Working with asylum seekers and homeless people in East Sussex

1
Working with asylum seekers and homeless people
in East Sussex

• Jane Cook
• Public Health Clinical Specialist

2
Asylum seekers

• A person who may apply for asylum in the United
• Kingdom on the ground that if he were required to
• leave, he would have to go to a country to which
• he is unwilling to go owing to a well-founded
  fear
• of being persecuted for reasons of race,
  religion,
• nationality, membership of a particular social
  group
• or political opinion. Any such claim is to be
• carefully considered in light of all relevant
• circumstances.
• Immigration Act 1971

3
Homelessness

• Homelessness is the problem faced by
• people who lack a place to live that is
• supportive, affordable, decent and secure.
• Covers circumstances ranging from rough
• sleeping to overcrowded unsuitable
• accommodation.

4
Statistics

• Asylum seekers supported by UKBA. Dispersed to
  Hastings. 120 bed spaces
• Single homeless those not is priority need
  Local Authority do not have a duty to provide
  accommodation as they do not fall under the
  priority need definition (1996 Housing Act). No
  hostels for homeless people in East Sussex. 120
  meals plated at Salvation Army at the drop in

5
Common issues

• Enforced mobility
• Discrimination
• Separation
• Insecurity
• Poor living conditions
• Overcrowding
• Poverty
• Low expectation, lack of confidence and self
  esteem

• Lack of knowledge
• Poor access to services
• Poor planning of services
• Exclusion
• Multiple and complex health problems
• Deterioration in health outcomes

6
Profile of rough sleepers

• 25 are aged between 18 and 25 SEU July 1998)
• Predominantly 20 50 years old
• 6 are aged over 60 years (SEU 1998)
• 80 90 are male (SEU1998)
• Between 18 to 32 were in local authority care as
  children (Randall and Brown 2001)
• The 4 week rule is the process by which newly
  homeless people become acclimatised to life on
  the streets. After that they become entrenched
  and it becomes more difficult for them to move
  back in to mainstream society (Crisis 1998)
• 9 increase across England

7
Profile of single homeless

• Numbers of single homeless women has risen
  significantly in recent years (Fitzpatrick 2000)
• B.M.E. groups are more likely to sleep on friends
  and familys floors (Crisis 2003)

8
Causes

• Relationship breakdown
• Loss
• Leaving an institution
• Leaving the armed forces
• Financial problems
• Redundancy
• Unemployment
• Abuse

• Violence
• Substance misuse
• Gambling
• Moving to look for a job/accommodation
• Lack of accommodation

9
Factors that increase the risk of homelessness

• Institutionalisation
• Health
• Relationship breakdown
• Unemployment
• Education
• Housing
• Poverty
• Debt

• Insecure
• Pollution
• Lack of planning and control of life
• Deprived neighbourhoods
• Isolation
• Environment less predictable
• Placelessness is a chronic stress

10

• The average time between triggers that lead
• to homelessness and when homelessness
• finally occurs is 9 years.
• (Routes in to Homelessness. 2000 Centre for the
  Analysis
• of Social Exclusion)

11
Where homeless people stay

• Hostels
• Squats
• Sofa surfing
• Bed-and-breakfast
• Homeless at home
• Street

• Prison
• Transitional housing
• Shared housing

12
Conditions

• Damp
• Cold
• Noisy
• Unsafe
• Lack of privacy
• Lack of space
• Pollution

• Infestation
• Lack of storage
• Shared amenities
• Insecure
• Lack of planning and control of life

13
Health

• The concept of health itself has emerged in
  recent years as something far more than just
  disease-free biological functioning. Health is
  powerfully influenced by cultural, social and
  philosophical factors, including the existence of
  meaning and purpose in life and quality of
  intimate personal relationships.
• Spirituality, religion and health an emerging
  research field Miller,W.R., Thoresen,C.E. (2003)
  American Psychologist 58(1)24-35

14
Health of rough sleepers

• 30 50 of rough sleepers suffer from mental
  health problems
• More likely to suffer from
• respiratory problems
• Twice more likely to have muso-skeletal problems
• Twice as likely to have digestive problems
• 35 times more likely to commit suicide than the
  general population (Crisis 1996)
• The average age of death for rough sleepers is 42
  years of age.

15
Health of single homeless people

• Only a quarter of G.P.s fully register homeless
  people seeking treatment (1995)
• Single homeless people are 40 times more likely
  not to be registered with a G.P. than the rest of
  the population (Crisis 2003) ? over use of crisis
  health care
• Mental health problems are up to 8 times more
  common in the homeless population
• A third of young homeless people have attempted
  suicide - a fifth within the last year (Craig
  T., et al Off to a Bad Start 1996)
• 81 are addicted to either drugs or drink (Crisis
  Home and Dry 2002)
• 50 have long term illness or disability (Crisis
  Missed Opportunities 2006)and have problems in
  accessing integrated care so present late in the
  pattern of illness

16
Impact on health

• ? rates of morbidity for all diseases
• ? mental health problems
• ? respiratory problems
• ? gynaecological problems
• ? gastric problems
• ?infections
• ? foot problems

• ? musco-skeletal problems
• ? dental problems
• ? cardiac problems
• ? psychosomatic disorders
• ? nutritional problems
• Presents with multiple and complex problems

17

• Homeless people each consume an
• estimated 8 times more hospital inpatient
• services than an average person of similar
• age, and then secondary care costs around
• 85 million in total per year.
• Compared to the rest of the general public, they
• are 40 times more likely not to be registered
  with a
• GP and have about 5 times the utilisation of AE
  (SI
• Unit 2010)

18
Harm reduction

• Internationally recognised term that defines
• policies, programmes, services and actions
• that work to reduce the
• health,, social and economic harms to
• individuals, communities and society that
• are associated with the use of drugs,
• alcohol and tobacco (Newcombe 1992)

19
Principles of Harm Reduction

• Pragmatic
• Prioritises goals
• Client centred
• Focuses on risks and harm
• Does not focus on abstinence it does support
  those who seek to moderate or reduce their use
• Seeks to maximise the range of intervention
  options that are available

20
Harm reduction

• Strategy focuses on
• BBVs- Hep c, HIV, Hep A, tetanus and influenza
• Drug related deaths
• Injecting behaviours
• Wounds
• Co-morbidity i.e. poly drug use, mental health
  issues/dual diagnosis, alcohol use
• Also takes in to account the families and carers
  of users
• Referral to specialist services
• Behavioural change
• Health promotion harm reduction, safe sex,
  nutrition, mental health and wellbeing

21
Drug related health complications

• DVT
• Abscesses
• Leg ulcers
• Overdose
• Lowered immune system
• Often drug use is replaced or supplemented by
  alcohol

22
Solutions for clients

• Client centred care
• Raise awareness
• Recovery model emphasises personal aspiration,
  resources they have, progress is possible
• Holistic
• Consultation

23
Solutions for commissioners

• World Class Commissioning
• Competencies
• Commissioning cycle
• HNA
• Realistic outcomes
• Sustainability

24
Solutions for providers/frontline staff

• Public health approach
• Multiagency approach
• Harm reduction focus
• Multi-skilled teams
• Specific training
• Appropriate supervision

25
Principles

• Appropriate
• Accessible
• Flexible
• Sustainable
• Creative
• Accountable
• Equitable

• Efficient
• Transparent
• Effective
• Acceptable
• Just