is because the
emergency departments offer 24x7 services without any prior appointments. The people get
recurrent admissions to the emergency settings because of improper discharge from the setting for
their last visit. When the people do not find feasible to manage their health needs on streets, they
again and again visit the hospitals.
The healthcare professionals need to follow preventive strategy to cope with the homelessness. The
care providers need to provide care services with same dignity and respect like other general people.

Impact of Homelessness on the Health of Single Adults in London 22
Legal Initiatives to prevent Homelessness
Homelessness Act 2002
The homeless Legislation undergone amendments to include certain sections of society in the
priority list of homeless people. Such as youth 16-17 year old, care leavers from 18-20 year old,
prisoners, armed forces people, those who are vulnerable in care, and those experienced violence.
This Act also recommends the local authorities to submit the review for homelessness strategy in
every 5 years.
Children Act 1989
Te social services departments are given the task of promoting and safeguarding the welfare of the
children. The Act entitles certain people for the accommodation: The youth below 17 year of age,
who have been the subject of care orders, and the children aged 16-17 years whose care is regarded
as prejudiced seriously.
Children Act 2000
The social services are provided the duty of assist the children until 18 year of age, either
financially or to meet their cost of care providers. The Act also recommends the social services to
maintain contact with them after that. The Act improves the lives of children at care homes, The
care givers are provided increased assistance to prevent these vulnerable groups from becoming
homeless and help them in attaining a job for them.
Supporting People Programme
It provides house related assistance to the single adults in certain conditions. It involves the
homeless youth, adults, disable and mentally ill people, women having undergone domestic
violence, and the people having learning disabilities.
Mediation Schemes
The local authorities provide mediation schemes to build up the broken relationships, preventing
them to turn homeless. This scheme mainly assists the 16-17 year old youth.
New deal
This scheme offer education and employment assistance to the youth aged 18-24 years.
Shelter’s Work

Impact of Homelessness on the Health of Single Adults in London 23
The schemes along with housing aids and the practical projects support more than 1lakh people in
their housing requirements every year. The scheme also campaigns for the new policies and the
laws for enhancing the condition of badly housed and homeless people. The Youth Persons Team
works with the local authorities to design training packages and educational tools for the young
people. The Ricochet project offers advocacy, assistance and advice on the subject of housing
issues and to reduce the causes of homelessness. The Gloucestershire Housing Advice Services
supports the single adults aged 16-25 year in their housing needs. It extends the support in tenant
issues, illegal eviction, rent, benefits, housing conditions and in accessing the support facilities.
Connexions
The connexions assist the youth between 13-19 years of age who are at increased risk of remaining
uneducated, unemployed or socially excluded. Every young person is provided with a personal
advisor. The scheme facilitates the partnership between the housing agencies, youth and the local
career advices.
Support Services for Homeless Single Adults
Day Centres
There are more than 250 day centres in London providing the accommodation services to more than
20,000 people on daily basis. They have an open door space area in building based care setting
providing the support, food, practical help, socialization and shelter to the homeless people. They
provide free or cheaper practical services, useful ways to spend the time, advice, medical services
and support.
Street Outreach Services
The street sleepers and the vulnerable homeless dwellers living in streets are contacted and helped
to bring them to long term care facilities. The workers are funded by the government schemes and
programmes.
Resettlement Services
These services provide practical and emotional assistance to the people in practical solutions to their
homelessness problems, assisting in alcohol addiction, financial issues, reducing the social isolation
and supporting them to return back into the employment market. Tenancy breakdown has been
primary cause behind the isolation and loneliness of the rough sleepers. The resettlement services

Impact of Homelessness on the Health of Single Adults in London 24
provide flexible support to the homeless people, improving the likelihood of successful tenancies.
These centres are successful in providing support from streets to the long term housing facilities
with help of services like outreach work, drop in centre, temporary hostel etc.
Structural Factors
The economic condition and the quality of employment as severely declined in the recent decade .
The youth having very low education qualification and low employment are the most adversely
affected. The National Minimum Wage was program started to provide the workers with a least
amount of wage according to the law. In 2005, the policy prescribed £3 for the youth aged 16-17
years, £4.25 per hour for the 18-21 year old youth, and £5.05 for the adults aged more than 22
years (Scanlon et al. 2018). The state support has been withdrawn from the homeless young people
making the problem a bit serious. The low levels of income show that they have been excluded
from the accessing the housing.
Housing Benefits can be availed by the low income single adults to assist them in paying the high
rent. Majority of the single adults who live in private rented accommodations got their housing
benefits limited by the single room rent in shared accommodations. It implies the single adults most
of the times feel short between the benefits and the cost of housing. After the SRR has been
introduced, the private rented accommodations have become unavailable for the youth below 25
years of age, who have been claiming for the housing Benefits. Such conditions resulted into
majority of the youths entering the informal living spaces without any written contracts. They sleep
at the friend’s floors.
Housing Policy
The housing policies of the government have reduced the opportunities of availing the permanent
accommodations for the youth in private or public areas. The entitlements to housing facilities
require age restrictions imposed by the state authorities or the house owners especially to the 16-17
year old homeless youths who are not given priority at the housing benefit list. Thoughthe private
sectors has provided housing for the youths, they are highly unaffordable for these peole and
demand high rent deposits and advance payment of rent.
Clinical Barriers in providing care for the Mentally Ill patients

