Skip to main content
SpringerLink
Log in

Working with Homeless Men in London: A Mental Health Service Perspective

  • Chapter
  • First Online:
The Palgrave Handbook of Male Psychology and Mental Health

Abstract

This chapter describes the work of a community mental health service for street homeless people in South London (the START Homeless Outreach Team) and is written by two clinical psychologists with current and previous experience of working in this service. The issue of homelessness is particularly relevant to this book because existing evidence reveals there to be a much higher proportion of street homeless men compared to women. To explore the issue of male homelessness and mental health in more depth, this chapter presents an overview and discussion of relevant literature. The chapter also considers the clinical implications of the issues discussed, which are illustrated by presenting an overview of the work of START and by describing an in-depth clinical case example.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    CHAIN—a multiagency database for recording information about rough sleepers and the wider street population within London.

  2. 2.

    This reflects the language typically used in the research literature but we recognise that some people have a preference for the term ‘complex trauma’.

  3. 3.

    The term ‘psychosis’ is a reference to the range of complex difficulties often experienced by the people who access our service. We take the position that such presentations are often rooted in adverse experience (i.e. trauma and abuse), which is highlighted by the clinical case example presented and wider literature.

References

  • Anderson, I. (2007). Tackling street homelessness in Scotland: The evolution and impact of the rough sleepers initiative. Journal of Social Issues,63(3), 623–640.

    Article  Google Scholar 

  • Archer, J. (2004). Sex differences in aggression in real-world settings: A meta-analytic review. Review of General Psychology,8(4), 291.

    Article  Google Scholar 

  • Ball, S. A., Cobb-Richardson, P., Connolly, A. J., Bujosa, C. T., & O’Neall, T. W. (2005). Substance abuse and personality disorders in homeless drop-in center clients: Symptom severity and psychotherapy retention in a randomized clinical trial. Comprehensive Psychiatry,46(5), 371–379.

    Article  Google Scholar 

  • Blanchard, J. J., Brown, S. A., Horan, W. P., & Sherwood, A. R. (2000). Substance use disorders in schizophrenia: Review, integration, and a proposed model. Clinical Psychology Review,20(2), 207–234.

    Article  Google Scholar 

  • Brown, C. H., Bennett, M. E., Li, L., & Bellack, A. S. (2011). Predictors of initiation and engagement in substance abuse treatment among individuals with co-occurring serious mental illness and substance use disorders. Addictive Behaviors,36(5), 439–447.

    Article  Google Scholar 

  • Buhrich, N., Hodder, T., & Teesson, M. (2000). Lifetime prevalence of trauma among homeless people in Sydney. Australian and New Zealand Journal of Psychiatry,34(6), 963–966.

    Article  Google Scholar 

  • Bunce, D. (2000). Problems faced by homeless men in obtaining health care. Nursing Standard (Through 2013), 14(34), 43.

    Google Scholar 

  • Burns, L., & Whittaker, E. (2015). No place to call home: What homelessness means for people who use drugs. Drug and Alcohol Dependence,156, e31.

    Article  Google Scholar 

  • Cockersell, P. (2015). The process of social exclusion. Clinical Psychology Forum,265, 13–18.

    Google Scholar 

  • Combined Homelessness and Information Network. (2017). CHAIN annual report: June 2015. The Greater London Authority.

    Google Scholar 

  • Crane, M., & Warnes, A. M. (2001). The responsibility to care for single homeless people. Health and Social Care in the Community,9(6), 436–444.

    Article  Google Scholar 

  • Department for Communities and Local Government. (2016). Rough sleeping in England: Autumn 2015.https://www.gov.uk/government/statistics/rough-sleeping-in-england-autumn-2015.

  • Donoghue, K., Doody, G. A., Murray, R. M., Jones, P. B., Morgan, C., & Dazzan, P., et al. (2014). Cannabis use, gender and age of onset of schizophrenia: Data from the AESOP study. Psychiatry Research, 215(3), 528–532.

    Google Scholar 

  • Eranti, S. V., MacCabe, J. H., Bundy, H., & Murray, R. M. (2013). Gender difference in age at onset of schizophrenia: A meta-analysis. Psychological Medicine,43(1), 155–167.

    Article  Google Scholar 

  • Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529–1540.

    Google Scholar 

  • Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS medicine,5(12), e225. https://doi.org/10.1371/journal.pmed.0050225.

    Article  Google Scholar 

  • Firn, M., Hindhaugh, K., Hubbeling, D., Davies, G., Jones, B., & White, S. J. (2013). A dismantling study of assertive outreach services: Comparing activity and outcomes following replacement with the FACT model. Social Psychiatry and Psychiatric Epidemiology,48(6), 997–1003.

