Abstract

Young homeless people have mental health needs. Research and national policies have highlighted that accommodation providers need to offer holistic interventions to encourage this vulnerable group to break the cycle of homelessness. Currently no research literature documents how homeless shelters respond to mental health needs. This research was intended to address this research question.

A postal questionnaire was sent to 132 managers of homeless shelters, achieving a response rate of 64.4%. Frequencies and descriptive statistics were calculated, and written data was analysed using content analysis. Mental health problems were highly prevalent, and homeless shelters responded in a variety of ways (use of GP services, internal services, referring to external services, in-house outreach services, no service provision, etc). Only 27.1% of managers of homeless shelters reported that their services were sufficient to meet their young people's needs. These findings reflect the need for inclusion of mental health in homeless shelters' strategic objectives, and development of commissioning of local partnerships with health agencies. Previous research has consistently demonstrated the complex needs of young homeless people, identifying high levels of physical and mental health problems, substance misuse, and risk of serious injury and assault (Wrate a Blair, 1999; Commander et al, 2002; Vostanis, 2002). In particular, mental health-related problems experienced by young people have been found to be exacerbated by homelessness (Martijn ft Sharpe, 2006) and are likely to persist in the absence of support (Vostanis et al, 1998; Craig a Hodson, 2000; Power a Attenborough, 2003).

Since the 1990s there has been a significant increase in the number of homeless residents in supported accommodation who display mental health problems (Johnson, 2004). Although appropriate housing is undoubtedly an essential ingredient in the care of homeless young people, it is not enough on its own (Mental Health Foundation, 1996). Once young people reach crisis point, it becomes both more difficult and more costly to restore their lives and engage them in employment (Social Exclusion Unit, 2004), warranting the need for early intervention with this vulnerable group of young people. In England, research evidence (Holland, 1996) and recent national policies have acknowledged that homeless people need much more than just rehousing if they are to break the cycle of homelessness (ODPM, 2002, 2003a, 2003b, 2004).

A number of policies from the housing (ODPM, 2003a), social/educational (DfES, 2003) and health sectors (DoH, 2004) are underpinned by the same philosophy, that resettlement and re-integration in the community require a more holistic approach, integrating social and mental health services to meet the complex needs of this vulnerable group (Holland, 1996; ODPM, 2002).

Policy makers and programme planners in the field of homelessness may base their guidance on perceived client needs, without taking into account the organisational context of mental health-related service developments (Delany & Fletcher, 1994), for example the levels of mental health problems in residents in particular organisations, service models and clinical or cost-effectiveness of services. Such context-based information - on how homeless shelters are currently responding to mental health - is not directly available in the current research literature, and could be used as a useful knowledge base to facilitate emergence of new service models and policy-related guidance on how young homeless people's mental health needs can best be met.

The aim of this study was therefore to gain understanding of how homeless shelters which offer accommodation services to young people are currently responding to mental health needs. In particular, this research sought to understand:

* awareness of residents' mental health problems among homeless shelter staff

* perceived impact of mental health-related problems on homeless shelters

* level of responsibility considered by homeless shelters to address mental health-related needs

* what services (if any) homeless shelters provide in relation to mental health

* whether homeless shelters would like to offer additional services in relation to mental health in the future.

Methods

Service context

The UK Foyer Federation is a non-statutory service providing accommodation and related services to homeless young people aged 16-25 in 132 individual foyers (homeless shelters) in England, Wales, Scotland and Northern Ireland. Given the geographical spread of the Foyer Federation's homeless shelters, a postal questionnaire was both the most cost-effective methodological approach and one which offered increased anonymity to respondents (McColl et al, 1998).

To encourage an optimum response rate, the three-page questionnaire used a combination of closed and openended questions, and was designed to be short, clear and simple to complete (Sommer & Sommer, 1991; David a Sutton, 2004). The questionnaire was phrased neutrally, so as not to imply that homeless shelters should or should not be addressing mental health problems in their residents.