Impact of Homelessness on the Health of Single Adults in London 25
There are no permanent community based treatment facilities and adequate housing for the
treatment of homeless people. Additionally this group has certain characteristics which impose
challenges for the treatment.
The homeless patients have negative perception and experiences about mental care services in
underfunded institutions and in most of the circumstances they prefer not to undergo further
treatments. Certain homes adults have experiences of abuse during medical consultation in mental
health facilities, and few of them have unpleasant experiences with antipsychotic medicines. Few
homeless people do not understand the need for continuous treatment and are unaware of the
severity of their health issue. Few other people who are aware of the need for medical support in
their treatment, do not avail it due to lack of trust in the treatment. Generally they have no support
from the family and friends. Most of them are slow in developing therapeutic relationships with the
care providers.
The therapists may lose their motivation to assist homeless people by observing their inconsistency
and irregularity in maintain the appointments. The care providers and the clinics may be
unsupportive to welcome the homeless patients who are disorganized and dirty in their appearance.
The treatment of mental health illness for the homeless adults needs extreme patience, rehabilitation
and residential resources to meet the requirements of persistent long lasting care. In many cases the
ambulatory care is preferred, certain cases might require hospitalization. Due to shortage of
sufficient in patient care services, the mental care providers are generally frustrated to assist the
severely disturbed homeless patients. In many Psychiatric facilities, there is limited capacity of beds
for the mentally ill patients; the economically poor sections of society have great problems in
accessing the bed as inpatient. Moreover, many times the people have to wait for several days at the
public healthcare facilities to avail the emergency admission to involuntary psychiatric services.
According to Seria-Walker (2018), there are few promising interventions to help the homeless
people in London such as-
 No Second Night Out, which is a 24 hour helpline for the public to report about the rough
sleepers.
 Housing First, is an observational study designed to extend the assistance to homeless
people with complex needs. People are housed for a particular long period of time like 4-5
years to improve their physical and mental health.

Impact of Homelessness on the Health of Single Adults in London 26
 Psychologically Informed Environments, to help the people bring changes in their behaviour
and lifestyle.
 Personalized Services, a review to respond to the homelessness and rough sleeping.
 MEAM, evaluative study to coordinate the existent local help facilities to improve their care
services for the homeless people.
3.3 Impact of Methodological Approach
The methodological approach is descriptive and qualitative. It helps to discuss in detail all the
aspects related to health impact and associated factors experienced by the homeless people in
London. Gathering the evidences from diverse range of sources leads to avail a variety of
indicators and the researchers can demonstrate a wider approach towards the topic. The
methodology of the research emphasized not only on the outputs of the exploration but also
assessed its impact. We explored and searched all the peer reviewed and reliable journals from
government bodies and other organizations of London from 2013 to 2019. For every published
article we retrieved full text, publication date and the title. The data was evaluated through
descriptive qualitative analysis for the effectiveness of outcomes.
3.4 Summary
Homelessness affects all round well being of the single adults. It imposes serious consequences on
the health in wide range of facilities such as musculoskeletal illness, neurological, respiratory,
mental, infectious diseases. Around 1/3 of the homeless people residing into the hostels are reported
to be suffering from personality disorders, anxiety and depression. The number of psychotic issues
is 50-100 times greater in street dwellers than the other general people in London. More than 1/3 of
the homeless people suffer from attention deficit disorders and disruptive behaviours. In terms of
coping strategies, more than 44% homeless people opt for self medications through drugs and
alcohol instead of consulting the physicians to save the treatment costs. The incidents of self harm
are also greater (!4%) in homeless populations than in general people (4%). The attempt to suicide
cases has been observed to be higher in homeless adolescent girls (45%) than in boys.
The single homeless people are most vulnerable to start taking alcohol and drugs which incepts
several physiological changes in the body at moderate and heavy dose. AT moderate dose, the