    Article  Google Scholar 

  • Galdas, P. M., Cheater, F., & Marshall, P. (2005). Men and health help-seeking behaviour: Literature review. Journal of Advanced Nursing,49(6), 616–623.

    Article  Google Scholar 

  • Gayer-Anderson, C., & Morgan, C. (2013). Social networks, support and early psychosis: A systematic review. Epidemiology and Psychiatric Sciences,22(2), 131–146.

    Article  Google Scholar 

  • Gilburt, H. (2015). Mental health under pressure. The King’s Fund. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/mental-health-under-pressure-nov15_0.pdf.

  • Gillingham, E. (2010). Understanding A8 migration to the UK since accession. Office for National Statistics, 1–26.

    Google Scholar 

  • Gregg, L., Barrowclough, C., & Haddock, G. (2007). Reasons for increased substance use in psychosis. Clinical Psychology Review,27(4), 494–510.

    Article  Google Scholar 

  • Hambrecht, M., & Häfner, H. (2000). Cannabis, vulnerability, and the onset of schizophrenia: An epidemiological perspective. Australian and New Zealand Journal of Psychiatry,34(3), 468–475.

    Article  Google Scholar 

  • Haro, J. M., Alonso, J., Bousoño, M., Suárez, D., Novick, D., & Gilaberte, I. (2008). Remission and relapse in the ambulatory treatment of patients with schizophrenia. Outcomes at 3 years. Actas Espanolas de Psiquiatria, 36(4), 187–196.

    Google Scholar 

  • Health Protection Agency and Partners. (2010). Understanding the health needs of migrants in the South East region. London: Health Protection Agency. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1284475770868.

  • Hill, R. P. (1991). Homeless women, special possessions, and the meaning of “home”: An ethnographic case study. Journal of Consumer Research,18(3), 298–310.

    Article  Google Scholar 

  • Homeless Link. (2014). Supporting women who are homeless: Briefing for homelessness services. http://www.homeless.org.uk/sites/default/files/site-attachments/Supporting%20women%20who%20are%20homeless%20March%202017_0.pdf.

  • Homeless Link. (2016). Trafficking and forced labour: Guidance for frontline homelessness services. http://www.homeless.org.uk/sites/default/files/site-attachments/Trafficking%20and%20Forced%20Labour%20guidance%20-%20May%202016.pdf.

  • Jainchill, N., Hawke, J., & Yagelka, J. (2000). Gender, psychopathology, and patterns of homelessness among clients in shelter-based TCs. The American Journal of Drug and Alcohol Abuse,26(4), 553–567.

    Article  Google Scholar 

  • Johnson, R., & Haigh, R. (2011). Social psychiatry and social policy for the 21st century: New concepts for new needs-the ‘enabling environments’ initiative. Mental Health and Social Inclusion,15(1), 17–23.

    Article  Google Scholar 

  • Jolly, S., & Reeves, H. (2005). Gender & migration. United Kingdom: Bridge.

    Google Scholar 

  • Kim, M. M., Ford, J. D., Howard, D. L., & Bradford, D. W. (2010). Assessing trauma, substance abuse, and mental health in a sample of homeless men. Health and Social Work,35(1), 39–48.

    Article  Google Scholar 

  • Lee, C. T., Guzman, D., Ponath, C., Tieu, L., Riley, E., & Kushel, M. (2016). Residential patterns in older homeless adults: Results of a cluster analysis. Social Science and Medicine,153, 131–140.

    Article  Google Scholar 

  • Lehman, A. F., Dixon, L. B., Kernan, E., DeForge, B. R., & Postrado, L. T. (1997). A randomized trial of assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry,54(11), 1038–1043.

    Article  Google Scholar 

  • Lemos, S., & Portes, J. (2008). The impact of migration from the new Eastern Union member states on native workers. Department for Work and Pensions.

    Google Scholar 

  • Lettner, B. H., Doan, R. J., & Miettinen, A. W. (2016). Housing outcomes and predictors of success: The role of hospitalization in street outreach. Journal of Psychiatric and Mental Health Nursing,23(2), 98–107.

    Article  Google Scholar 

  • Linn, J. G., Brown, M., & Kendrick, L. (2005). Injection drug use among homeless adults in the southeast with severe mental illness. Journal of Health Care for the Poor and Underserved,16(4), 83–90.

    Article  Google Scholar 

  • Maguire, N. J., Johnson, R., Vostanis, P., Keats, H., & Remington, R. E. (2009). Homelessness and complex trauma: A review of the literature. Southampton: UK University of Southampton.

