Homelessness and public health

Fransham, Mark; Dorling, Danny

doi:10.1136/bmj.k214

Cited by 53 publications

(44 citation statements)

References 4 publications

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“…Drugrelated deaths in the UK are higher than any European Union (EU) country; in the year before Britians exit they accounted for one third of all reported in the EU country and, in the year prior to Britain's exit, accounted for a third of all reported in the EU [5]. In an austerity context, where health harms are exacerbated by cuts to social and health services [6]-particularly among a growing homeless population [7]-services must innovate to reach those most at risk. To do so effectively, it is essential that interventions are informed by an in-depth understanding of current constraints to safe injecting practices and how environments can be modified to facilitate or protect against health harms.…”

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confidence: 99%

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

et al. 2020

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Background: The United Kingdom is experiencing an increase in drug-related deaths and serious bacterial infections among its most vulnerable citizens. Cuts to essential services, coupled with a growing homeless population, create a challenging environment to tackle this public health crisis. In this paper, we highlight an underexplored environmental constraint faced by people living and injecting drugs on the streets. Access to water for injection is restricted in the UK, due to legislative and financial barriers. Austerity measures, such as public toilet closures, further restrict the ability of people made homeless to access clean water and protect themselves from health harms. Methods: We generated questionnaire (n = 455) and in-depth qualitative interview (n = 32) data with people who inject drugs in London for the Care and Prevent study. Participants provided detail on their life history; drug use, injecting and living environments; health conditions and care seeking practices. Findings: A high proportion of the survey sample reported lifetime history of street homelessness (78%), bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts highlight unsafe, potentially dangerous, injection practices in semi-public spaces. Multiple constraints to sourcing sterile water for injection preparation were reported. Alternatives to sterile water included puddle water, toilet cistern water, whisky, cola soda and saliva. Participants who injected heroin and crack cocaine together unanimously reported adding water at two stages during injection preparation: first, adding water as a vehicle for heroin (which was then heated); second, adding cold water to the heroin mixture prior to adding the crack cocaine. This new finding of a stage addition of solvent may represent an additional risk of infection.(Continued on next page)

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confidence: 99%

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

et al. 2020

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“…Homelessness is affecting an increasing number of people in the UK, including PWID. Contributing factors have been identified as the rising cost of private housing and reduced availability of social housing; reduced funding for homeless and related support services as a result of austerity policies; and welfare changes, such as the introduction of Universal Credit, reducing the availability and relative value of housing benefit (see Fransham & Dorling, ). While many homeless people have difficulty accessing services in this context, PWID were perceived as being more vulnerable and likely to experience much greater difficulty dealing with being homeless than those without ID.…”

Section: Discussionmentioning

confidence: 99%

Homelessness—‘It will crumble men’: The views of staff and service users about facilitating the identification and support of people with an intellectual disability in homeless services

McKenzie

Murray

Wilson

et al. 2019

Health Soc Care Community

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People with an intellectual disability (ID) face significant health inequalities and barriers to accessing appropriate support, which are made worse if the person is also homeless. An important barrier is that services may not recognise that the person has ID. This qualitative study explored the views of staff members and service users about the identification and support needs of homeless people with ID and the role of an ID screening questionnaire as a way to help improve service provision. Semistructured interviews were conducted with 16 staff members and 8 service users from homeless services in the South East of Scotland between March 2017 and 2018. Thematic analysis identified four themes: 'not diagnosed or declared', which explored the barriers to support due to the person's ID not being identified by others or disclosed by the person; 'It will crumble men', which reported on the additional challenges faced by homeless people with ID; 'disabling environment' which identified the ways in which organisations can make support difficult for people with ID to access; and 'It's not against them, it's to help them' which explored the benefits and issues associated with screening for ID in homeless services. The results identified the complex support needs likely to be experienced by many homeless people with ID and suggested a number of implications for practice. First, the screening tool was seen as having a number of benefits, if used where there is a process to provide the person with further specialist assessment and support. Second, staff members identified a need for training in relation to identifying and supporting this group of people. Third, the screening tool was seen as a way to help provide information about the prevalence and needs of people with ID, in order to inform and shape policy, service development, and delivery. K E Y W O R D Shomeless, intellectual disability, learning disability screening questionnaire, qualitative

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“…Domestic violence is the third leading cause of homelessness in the United States (Fransham, 2018). In a study by Stark and Flitcraft (1996), it was noted that one third of suicide attempts in women occur in this context.…”

Section: Epidemiologymentioning

confidence: 99%

A psychoanalytic perspective on victims of domestic violence and coercive control

Brandt

Rudden

2020

Appl Psychoanal Studies

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Based on long clinical and forensic experience in the assessment and treatment of victims of domestic violence, the authors discuss some predisposing psychological factors that can lead to a woman's vulnerability to forming and maintaining an attachment to an abusive partner. Clinical vignettes to illustrate some kinds of observed vulnerabilities along with the authors' ideas as to their origins are presented. The authors argue that these women present with some common but hidden difficulties that may go unrecognized even in a psychoanalytic setting. This is, in part, because of our profession's lack of familiarity with the nature of domestic violence. A more nuanced understanding of the phenomenon of domestic violence is obscured by two crucial factors: first, there is an initial clinical focus on the reality of significant external obstacles to terminating these often intense bonds – even in the face of foreseeable danger to the victim and children; second, and perhaps more limiting, are psychoanalytically based assumptions about “characterological masochism” that often reflect simplistic, moralistic, misogynistic assumptions about women that continue to inform psychoanalytic theory in the area of family life. In addition, the authors discuss some of the interactions contained within the perpetrator/victim relationship that reflect and reinforce the internal liabilities observed in this group of victims.

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Homelessness and public health

Abstract: Homelessness is soaring, with serious health implications for those affected

Cited by 53 publications

References 4 publications

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

Homelessness—‘It will crumble men’: The views of staff and service users about facilitating the identification and support of people with an intellectual disability in homeless services

A psychoanalytic perspective on victims of domestic violence and coercive control

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