Impact of Homelessness on the Health of Single Adults in London 27
person feels dizziness, nausea, and feelings of detachment, hallucinations, high cardiac rate, and
confusion. At high dose, the addiction may lead to memory loss, hallucinations, aggression,
physical distress, anxiety, and panic ultimately resulting into death.
CHAPTER 4: CONCLUSION & RECOMMENDATIONS
4.1 Brief Summary of Findings
The dataset of Poverty and Social Exclusion (PSE) Survey 2012, includes the experiences of
homeless people in UK with a follow up of 5 years. The 3 cases of single individuals were included:
(a) A single adults having permanent job at semi routine 2 room accommodation, (b) A single
parent living alone working part time and living in 3 room social rented accommodation. (c)
Unemployed adult living with the parents ,and (d) A single adult having prolonged illness not
working, not qualified living in 3 room socially rented accommodation. According to the PSE three
types of respondents exhibited the following probability statistics for experiencing homelessness:
Scenario (a) Single
working
(b) Lone
Parent
(c) Unemployed
Youth
(d) Single
Sick
Adult
Ever Homeless 0.113 0.480 0.220 0.559
High
Unemployment
/ Poverty
0.162 0.545 0.268 0.622
High Housing
Market
Pressure
0.130 0.520 0.249 0.598
Source: Bramley & Fitzpatrick (2016)

Impact of Homelessness on the Health of Single Adults in London 28
The probability for ever being homeless is 11.3% in case scenario A, 48% in scenario B, 22% in
scenario C and 56% in scenario D. The elevated probabilities of B and D reflect that for these
groups, the homelessness experience has become a norm. The housing market and the labour both
have same magnitude of impact over homelessness. However the condition may get complex when
we observe simultaneous changes in the labour market and the poverty index.
Mental Health
The single homeless people in London have been adverse effect on the physical and mental health.
The single adults residing at the hostels are 8 times more vulnerable and the singles sleeping rough
are 11 times more vulnerable to the mental health deterioration. In comparison to other general
people, the single adults reported high rates of drinking and drug addiction along with high
incidence of schizophrenia (Bramley & Fitzpatrick, 2016).
In addition to other stressed life events such as relationship breakdown in combination with
economic and social problems, the homeless people find it highly difficult to sustain social support
networks and the accommodation. As per the reports of DETR survey many homeless adults are
discharged from the mental hospitals directly on the homeless conditions. In wake of this situation,
the Homeless Mentally Ill Initiatives were started in London, which exhibited an increasing concern
among the homeless people about the mental health issues. The medical teams were funded by this
initiative could successfully target the people who have been suffering from severe mental health
issues and have been failed by the social and psychiatric help.
Health and Alcohol
More than half rough sleepers have the problem of heavy drinking and alcohol addiction. Out of
them 1/10 people living in the hostels and B&Bs. Just 1/3 of the single adults living in hostels or the
other temporary shelters were found to take treatment for their mental health. The heavy drinking
habits are aggravated through the homelessness. There are evidences that homeless street drinkers
find it very difficult to access any detoxification treatment plan. In this regard the homeless singles
having alcohol dependence have been accommodated in the wet and dry hostels. It is estimated that
around35% of the street dwellers in London use heroine. Few of the hostellers are reported to take
the opiates as self medication to address the stress and underlying mental illness.
Access to Medical Care

Impact of Homelessness on the Health of Single Adults in London 29
Though majority of the single adults are registered with the GPs, rarely anyone visits the GPs on
feeling unwell. The studies of Mehet and Ollason (2015) reported that only 30% of the homeless
people those registered with emergency services were registered with the GPs while 97% of the
general populations is registered with GPs.
Several government policies and the shortage of affordable houses has made the unemployed and
other single youth to access the housing as per their requirements. The government has shown
initiative by improving the homeless legislation, still several homeless single adults face long term
difficulties.
The research evaluated a wide range of topics such as the definition and experiences of
homelessness in single adults in London, its extent, causes, predictors and other related aspects of
lifestyle.
Poor physical and mental health is associated with homelessness in single adults and the families as
well. The rate of mental illness is seen to be double in the homeless single adults when compared to
the extent of mental illness in other populations. Around 47% of the homeless women exhibit
severe depressive disorders in comparison to the general populations. The homeless people are
more vulnerable to experience poorer mental and physical health, including diseases like asthma,
diabetes, TB and hypertension. The STDs with prevalence of HIV are also prominent in the
homeless single people who are more involved in the high risk sexual activities and drug use.
In fact the health outcomes of single homeless adults are a combination of complex interplay
between economic, social, cultural, legal, political, biomedical and historical influence. Among all
these health determinants the earning is considered to play the most important role. The people aho
have good salary and have stable socio economic status are known to live longer and they have
reduced levels of injury and illness. They have better health outcomes. In contrast the people who
are poor, experience high rate of diseases and low life expectancy. The poor health may make the
person homeless as he loses his productivity and income sources when he walls ill. Moreover the
homelessness may expose the people towards several health problems.
The homeless people experience the short term and long term consequences of health particularly
adding to the mortality rate. Mainly the deaths in homeless single adults are due to injuries and
harsh living conditions of the street life. Psychological strains, climatic conditions and exposure to
infectious conditions develops many life threatening health conditions like TB, nutritional

