Health and Homelessness

Question 1

Maslow’s Hierarchy of needs

Answer 1

TOP to BOTTOM

Self-actualisation
Esteem
Love/Belonging
Safety
Physiological

Question 2

State the main determinants of health

Answer 2

Individual lifestyle factors
Social and Community networks

General socio-economic, cultural and environmental conditions

Question 3

Key determinant of health

Answer 3

Housing
Health-care services

Question 4

ECG of wellbeing

Answer 4

5Rs

• Rafters (firm foundations)
• Relationships (firm foundations)
• Resources
• Restoration
• Resilience

Question 5

Rafters

Answer 5

Shelter, Security and Continuity

Question 6

Resources

Answer 6

Income, Wealth, Education, Employment, Opportunity

Question 7

What is homelessness ?

EXAM TYPE Q

Answer 7

Has no accommodation in the UK or elsewhere that they can reasonably occupy.

Cannot gain access to their accommodation or risk domestic violence by living there.

Accommodation which is unreasonable, overcrowded or risk to health.

‘Likely to become homeless’ - within 2 months

Question 8

State some forms of temporary accommodation

Answer 8

Council Housing
Voluntary Sector Hostels
Women’s Refuge
Supported Flats
Bed and Breakfast

Question 9

Why do people become homeless ?

Answer 9

Social issues
Personal factors/ vulnerabilities
Housing Factors

Question 10

State some social issues

Answer 10

Lack of affordable housing
Lack of Jobs

Inadequate levels of welfare & disability payment

Ethical & Racial Discrimination
Economic Downturn / Welfare Reform

Question 11

State some personal factors (family related)

Answer 11

Adverse Childhood experiences
Childhood family environment
History of Institutional living

Relationship breakdowns
Social Isolation
Life-coping skills are overwhelmed

Bereavement

Question 12

State some personal factors (illness related)

Answer 12

Mental illness
Substance misuse
Domestic/ Sexual Abuse

Learning Disabilities
History of anti-social behaviour/ offending

Question 13

State some personal factors (financial related)

Answer 13

Poverty and Debt
Household with no recourse to pubic funds (NRPF)

Question 14

NRPF

Answer 14

No recourse to public funds

Question 15

State some housing factors

Answer 15

Rent or Mortgage arrears
Impending eviction/ repossession

Tenure insecurity - tied tenancy
History of neighbour complaints

Previous homelessness
House unable to be adapted to needs

Question 16

State some people who are at high risk of homelessness (younger generation)

Answer 16

Single young males
Young adults 18-25

Family breakups

Question 17

State some people who are at a high risk of homelessness (people serving time)

Answer 17

Those leaving the HM forces
Leaving prison

Refugees / Those with NRPF

Question 18

State some people who are at a high risk of homelessness (medical)

Answer 18

Victims of domestic abuse
Hospital Discharge
People with addictions/ mental health issues

Looked after young people

Question 19

Describe some health consequences of homelessness

Answer 19

Impact on life expectancy (lowered)
Mental Illness and Substance abuse
Physical Ill health

Question 20

State the life expectancy for rough sleepers

Answer 20

Average life expectancy of 41 years, compared with the national average of 79 for men and 83 for women.

Question 21

State the top causes of death amongst the homeless

Answer 21

Drugs (20x)
Intentional Self Harm (8x)
Assault (7x)
Chest (6x)
Infections (6x)
Alcohol (5x)

Question 22

What is ‘Housing First’ ?

Answer 22

A wrap around support to rebuild connection and wean off support, once a previously homeless individual moves into their new accommodation.

Question 23

Dual Diagnosis

Answer 23

Mental Illness
Substance Abuse

Question 24

SII

Answer 24

Slope Index of Inequality

Question 25

What is the Slope Index of Inequality ?

Answer 25

Epidemiological measure of the difference in life expectancy between the most and least deprived sections of the local population.

Question 26

SMR

Answer 26

Standardised Mortality Ratio

Question 27

Cross-Cutting issues of homelessness

Answer 27

- 3rd sector dental care - Nutrition - Social work - Podiatry - Substance use - Emergency Departments - Primary Care - Alcohol abuse - Mental Health - Skin care

Question 28

Why is Emergency department a cross cutting issue of homelessness ?

Answer 28

Since some homeless people are not registered with a GP/ have issues trying to access the GP, the ER may tend to be the front door for these people.

Question 29

Why is Nutrition a cross-cutting issue of homelessness ?

Answer 29

Malnourished due to not getting enough food. Diet may not be the best, as donated food may not be the healthiest food choices / they may buy the cheapest food.

Question 30

Barriers to accessing healthcare

Answer 30

NHS administration Staff attitudes Aggressive behaviour Location and timing of appointments Problem of 'Dual Diagnosis' referral patients Temporary accommodation

Question 31

NHS administration barrier

Answer 31

Need for a permanent address to register

Question 32

Staff attitudes barrier

Answer 32

Hostile reception staff

Question 33

Aggressive behaviour barrier

Answer 33

Substance misuse (from the homeless) may cause aggressive behaviour.

Question 34

Temporary accommodation barrier

Answer 34

Loss of contact

Question 35

Methods of service delivery

Answer 35

Dedicated GP / Dental Practices Dedicated Health Visitors for homeless families Specialised mental health, drug and alcohol staff Mainstreamed service One-Stop Shop arrangements

Question 36

Mainstreamed Service

Answer 36

With bespoke access arrangements (in reach, out reach)

Question 37

One stop shop arrangements

Answer 37

At homeless venues with voluntary organisations

Question 38

Range of needs for homeless

Answer 38

Physical ill-health Increased mortality Increased multiple morbidity Long term conditions

Question 39

Recovery for homeless

Answer 39

Relationships and Resilience Quality and Quantity

Question 40

What are resilience factors ?

Answer 40

Hope generators

Question 41

State some resilience factors (network related)

Answer 41

Supportive family / friends Strong social networks Appropriate support services Available advice and advocacy

Question 42

State some resilience factors (work related)

Answer 42

In a stable employment Personal empowerment Savings or access to financial help

Question 43

Inverse Care Law

Answer 43

Those who need healthcare the least, use the services more and more effectively. Those with the greatest need and those people in the worst healthcare receive the least services.

Question 44

What is the purpose of homelessness prevention ?

Answer 44

Rebuild hope, purpose and self-respect

Question 45

State some homelessness prevention strategies (conflict / issue resolution)

Answer 45

Family/ relationship conflict resolution Alcohol and Drug Partnerships Personal resilience skills Employment support Income maximisation

Question 46

State some homelessness prevention strategies (social help)

Answer 46

Health outreach services Education and Skills Housing support Social work

Question 47

Homelessness Services function

Answer 47

Homelessness is about supportive relationships and communities. Services need to build networks of supportive relationships Relationships thrive in strong communities.