    Google Scholar 

  • Malla, A., & Payne, J. (2005). First-episode psychosis: Psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin, 31(3), 650–671.

    Google Scholar 

  • Marshall, E. J., & Bhugra, D. (1996). Services for the mentally ill homeless. In D. Bhugra (Ed.), Homelessness and mental health (pp. 99–109). Cambridge: Cambridge University Press.

    Google Scholar 

  • McGrath, J., Saha, S., Welham, J., El Saadi, O., MacCauley, C., & Chant, D. (2004). A systematic review of the incidence of schizophrenia: The distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine,2(1), 13.

    Article  Google Scholar 

  • McIntyre, J. C., Wickham, S., Barr, B., & Bentall, R. P. (2017). Social identity and psychosis: Associations and psychological mechanisms. Schizophrenia Bulletin, 44(3), 681–690.

    Google Scholar 

  • Morgan, V. A., Castle, D. J., & Jablensky, A. V. (2008). Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Australian and New Zealand Journal of Psychiatry,42(1), 74–82.

    Article  Google Scholar 

  • Mostowska, M. (2014). ‘We shouldn’t but we do…’: Framing the strategies for helping homeless EU migrants in Copenhagen and Dublin. The British Journal of Social Work,44(suppl_1), i18–i34.

    Article  Google Scholar 

  • National Audit Office. (2017). Homelessness. Department for Communities and Local Government.https://www.nao.org.uk/wp-content/uploads/2017/09/Homelessness.pdf.

  • O’Brien, A., Fahmy, R., & Singh, S. P. (2009). Disengagement from mental health services. Social Psychiatry and Psychiatric Epidemiology,44(7), 558–568.

    Article  Google Scholar 

  • Ochoa, S., Usall, J., Cobo, J., Labad, X., & Kulkarni, J. (2012). Gender differences in schizophrenia and first-episode psychosis: A comprehensive literature review. Schizophrenia Research and Treatment, 2012, 1–9. https://www.hindawi.com/journals/schizort/2012/916198/.

  • Office for National Statistics: Overview of Violent Crime and Sexual Offences. (2017). https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/compendium/focusonviolentcrimeandsexualoffences/yearendingmarch2016/overviewofviolentcrimeandsexualoffences.

  • Opler, L. A., White, L., Caton, C. L., Dominguez, B., Hirshfield, S., & Shrout, P. E. (2001). Gender differences in the relationship of homelessness to symptom severity, substance abuse, and neuroleptic noncompliance in schizophrenia. The Journal of Nervous and Mental Disease,189(7), 449–456.

    Article  Google Scholar 

  • Patterson, M. L., Somers, J. M., & Moniruzzaman, A. (2012). Prolonged and persistent homelessness: Multivariable analyses in a cohort experiencing current homelessness and mental illness in Vancouver, British Columbia. Mental Health and Substance Use,5(2), 85–101.

    Article  Google Scholar 

  • Reeve, R., Casey, E., Batty, E., & Green, S. (2009). The housing needs and experiences of homeless women involved in street sex work in stoke-on-trent. Centre for Regional Economic and Social Research, Sheffield Hallam University. http://www4.shu.ac.uk/research/cresr/housing-needs-and-experiences-homeless-women-involved-street-sex-work-stoke-trent-pdf-41975-kb.

  • Saha, S., Whiteford, H., & McGrath, J. (2014). Modelling the incidence and mortality of psychotic disorders: Data from the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry,48(4), 352–359.

    Article  Google Scholar 

  • Schindler, H. S., & Coley, R. L. (2007). A qualitative study of homeless fathers: Exploring parenting and gender role transitions. Family Relations,56(1), 40–51.

    Article  Google Scholar 

  • Seager, M. (2015). Why long-term homelessness begins and ends with the mind. Clinical Psychology Forum,265, 19–22.

    Google Scholar 

  • Shelter. (2016). Green book 50 years on: The reality of homelessness for families today. http://www.shelter.org.uk/__data/assets/pdf_file/0003/1307361/GreenBook_-_A_report_on_homelessness.pdf.

  • Shelter. (2017). Homelessness: Are you in priority need?http://m.england.shelter.org.uk/get_advice/homelessness/help_from_the_council_when_homeless/priority_need.

  • Simons, R. L., & Whitbeck, L. B. (1991). Sexual abuse as a precursor to prostitution and victimization among adolescent and adult homeless women. Journal of Family Issues,12(3), 361–379.

    Article  Google Scholar 

  • Sonne, S. C., Back, S. E., Zuniga, C. D., Randall, C. L., & Brady, K. T. (2003). Gender differences in individuals with comorbid alcohol dependence and post-traumatic stress disorder. The American Journal on Addictions,12(5), 412–423.

