Written evidence submitted by Dr Natasha Chilman (TH0014)
The following submission represents my research findings and views. I recently completed my PhD research at King’s College London which investigated homelessness and health, with a focus on mental health. As an expert in this area, I am well placed to submit this evidence from my PhD research findings and from my experiences conducting this research. This evidence applies to the “government’s understanding of the extent, causes and costs of homelessness” from the call.
Section 1: Extent of homelessness
1.1
For many people homelessness is a temporary, although often impactful, experience. An estimated 4% of people living in private (residential) households in England have previously experienced homelessness in their lifetime. This statistic is from my study using data from the government’s own nationally representative household survey of the nation’s mental health (reference 1), which has recently been peer-reviewed and published (reference 2).
1.2
Homelessness often has a long-term impact on individuals, even after moving into secure housing. I conducted interviews people with lived experience of homelessness and mental health service use, and with mental health staff members. Participants spoke about the impacts of homelessness and social exclusion extending after they had secured housing. In the words of one of these participants with lived experience of homelessness, “When you’re homeless you really do feel just so, so worthless, you don’t belong to society in any way, shape, or form … it’s just really hard to sort of get that back, once you’ve been in that place … I still think like I’m homeless.” This shows how the extent and impact of homelessness extends post experiences of homelessness.
Section 2: Adverse experiences and homelessness
2.1
People who have experienced homelessness are more likely to experience other adverse life events compared to people who haven’t experienced homelessness. In statistical analysis of a nationally representative household survey (reference 1), half (52%) of people who previously experienced homelessness had experienced bullying, over a third (40%) had experienced violence in their homes, and a quarter (24%) had experienced sexual abuse. This analysis has been peer-reviewed and recently published (reference 2).
2.2
People who experience homelessness often report experiences of adversity which pre-date homelessness. In my interview study with people with lived experience of homelessness, participants described experiences of adversity early in their life before first experiencing homelessness, such as violence and abuse, and family relationship breakdowns. Some participants attributed the cause of their homelessness to these adverse experiences.
2.3
Overall, this evidence demonstrates that when considering the causes of homelessness, homelessness does not occur within a vacuum and these adverse experiences often occur early in life and pre-date homelessness. Interventions to prevent homelessness should also target these adverse experiences early in life.
Section 3: Contribution of homelessness to population health
3.1
It is well known that people who experience homelessness are more likely to experience poor mental and physical health. This health inequality extends post experiences of homelessness. In analyses of a nationally representative household survey, almost half (45%) of people who previously experienced homelessness were currently experiencing depression and/or anxiety, compared to 15% of people who did not experience homelessness. Their mental health symptoms were also more severe. Furthermore, 77% of people who had previously experienced homelessness had one or more physical health condition. This demonstrates the longer-term poor mental and physical health outcomes for people who experience homelessness. This study has been published (reference 2).
3.2
People who have experienced homelessness are more likely to experience multiple and co-occurring health conditions (multimorbidity). I have conducted a systematic literature review of the evidence looking at homelessness and multimorbidity, where the evidence showed a high prevalence of multiple co-occurring mental and physical health conditions in homeless populations (estimated pooled prevalence in homeless populations = 51%). This shows the high burden of health needs for people who experience homelessness.
3.3
‘Trimorbidity’ refers to co-occurring mental, physical, and substance use conditions. The term trimorbidity was coined specifically to describe the complex health profiles of people who experience homelessness. In analyses of a nationally representative household survey, statistical models indicated that 16% of trimorbidity in the entire private household population could be prevented if homelessness was eliminated or prevented. When we consider that former homelessness impacts just 4% of the household population, this impact on population health is disproportionate and substantial. This study has been published (reference 2).
3.4
The evidence presented in this section is relevant to the costs of homelessness, as the poor health of people who have experienced homelessness contributes to the high personal and economic costs of homelessness.
Acknowledgments
This evidence has been prepared by Dr Natasha Chilman (King’s College London & Population Health Improvement UK (PHI-UK); PhD research funded by the London Interdisciplinary Social Science Doctoral Training Partnership (LISS-DTP)) with contributions from:
Professor Sally McManus, City St George’s.
Dr Peter Schofield, King’s College London & Population Health Improvement UK (PHI-UK)
Professor Jayati Das-Munshi, King’s College London & Population Health Improvement UK (PHI-UK)
Section 4: References to published work
Reference 1: McManus, S., Bebbington, P. E., Jenkins, R., Morgan, Z., Brown, L., Collinson, D., & Brugha, T. (2020). Data resource profile: adult psychiatric morbidity survey (APMS). International journal of epidemiology, 49(2), 361-362e.
Reference 2: Chilman, N., Schofield, P., McManus, S., Ronaldson, A., Stagg, A., & Das-Munshi, J. (2024). The public health significance of prior homelessness: findings on multimorbidity and mental health from a nationally representative survey. Epidemiology and Psychiatric Sciences, 33, e63.
November 2024