Women, Homelessness and Health

What do we know about the health issues facing homeless women? Of having no meal at all or eating five meals in one day for fear of having none the next day, of getting bed bugs and respiratory illnesses from sleeping on dirty mattresses and in damp places, of feeling too ashamed or exhausted to seek help?

Because homelessness is often seen as a male phenomenon, the experience of homeless women has been largely neglected by researchers and policy makers. We know far less about women’s homelessness than men’s – and almost nothing about health issues they face. Yet, homeless women have differing health needs to those of men and these specific needs are often overlooked in policy or service responses.

Women, Homelessness and Health, a new study by the homeless charity Groundswell and funded by the Greater London Authority, is focusing on these overlooked issues. The study is particularly valuable because it used researchers who have experienced homelessness, in all stage of the research process.
Groundswell researchers interviewed 104 women aged from 19 to 75 in London, using questionnaires, face-to-face interviews and focus groups.

They found that the trajectory to homelessness is often different for women and men: for women, the main causes are relationship and family breakdown, physical health issues and domestic abuse.  Not only is violence a cause of homelessness, but women also experience violence or harassment at homelessness services, day centres, hostels and on the streets, which is often a factor in perpetuating homelessness. Here is what one woman interviewed said:  “Being approached by men too often; being made fun of in the street; some guys take the micky out of you; guys touching but the tiredness from homelessness makes me let down my guard and get tired of fighting back. ” It is not surprising then that women are often reluctant to use services designed for and dominated by men, which can often be hostile places for women.

The research stresses that there is a clear need for gendered specific services, but they are not provided because homelessness is seen mostly as a men’s problem. “Women are not measured and counted – they are not as visible,” says Dr Joanne Bretherton, Co-Director, Women's Homelessness in Europe Network, University of York.  Rough sleeper statistics, for example, count people visibly sleeping rough.  Many homeless women sleep rough, but they make efforts to remain invisible – sleeping in hidden places or on buses - and so remain unknown to rough sleeper teams. 

“Often women will only access services when all other avenues, such as friends and family, have been exhausted,” adds Dr Bretherton.  “And they don’t seek help for fear that their children will be taken away.  They feel their mothering skills are judged all the time.”   Nearly half of the women in the Groundswell study are mothers and 22% of those women had children taken into care – an experience that was incredibly traumatic. 

Among the main findings, the study shows that participants have long and complex histories of homelessness, with 42% having been homeless more than once before and 70% having slept rough at some point of their lives. This suggests that women experience a cycle of repeated homelessness.

Three-quarter of the women interviewed have physical health issue problem compared to 37% of the general population. They mostly complain about joints, bones and muscles pain, problems with feet and stomach issues.  Many said that their health issues arose as a result of being homeless. This is unsurprising given the poor conditions women are sleeping in, the stress of homelessness and the amount of time women spend on their feet.

Sixty-four percent have a mental health issue- most commonly depression, anxiety/phobia and PTSD - compared to 21% of general population, suggesting that mental health conditions can develop and/or are exacerbated upon homelessness. In some circumstances, declining mental health can lead to addictions that where not present before homelessness.

Many participants spoke about how the stress and trauma of homelessness put pressure on their physical and mental health. “You are under stress constantly.  It means you are very vulnerable...in terms of illnesses and everything,” said one woman interviewed.  Stress causes headaches, hair loss, stomach pain, eye irritation, rapid heartbeat, panic attacks, chest pain and periods to stop.

Many say that the stress of being homeless and the lack of routine mean it is difficult for them to look after themselves or attend appointments.  Sixty-five percent say that they struggle to find the motivation and confidence to deal with their health issues. “I can’t make appointment, [I need to] wash first and eat first. Survival comes first.  Last thing we have as dignity is to keep clean.”  
 
“Until we have a larger body of evidence about women's homelessness, there is a risk that policy responses to, and services for homeless people will not adequately meet the needs of women,” says Dr Kesia Reeve, Principal Research Fellow at the Centre for Regional Economic and Social Research (CRESR), Sheffield Hallam University. “It raises issues about, for example, maternal and reproductive health and wellbeing issues that rarely feature in other research but are central to some homeless women's experiences and needs.”
 
The report concludes that in order to better support the health of women experiencing homelessness there is a need for:
- a deeper understanding of the health of women experiencing homelessness
- more flexible, considered and participatory commissioning 
- flexible, compassionate and consistent support centered around individual need 
-  focused approach on the health of women who are homeless within NHS services
- joined up working between services and sectors who support woman experiencing homelessness 

You can read the full report here