Impact of Homelessness on the Health of Single Adults in London 30
deficiency, musculoskeletal disorder, sleep deprivation, dental troubles and skin issues. They also
feel difficulty in accessing the healthcare services. The homeless single adults are unable to avail a
medical assistance without possessing a medical card. To apply for the government ID, needs
permanent residential address. They cannot pay for the medical items uncovered under the medical
insurance plans. They do not successfully avail the treatments where their personal appearance does
not suit to the care providers. Due to lack of an address they do not find it feasible to book for the
health appointments. They sometimes fail to avail the coordinated and integrated care when their
records are not kept at a single location under one care provider.
Following the hospitalization and regular follow up, the homeless single people find it difficult to
follow the care plan due to unavailability of any stable place to reside or relax. Also they have no
one living with them who can support them with the care. Therefore the healthcare for the Single
homeless adults is mainly concentrated to the emergency departments. These departments are
structured at the central region of the city and are run by the institutions providing social support
and shelter needs of the homeless adults. There is great need to respond to the acute and chronic
healthcare issues of these people to focus on the preventive care.
Interactions between the Health & Homelessness
The interactions between the health and homelessness lie in three categories: (a) Some health issues
elevate and contribute to the risk of homelessness. (b) Some health issues are the consequences of
homelessness. (c) The treatments of few other illnesses are complicated by the homelessness.
(a) Health Issues contributing to the risk of homelessness
Among the health issues causing Homelessness, the most prominent is Schizophrenia or other
mental problems. With worsening disabilities they lose their ability to deal with the surroundings
and their behaviours get highly strained. Due to absence of appropriate housing and effective
therapeutic interventions they may end up residing on the streets.
Another significant health issue leading to homelessness is AIDS. When the illness progresses, it
leads to repetitive and serious infections, the people lose their jobs and thus become incapable to
pay their rents. Third health problem which increases the likelihood of getting homeless is Drug
Addiction and Alcoholism. These conditions disable the people rendering them unemployed. The
person may develop other serious health issues which may impose heavy burden of medical
expenses on him.

Impact of Homelessness on the Health of Single Adults in London 31
Job related or accidental injury and degenerative diseases also imposes similar effect on the people.
The person loses his ability to do employment and earn making him homeless.
(b) Health Issues resulting from Homelessness
Homeless single adults develop skin diseases and diseases of extremities. Such conditions elevate
the chances of trauma due to physical and sexual assault. A small health problem can turn into a
serious health issue. The other problems emerging from the homelessness are malnutrition,
degenerative joint illness, dental issues, parasitic infestations, venereal diseases, hepatic cirrhosis
and hepatitis.
(c) Homelessness complicating the health problems
The homeless single adults find it most difficult to take regular high quality care for their health.
They cannot even afford the requirement of a sound bed rest. For example in shelters where the
people leave the beds early morning, and on some shelters where the people are not provided with
any beds. The homeless people find it difficult to manage the care for diabetes as it requires control
of diet and regular insulin injections. The homeless diabetic person taking insulin injection is
sometime misinterpreted as an IV drug abuser. The soup kitchens are ineffective in providing the
diet control as they rule out the provision of special therapeutic diets. Moreover certain kinds of
insulin requires refrigeration, in most of the cases the syringes are stolen.
The people if do not possess any health insurance are generally devoid of effective treatments or
rehabilitation therapies. Certain health problems like cellulites leg ulcers do not accept the patients
fit for the hospitalization. Such conditions are to be treated on outpatient basis. They are not
provided bed in hospital as the bed might be required for some other emergency patient. For a
homeless patient suffering from Cellulites, it is difficult to avail the hospitalization facilities
including bed rest and antibiotics. The hospital does not reimburse the treatment for such health
problems as it is not covered under the Medicaid Scheme.
4.2 Conclusion
There are many high quality studies which provide extensive data about homelessness for example
adequately funded large scale research projects as well as small scale evaluations. However there is

