Most people in Britain have probably become desensitised to the sight of homeless people huddled in doorways or sitting on the pavements of the nation’s cities and towns. This is just the tip of an iceberg-the public face of a much more widespread problem.
The true extent of homelessness in the UK is not known. The Rough Sleeping Count is compiled from an estimate by local councils in England. There were 4, 751 rough sleepers on a single given night in autumn 2017 in England, followed by 4,677 in autumn 2018. These figures do not include those sleeping rough, but out of the sight of council officials, such as squatters in abandoned and derelict houses.
Rough sleepers are the most visible manifestation of homelessness. In parts of the Western world, especially in the US, entire populations of the homeless are hidden away in tent cities . The housing charity Shelter estimated that there were at least 320,000 homeless people in Britain in 2018. These hidden homeless live in temporary accommodation which includes hostels, night shelters, squats, bed and breakfast accommodation and women’s refuges, or in ‘concealed’ housing, sleeping on the floors or sofas of family and friends. It is easy to understand why counts of those visibly homeless are gross underestimates at best.
Homelessness results from a variety of reasons. A shortage of affordable housing, rising housing costs, a breakdown of relationships, the loss of employment, mental health problems, and substance misuse all continue to add, either singly or in various combinations, to the numbers of the homeless. In Britain, people who leave prison, the care system, or the armed forces may unexpectedly find themselves on the streets due to a shortage of housing.
Homelessness is a major cause of inequalities in health care and a leading cause of premature death. The NHS is poorly equipped to meet the needs of people with no fixed address. Access to health services is patchy at best. Hospital emergency departments often end up providing makeshift and even unsuitable care for the homeless who have nowhere else to go. In some cities, walk-in primary care centres and GP surgeries have developed innovative and practical ways of meeting the health needs of the homeless.
Many homeless people have complex health needs, often caused by the combination of physical illness, mental health problems, as well as substance misuse. Problems with long-term physical health include skin and foot problems, dental problems, infectious diseases, respiratory disease, and sexually transmitted infections. A lack of protection against cold weather may lead to hypothermia and frostbite. The homeless are often the victims of violent crime and assaults which can lead to physical injuries.
Homelessness can attract conflicting emotions. Some people believe that many of the homeless have deliberately chosen their lifestyle, probably because of a poor work ethic and in order to fund substance misuse. Tabloid stories have even described a group of professional beggars of considerable means who exploit public sympathy in order to make easy money on the streets. Much of this is part of the mythology of homelessness.
The support that is provided to the homeless by local councils, charities and churches, in the form of basic needs such as food and shelter, is of a temporary nature. These actions do not provide any long-term solutions to the problem. The main issue appears to be a structural one, caused by the lack of affordable housing. Not enough homes for all equates to homelessness.
Ashis Banerjee (have spoken with and treated many homeless people)