Barriers to accessing healthcare support when homeless

Healthwatch West Sussex used data shared with them by Stonepillow from their homelessness lived experience project.  They heard from 64 people.

This information highlighted that people who are homeless live with neurodiverse, musculoskeletal, mental health and numerous long-term conditions. It is noted that these health conditions do have a direct impact on assessing healthcare services.

22% of respondents identified themselves as having a disability. Their main conditions included being neurodiverse, mental health and musculoskeletal. 

42% of respondents stated they live with a physical health condition and that their physical health condition affected access to healthcare services. The main areas affected were poor communication, rude reception staff, lack of translation services, and transport. However, 20% confirmed that their physical health condition did not affect access. So many services put you on hold and don’t answer. Anxiety makes it hard to go to appointments. 

58% of respondents stated they live with a mental health condition, and 27% said that their mental health affected access to services. The main reasons cited were due to; not able to access via online or mobile (no access to equipment), unable to leave the house, communication barriers (staff not listening, no translation support, incorrect information provided) and need additional support to be able to access services. However, it is important to add that 72%  do not use online services due to not owning a device. Apps and online access being too difficult due to issues with charging and using equipment and needing support to use equipment. 

Some responders stated they felt judged by healthcare professionals and lacked respect because of being homeless. Other areas of concern included healthcare professionals not having enough time, no translation service, no follow up appointments, information being sent to the wrong address, not being listened to, and unsure how to reach services. For some people who have multiple health conditions and increased complexity, who need to engage with a range of services such as primary care, mental health services, secondary care, dental and pharmacy  means that multiple appointments are needed. Currently the system tends to treat episodically and are not using a whole person holistic approach. This means that the person has to repeat the same conversations over and over again as the multiple services are not integrated and have to tell their story multiple times.

Many people were living with neurodiverse, and mental health conditions which can cause unpredictable and challenging behaviour due to being hyper-alert and anxious. Unfortunately, this tends to translate in negative interactions from the places designed to offer support (GPs, A&E, pharmacies, dentists etc.). It is important that appropriate knowledge and awareness of the effect of such health conditions and how best to support is understood by healthcare staff in order to help break this vicious circle. 

The data suggests that people who are homeless experience poor communication from healthcare professionals, with many feeling not listened to, or unheard, not being aware of the person’s experience, feelings and perceptions, culture, and social circumstances. Yet this is one of the core values underpinning integrated care. 

There is an urgent need in West Sussex for a one point of access for effective emotional health support, which is clearly communicated and easy to access. Currently the ways people try to access emotional health support is not supportive for people as many do not know how, who or where to make contact, thus making access to services unclear and difficult.

Integrated health services/inclusion health is needed to help people who live with comorbidities and increased complexity to access the right services timely, to better support their physical and mental health needs. People are asking for a simple, single point of access to support people before the point of crisis to help avoid homelessness and offer appropriate holistic support once homeless. 

This lived experience report shows that there is a need for people who are homeless to have access to the right healthcare and support, at the right time and in the right place; a collaborative approach between the NHS, local authority, voluntary and community organisations, to build integrated strategies to better meet the needs of people who are homeless.