We need to examine psychologically why people become homeless, rather than just a providing housing or medication
There are fewer than five NHS specialist clinical psychology posts in England specifically serving homeless populations. Why such a small number? One factor is that the focus when tackling homelessness has been on housing and a lack of tenancies. This may be an important issue for homeless families, but it tends to leave out many of the issues facing single people who repeatedly lose their homes and find themselves sleeping rough.
Latest figures from the Department for Communities and Local Government put the number of rough sleepers in England in autumn 2010 at 1,768 and, according to the homelessness charity Crisis, that number is growing. Despite good work done by third sector agencies and the government, homelessness seems an intractable problem. This is due, in part, to changes to housing benefit policy and funding cuts for measures aimed at reducing homelessness.
Perhaps another part of the problem is the way that services are provided, related to how we understand rough sleeping. It is understood to be caused by social factors (such as poverty, housing shortages and so on); or individual factors (fecklessness, alcohol, drug use, mental health problems, for example). So, either society is to blame or the individual is. This polarised understanding promotes social solutions, such as housing, or interventions that try to “fix” people, such as medication, or sweep them off the streets (arrest).
A psychological understanding of the problem, however, makes explicit the interaction between the person and their environment. Rough sleeping should be considered as a behaviour. The logical question is why do people do it? What precipitated it? For many, the answer is that they were evicted from or abandoned their residence, often because of antisocial behaviour, such as violence and drug use, and practical issues, such as non-payment of rent.
Growing evidence for homelessness implicates mental health problems associated with early childhood trauma. People struggle with how they think about themselves, and aggressive outbursts are common as intentions and motives are misinterpreted. Importantly, many then have problems managing these difficult emotions and may use alcohol or drugs to temporarily reduce them.
The dominant way of thinking about mental health is in terms of medical diagnosis, resulting in services being funded according to those diagnoses (either mental health programmes or treatment for addiction). Once there are service categories, there are service gaps through which people fall.
Rather than over-simplifying complex problems using diagnostic boundaries, a psychological understanding can be useful to find ways to tackle the factors behind behaviour that leads to loss of tenancy. Clinical psychologists are trained to do this.
Until we rethink why people become homeless, and move away from a categorical, diagnostic approach towards a psychological understanding, the dearth of specialist psychologists working with this group will remain, and the elimination of rough sleeping will continue to elude us.
• Dr Nick Maguire is a chartered clinical psychologist at the University of Southampton.