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. 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 Common issues

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 family’s floors (Crisis 2003)

8. 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 Causes

9. 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 Factors that increase the risk of homelessness

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. Hostels Squats ‘Sofa surfing’ Bed-and-breakfast’ Homeless at home Street Prison Transitional housing Shared housing Where homeless people stay

12. 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 Conditions

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.  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 Impact on health

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. Appropriate Accessible Flexible Sustainable Creative Accountable Equitable Efficient Transparent Effective Acceptable Just Principles