Homelessness of People with Mental Disorder: Analytical Essay

Introduction

The essay will focus on the older adults’ groups of mentally disordered people. The chosen vulnerable group are homeless with mental disorder. The vulnerability factors for this vulnerable group of mentally disordered older adult will be analysed and interpreted. The essay will put forward an argument of the multi-professional and multi-agency interventions which will bring about actions to reduce the recognised vulnerability factors inclusive of the anticipated outcomes of such identified interventions. The chosen vulnerable group as an increasing population requiring decent health and social care.

The term ‘vulnerable’ is difficult to define as people can be vulnerable at some point in their life (Maude & Hawley 2007). According to the department of Health (DH 2000; updated 2015) definition of a vulnerable adult is; ‘A person who is 18 or over, in need of community care services by reason of Mental or other disability illness or age unable to take care of him or herself against harm or exploitation.

It is difficult to know the total numbers of homeless people due to the fluctuating nature of the homeless population. There are different ways by which the agencies on counting homelessness due to some being street homeless, some sofa surfing and other ways being assumed (Greenfields et al 2012). Page on facts and figures in relation to homelessness can be find at www.homeless.org.uk/facts. This changing demographic has created vulnerable population and a demand for healthcare that meets homeless increasingly complex health needs.

To define homelessness on being homeless and being able to provide accommodation, under the (Housing Act 1996, cited Larkin 2009) local authorities must consider all applications from people seeking accommodation or assistance in obtaining accommodation.

Some homeless groups are less responsive to the expansion of service provision that has taken place and therefore remain more vulnerable to homelessness. One of these group is older people; because of mental health problems, alienation, or apathy they are less likely to ask for help from mainstream advice services and helplines (Crane and Warnes, 2005; Means, 2007; Shelter, 2007b).

To understand vulnerable old groups homeless, we need to explore the meaning of vulnerability. According to (Rogers 1997, cited in Larkin 2009), it’s difficult to define a vulnerable group as anyone can be or feel vulnerable at different point in their life’s. The term vulnerable is commonly used in health and social care setting although, a universal definition is lacking meanings including a person being in danger, at risk, under threat and in need of protection (Larkin 2009). The care Act (2014) refers to vulnerable people as those who are at risk and define this as someone who has care needs and support and is experiencing, or at risk of, abuse or neglect and as a result of those care unable to protect themselves resulting from their care needs.

It is estimated that there is around 400,000 ‘hidden homeless’ adults at any point in time (Riddell, 2006; Firth, 2007b; New policy institute, 2007). Ultimately, based on ethnic, social, economic, health or cultural characteristics, all these populations are vulnerable to suffering inequalities to healthcare access and at greater risk of poor health outcomes (Shivayogi, 2

Vulnerability is caused by a combination of medical, psychological, social, and cultural factors and these factors has to be considered holistically and contextually (Shepherd and Mahor 2002). Regular forms of social support to which other groups

Homeless people lack the Regular forms of social support to which other social groups have access. The main consequence of this is that loneliness is pervasive among the homeless. For the older people population in England, It is emotionally painful and has detrimental consequences for physical and mental well-being leading to vulnerability has been described as an urgent issue for public health (Department of Health, 2012;Goll et al,2015) Evidence have shown that both the causes and the experience of loneliness during homelessness are different from those of the general population. Noting the causes of loneliness, these enclose personal adequacy, developmental deficits, unfulfilling personal relationships, relocation and major separations, social marginality, which are significantly different from the causes seen in housed people.

According to Rokach (2004) in her study, found it to be of five factors. These are emotional distress, social inadequacy and alienation, interpersonal isolation, growth and discovery and self-alienation. She reiterated that when the loneliness experience of the homeless was compared to that of the rest of the population, the homeless (both male and female) scored higher on each factor except growth and discovery(Rogers and Pilgrim, 2003; Rokach, 2004, 2005).

Homeless people with physical and mental health problems are likely to be more than other members of the population. 19 percent of rough sleepers (Shelter 2007, cited Greenfields 2012) reported having mental health problems. It is not known whether this exacerbated due to them being homeless or happened before they become homeless meaning, they were ill at that point in time. There are plenty of reasons for this, homelessness is often caused by health problems, like mental illness, drink and drug related health problems (Firth, 2007b, cited M, Larkin 2009). For that reason, it’s easy to vision how an older individual can experience a cycle of vulnerability that lingers over time.

Identified health problems are chronic chest, respiratory, wound and skin problems, Musculo-skeletal and digestive. Also, tuberculosis rates among rough sleepers are also 200 times that of the rest of the population (Larkin, 2009).

Victims of abuse is another factor that some individuals or groups who are homeless are more likely than members of domiciled population to have been in a violent relationship with a parent or partner. Domestic abuse accounts for on average 16 percent of the households accepted as homeless each year (Rogers and Pilgrim, 2003; Hill, 2006). And the social exclusion concept explains that people suffer from a combination of linked problems such as low incomes, poor housing, unemployment and health, family breakdown and poor skills (social exclusion unit 2002; cited in Larkin 2009). Eating problems, post-traumatic stress disorder, anxiety, drug overdose, sleep disturbance, depression, substance intake is all part of domestic violence (Walby, 2009).