    Article  Google Scholar 

  • Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., & Susljik, I. N. A. (2006). Impact of immigration detention and temporary protection on the mental health of refugees. The British Journal of Psychiatry,188(1), 58–64.

    Article  Google Scholar 

  • St Mungo’s. (2014). Rebuilding shattered lives: The final report. https://www.mungos.org/publication/rebuilding-lives-final-report/.

  • St Mungo’s. (2016a). Stop the scandal: An investigation into mental health and rough sleeping. http://www.mungos.org/documents/7021/7021.pdf.

  • St Mungo’s. (2016b). Nowhere safe to stay: The dangers of sleeping rough. http://www.mungos.org/documents/7353/7353.pdf.

  • Thorup, A., Albert, N., Bertelsen, M., Petersen, L., Jeppesen, P., & Le Quack, P., et al. (2014). Gender differences in first-episode psychosis at 5-year follow-up—Two different courses of disease? Results from the OPUS study at 5-year follow-up. European Psychiatry, 29(1), 44–51.

    Google Scholar 

  • Timms, P. (1996). Management aspects of care for the homeless mentally ill. Advances in Psychiatric Treatment,2(4), 158–165.

    Article  Google Scholar 

  • Timms, P., & Perry, J. (2016). Sectioning on the street—Futility or utility? BJPsych Bull,40(6), 302–305.

    Article  Google Scholar 

  • Timms, P., & Taylor, K. (2015). Breaking down barriers: Clinical psychology and psychiatry in a mental health service for homeless people. Clinical Psychology Forum,265, 28–32.

    Google Scholar 

  • Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin,132(6), 959–992.

    Article  Google Scholar 

  • Torchalla, I., Strehlau, V., Li, K., Aube Linden, I., Noel, F., & Krausz, M. (2014). Posttraumatic stress disorder and substance use disorder comorbidity in homeless adults: Prevalence, correlates, and sex differences. Psychology of Addictive Behaviors,28(2), 443.

    Article  Google Scholar 

  • Torchalla, I., Strehlau, V., Li, K., Schuetz, C., & Krausz, M. (2012). The association between childhood maltreatment subtypes and current suicide risk among homeless men and women. Child Maltreatment,17, 132–143.

    Article  Google Scholar 

  • Vila-Rodriguez, F., Ochoa, S., Autonell, J., Usall, J., & Haro, J. M. (2011). Complex interaction between symptoms, social factors, and gender in social functioning in a community-dwelling sample of schizophrenia. Psychiatric Quarterly,82(4), 261–274.

    Article  Google Scholar 

  • Willhite, R. K., Niendam, T. A., Bearden, C. E., Zinberg, J., O’Brien, M. P., & Cannon, T. D. (2008). Gender differences in symptoms, functioning and social support in patients at ultra-high risk for developing a psychotic disorder. Schizophrenia Research,104(1), 237–245.

    Article  Google Scholar 

  • Williamson, E., & Taylor, K. (2015). Minding the margins: An innovation to integrate psychology in a homeless hostel environment. Clinical Psychology Forum,265, 33–37.

    Google Scholar 

  • Wilsnack, R. W., Vogeltanz, N. D., Wilsnack, S. C., & Harris, T. R. (2000). Gender differences in alcohol consumption and adverse drinking consequences: Cross-cultural patterns. Addiction,95(2), 251–265.

    Article  Google Scholar 

  • Zammichieli, M. E. (1997). Predicting homelessness following psychiatric hospitalization. Doctoral dissertation, University of Maryland Baltimore County.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. South London and Maudsley NHS Foundation Trust, London, UK

    James Duffy

  2. Derbyshire Healthcare NHS Foundation Trust, Derbyshire, UK

    Andrew Hutchison

Authors
  1. James Duffy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Hutchison
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James Duffy .

Editor information

Editors and Affiliations

  1. UCL, London, UK

    John A. Barry

  2. Norfolk and Suffolk NHS Foundation Trust, Wymondham, UK

    Roger Kingerlee

  3. Change, Grow, Live, Dagenham/Southend, Essex, UK

    Martin Seager

  4. Community Interest Company, Men’s Minds Matter, London, UK

    Luke Sullivan

Rights and permissions

Reprints and permissions

Copyright information

© 2019 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Duffy, J., Hutchison, A. (2019). Working with Homeless Men in London: A Mental Health Service Perspective. In: Barry, J.A., Kingerlee, R., Seager, M., Sullivan, L. (eds) The Palgrave Handbook of Male Psychology and Mental Health. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-04384-1_26

Download citation

Publish with us

Policies and ethics

Search

Navigation