The mental health of young people with experiences of homelessness

Background: A link between youth homelessness and mental illness is recognised (Bines, 1994; Craig & Hodson, 1998; Kamieniecki, 2001; Whitbeck, Johnson, Hoyt, Cauce, 2004). However, very little empirically robust research has examined the role mental health plays in the lives of young homeless people, particularly in the United Kingdom. In the UK, approximately 80,000 young people are known to experience homelessness each year. The actual figure is likely to be far larger as it does not take into account those young people who are ‘hidden homeless’ (DePaul UK, 2013). Young people with experiences of homelessness represent a highly vulnerable group in terms of their mental health (Hodgson, Shelton, van den Bree & Los, 2013). This thesis aimed to explore the relationship between psychopathology and youth homelessness and presents the findings of a prospective longitudinal study comprising of three interview stages over the course of two years. The design aims to address the gaps in our knowledge about these two phenomena. The thesis begins by providing an introduction to the area of youth homelessness in the UK (Chapter 1). The relationship between mental illness and homelessness is explored by drawing on a number of psychological theories including family systems, attachment, diathesis stress and the social support stress buffering hypothesis. This is followed by a systematic literature review examining the prevalence of mental health issues within this population and exploring the link between the two phenomena (Chapter 2). The review reveals high rates of psychopathology among young homeless people and identifies a possible reciprocal relationship between homelessness and mental illness. Chapter 3 provides a description of the research method and questionnaires. The longitudinal design used in this project involved three waves of data collection using a pack of questionnaires that explored a range of housing situations, family background, maltreatment, 2 criminality, self-control, loneliness and self-mastery. The interviews also included a full neuropsychiatric assessment in order to assess presence or absence of mental illness. In Chapter 4 a detailed description of the 121 participants recruited for the study revealed a sample representative of the youth homeless population as a whole. The sample had high levels of mental health problems (88%) and had a number of other areas of vulnerability including high rates of comorbidity, past abuse experiences, heavy use of drugs and alcohol, problematic family relationships and premature exits from education. Chapter 5 involved the analysis of the relationship between current disorder and future access to health and mental health services. The results revealed that while young homeless people had a particularly high rate of disorder they also had relatively low levels of access to appropriate services at follow up. However, access to emergency medical care was high. Some forms of disorder, such as depression, were particularly predictive of future health care use whereas other disorders including substance dependence were not. Cluster analysis using differing lifetime mental health conditions was conducted in Chapter 6 in order to identify subgroups of young people with experiences of homelessness. The subgroups derived from this analysis were used to examine differences in past, current and future experiences. Identification of three groups enabled prediction of future outcomes measured at follow up including differences in levels of observed loneliness and self-mastery, as well as level of suicide risk. The final analysis in Chapter 7 was concerned with change in mental health status over the course of the longitudinal study. A fine grained analysis of different characteristics and experiences was conducted, with the aim of assessing the differences between young people whose mental health improved, worsened or remained stable. The research reported in this chapter and the findings of the cluster analysis was then synthesised to further validate the 3 subgroups. This revealed relationships between poor past mental health and future mental health problems. The implications of the findings are discussed in Chapter 8 in terms of psychological theory, intervention work and current government policy relating to youth homelessness. Service providers need to be aware of the prevalence and variation of mental illness among the young people they support. Mental health offers a way of grouping young homeless people in order to tailor support that improves outcomes. Interventions need to be adapted and made accessible, collaborative work should be encouraged enabling support that accounts for heterogeneity in this population