Impact of Homelessness on the Health of Single Adults in London 32
limited sources of data for the single adult homelessness. Few studies are focused on superficial
information collected through the questionnaires with small sample population. Sometimes the
failure of sampling techniques makes it difficult to focus over the depth of the findings. Most of
these studies are performed by the local small scale agencies. There are several constraint in the
research faced by them time to time. This type of study essentially puts light over the neglected
topics and recommends certain positive suggestions.
Certain poor quality studies are also funded by the national agencies at national level. They had
limited scope of study and the analysis of data is disappointing. The studies also included quotes of
the homeless people, which never guarantee the authenticity and reliability of data. This type of
material is presented without analyzing the context properly.
In both the policy and research, the focus is on preventing the homelessness. However there is
increasing need that the studies further should involve not only prevention of homelessness but also
the crisis interventions and resettlements. Only the articles which are government sponsored are
authentic in their content and coverage at national level. The non-governmental academic studies
emphasize on the small localities and areas. This type of research is often not up to the mark in
terms of quality and imposes constraints money, time and expertise in research. In most of the
retrieved studies there were high level of duplication of statistics and content. However many areas
are effectively researched such as definition of homelessness, the legislation related to
homelessness, youth homelessness, health especially mental health, and rough sleepers.
The studies collected have also showed widespread gaps in the research. The most prominent gaps
are evident in the hidden homelessness, homelessness prevalence in ethnic minorities, drugs and
related homelessness, and study material specific to London.
Certain unresolved issues are there for example in the analysis of government initiatives and their
effectiveness in eliminating the homelessness in London and the support requirements of these
people.
The main prominent themes came out of the literature review are:
1. There is high need to research the facts about what is effective and what is ineffective in
helping these people in reality.
2. There is great need of flexible approach tailored to satisfy the requirements of homeless
single people in London.

Impact of Homelessness on the Health of Single Adults in London 33
3. There is high need to devise holistic solutions to the homelessness.
4. There is growing stress on the early intervention and prevention of homelessness.
5. The importance of long term resettlements and not just the interventions for the crisis.
6. There is need to improve the service quality and including the people in evaluation and
service developments.
4.3 Recommendations
 Effective primary care services should be provided for the homeless people before they turn
into sever problems. There should be an accurate mechanism to assist the patients to access
care and take correct decisions at right time.
 For accurate addressing the disparities and accessibility of services there should be
appointment of post of lead commissioners in agreement with CCGs and the people.
 The relationships between the lead commissioner, CCGs and local authorities should be
established to facilitate integrated healthcare support between housing, health and social
care.
 Local innovations and interventions like Street Outreach may facilitate improvements in
services offered to the homeless singles.
 For long term planning and support in homeless healthcare services, the lead commissioners
should support consistent funding. Multidisciplinary community teams should be
established.
 There should be adequate support from the government for improving residential security.
There is increasing need to focus on the structural causes of homelessness rather than solely
focusing on the symptoms. The early interventions and preventive work on the single adults facing
life crisis mat help in early identification. The mainstream services should take the responsibility of
addressing homelessness. There should be collaboration between different agencies. Some single
homeless adults face intensive support. The interventions should be developed with long term
outcomes.

Impact of Homelessness on the Health of Single Adults in London 34
4.4 Critical Reflection of Methodology
I found this method quite helpful in analyzing and evaluating the different types of researches
carried out to explore such a topic which has limited sources of evidences available. Most of the
researches on this topic are based on data collected through interviews and immediate responses of
the respondents. I found that the data collected through government bodies and authentic social
service organisations working in this sector in London have disclosed effective analysis of the topic.
An important aspect brought forward of the review is there are restricted statutory rights for the
accommodations of homeless families who have kids. It reflects that most of the studies are
emphasizing over the single homeless citizens in London. It could be more fruitful to bring together
the two areas and unite them to add value to the combined research. I found this research has been
quite exploratory for my educational experience. I learned all the aspects related to the single
homeless adults and their lifestyle in London. The qualitative methodology helped to emphasize
more on the overall holistic research not only focussing on the health issues but also exploring the
concepts affecting homelessness like unemployment, lifestyle, most prominent reasons for
separation from family, legal policies, support services, healthcare accessibility and other aspects.

Impact of Homelessness on the Health of Single Adults in London 35
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