For rough sleepers,70 percent have mental health problems, 50 percent are heavy drinkers, one in seven has a drug problem and an average age of death is between 42 and 53 which is high. Also, four times more likely to die due to unnatural causes like accidents, assaults and drug or alcohol poisoning and likely to commit suicide 35 times than rest of the population (National statistics, 2004). Rough sleepers in their 40s and 50s may have the health problems normally associated with older adults (Donnellan,2004; Firth, 2007b).

These are the interventions, as mentioned by NICE (2014) that offered advises that all health and social care providers are to offer safety to victims of domestic violence. The voluntary sector plays a centre role in provision of support and services for the homeless. The First multi-Agency is called Crisis, this helps vulnerable single/groups homeless people. There services are education, transform homeless life’s, publishing and commissions research, organised events to promotes awareness cause and nature of homelessness and campaigns for more inclusive society Larkin 2009 cited (Crisis, 2008).

Some responsibilities of a mental health Nurse is coordinating care planning and delivery of care for older homeless mental disorders groups, particularly in community and frequently required to work as Multi-professional and with multi-agency teams when caring for vulnerable people (Cornwell, 2012). Since decision-making by professional regarding mental capacity appears made on an ad voc basis (Collins, 2005). However, policy guidance and legislation, such as No Secrets (Department of health, 2000a), the mental capacity Act, 2005 (Department of Health, 2005b), and the accompanying code of practice, provide a framework, which is meant clarify and improve decision-making around capacity, particularly in relation to adult protection.

The government put in place some mechanisms to enhance information sharing among some organisation such as Multi-Agency Risk Assessment and control (MARAC) and Multi-Agency Public Protection Arrangements (MAPPA) (Norman and Ryrie 2013).

The lifestyle interventions to improve health should be added to a mental health care and should start when service-user encounters mental health services (Robson; cited in Norman & Ryrie).

There exist various types of paths which are adopted by the Multi-agencies working team. They share information among themselves, joint decision making and coordinate intervention (Home office 2014). The six key principal which helps the team to reduce the problem in the society are empowerment, proportionality, prevention, protection, partnership and accountability.

Empowerment, this is influence by vulnerable homeless people having a say and making their own decision. Happy with it and thinking about their future health in the accommodation provided and the surrounding area. Proportion meaning informing the vulnerable that is the older homeless mental disorder groups not to allow any types of discrimination like age, ethnicity in the society. Prevention against any bad event like attacks, beating up in the street, whereby awareness/surrounding is much important before any sign of bad situation. Protection stables their mental states and gives them self-confidence, comfortable and safe which satisfaction. Partnership between the multi-agency and the homeless people in the community is the best especially when they feel isolated and needs assistant. Accountability sustain homeless people in the safeguarding situation.

Psychological interventions are in place for mentally disordered older homeless people to work out ways of dealing with their distress. They with depression at significant risk of relapse should be offered psychological interventions such as cognitive behavioural therapy (Gurney; cited in Norman and Ryrie).

Well, number of factors contributing to vulnerability in the older homeless people and their complex needs shows why multi-agency and multi-professional work is very crucial in achieving the best results for the elderly (NHS England, 2014). Mental capacity Act (2007) works collaboratively with vulnerable individual with their consent regarding safeguarding activity. The Act says everyone has right to make their decision and every Health professional should support them with the decision (NHS Choices 2015). Older homeless people need to be referred to local primary care services which provide therapeutic interventions to adults leaving in borough who require care and treatment for anxiety and depression due to being homeless.

Mental health nurses have duty of care to protect those in their care (NMC 2015), people and organisations required to work together to prevent risks and experience of abuse and neglect (DH 2014).

Local authority retains responsibility as the lead co-ordinating organisations, NHS safeguarding our service users (London Multi-Agency safeguarding Adults policy and procedures). Psychological stress, social isolation depression and reduced quality of life is associated with financial hardship (Tucker-Seeley et al, 2009). The quality of life is promoted, the outcomes gets improved through financial and assistance relief.

In summary, Groups of mentally disordered older people vulnerability is restricted to access to health, homelessness and accommodation outcomes. Also, older population of mental disordered groups in England represent a high risk of vulnerable homelessness among their groups due to factors such as social isolation, high rates of financial hardship and lack of social participation. This vulnerability increased rates of hospitalisation amongst older group are due to health issues such as chronic chest, respiratory, wound and skin problems leading to mortality reducing functional and cognitive capacity.

Early intervention for the vulnerable is vital with the services of Multi-professional and Multi agency approach. The Mental Health nurses are to recognise vulnerable especially homelessness however professionals from other disciplines are required to action multifaceted interventions. The interventions require multi agency working along such as local authorise to help find homes for the qualified vulnerable older groups.

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