Of not passing: homelessness, addiction, mental health and care during COVID-19

Abstract

People experiencing homelessness in the UK were unconditionally offered housing (and support) from the beginning of the first lockdown in March 2020. For many, that meant ‘(re)entering’ the support system and having a chance to ‘move on’ to longer-term housing. This beneficial effect of some of the policy reactions to the pandemic on people experiencing homelessness was unexpected. On the flip side, however, particularly for people struggling with drug use and mental health issues, adequate support was not available for long periods of time; support was either suspended temporarily or people were excluded from institutional support for not adhering to, for instance, lockdown rules. Similarly, digital support alternatives—modelled on increasingly widespread telemedicine—did often not work specifically for people struggling with complex needs or women experiencing homelessness. This research paper reports detailed evidence of what we observed as continued and catalysed exclusions based on interviews and ethnographic observations with both people experiencing homelessness and service providers from the beginning of the COVID-19 pandemic. Referring to our insights and learnings from three locally and temporally overlapping research projects between May 2020 and April 2021, we also propose changes to redesign future (health)care provision to prevent such impasses—which extend beyond lockdown situations to general conditional housing and support.

Interventions to mitigate the risks of COVID-19 for people experiencing homelessness and their effectiveness: a systematic review

“…Fifteen studies were included ( Figure 1 ) ( 26–39 , 45 ). There were six observational studies ( 27 , 30 , 31 , 33 , 34 , 39 ), four pre−/post-intervention studies ( 26 , 32 , 38 , 45 ), two qualitative studies ( 35 , 37 ), and three modelling studies ( 27 , 28 , 34 ). Eleven of the included studies were from the US ( 27–34 , 37 , 38 , 45 ) and three from the UK ( 35 , 36 , 39 ).…”

“…Eight studies included an intervention with the provision of housing for people experiencing homelessness regardless of their infection status. This included two comparative cohort studies ( 32 , 33 ), one quasi-experimental study ( 45 ), one observational study ( 39 ), two qualitative studies ( 35 , 37 ), and two modelling studies (Section 4.6) ( 27 , 34 ).…”

“…One qualitative study reviewed the impact of the pandemic on those experiencing homelessness in the UK ( 35 ), including the effects of providing accommodation and changes in access to healthcare during the pandemic. People with substance misuse and mental health issues had less access to support during COVID-19 restrictions.…”

“…People with substance misuse and mental health issues had less access to support during COVID-19 restrictions. Conversely, one unexpected positive outcome was that some people experiencing homelessness had a better chance of securing more permanent accommodation through being offered accommodation ( 35 ).…”

“…To prevent the risks of COVID-19 outcomes in people experiencing homelessness, as well as the health inequalities they experience, continuation of accommodation provision and healthcare is vital ( 28 , 33 , 34 , 36 , 37 ). There is, however, concern that interventions have been applied or advocated on a “one-size-fits-all” basis and are not sufficiently flexible or tailored to a wide range of individual circumstances and needs ( 35 ). Studies on interventions in shelters (mainly in the US) may initially appear to have less transferability to other settings, but there is the potential for learning and adapting.…”