PUBH7000 Public Health: Homeless Population in Manchester

Select a defined community and demonstrate the effectiveness of intervention(s) or strategies in promoting environment, housing and wellbeing. 

This is an individual piece of work that should be presented in article style, suitable for publication in a professional journal. It may therefore be presented in suitable article format including photographs or other illustrations as if ready to submit to a journal for consideration. 

Wider social determinants and structural realities faced by this population and impact of these on needs and well-being

Homelessness, more specifically unstable housing, is referred as a major social determinant of health. Individuals who are homeless are often predisposed to worse health outcomes as a result of outright poor living conditions along with the insecurity of food. In addition, the individuals also have limited access to resources are that are important for self-are. As an example, a patient who is homeless and has diabetes face extreme difficulties in the management of the condition due to lack of a proper place to secure insulin and lack of nutritional diet. Homeless people are very transient and also reside in places that are hard to reach, and therefore it is difficult to provide resources to such places with very little transportation. Such issue is a major reason for challenges faced by health care providers who are responsible for delivering care interventions to this population. They are faced with the issue of reaching to the homeless individual and establish a successful patient-provider therapeutic relationship that is pivotal for effective treatment (Herbers et al. 2017).

As opined by Skosireva et al.(2014) discrimination and homelessness go side by side as all homeless individuals are faced by aggressive discrimination at some of the time in their lives. The homeless can be pointed out to be vulnerable population considering to multiple factors. Those who experience homelessness experience economic hardship and personal hardship and even face discrimination as well as exclusion due to their housing status. A rich pool of literature has indicated that the experience of homeless individuals regarding group-based discrimination have the potential of hindering the connection between the individuals and the social world. Pervasive discrimination is based on access to services and goods and contributes to high rate of ill health. What contributes to more severeness of discrimination is that fact that under many circumstances discrimination exhibited towards the homeless is distinguished to be legitimate. What is striking is that the individuals who are homeless themselves have this perception of legitimacy along with the common public.

Hatzenbuehler, Phelan and Link (2013) have analysed the relation of stigma and homelessness. Stigma can be stated as a basic cause of health inequalities among the homeless individuals. A huge body of research have time and again highlighted that homeless individuals are often constructed as different from the rest of the population. The moral misgivings and apprehensiveness about this state of destitution are often repressed, that allows common individual sees them in a different manner. Johnstone et al. (2015) argue that people living in destitute have long been subjected to stigmatisation and have been blamed for the situation they are in. As per the theory of stigma, homeless people are to be stigmatised are to be more relentlessly stigmatised in comparison to those who are poor. The authors support that the homeless individuals are stigmatised more than those individuals who are domiciled and the strength of stigma is equivalent to the stigmatisation done towards those in mental hospitals. Apart form the hardships the population faces stigmatisation is also faced by the fellow citizens.

Theoretical frameworks of well-being and housing applied in this context

The conceptual framework that forms the basis of the concept of well-being and housing for homelessness outlines the two fundamental factors that limit the societal resources. These are an accumulation of wealth received from ancestors and amount of time and resources available for making wealth. Well-being can be attributed to two major aspects; well-being resulting from the intrinsic benefits produced by all sorts of activities individuals engage in, and people deriving benefits from the existence of beneficial stocks (Knight et al. 2014).

Housing is a tangible output of accumulation of wealth or timely management of wealth. It is the most basic unit of human settlements and development of housing holds much importance as an element of social development. Achievement of sustainable development is not possible without housing development. The concept people have regarding shelter is, through many dimensions, different across multiple professions, tradition, lifestyle and culture. Along the side of being a necessity, housing is a means of forming a standard social identity that has an impact on the psychological well being of the individuals (Galvi and Todres 2011).

Current strategies and interventions targeted for the population

Reduction of homelessness in Manchester is a prime priority for the Manchester Council. The Manchester City Council has drafted a strong set of strategy that aims to make Manchester a world class city to live in and invest in. The vision is to have a city where all citizens contribute to sustained prosperity and gain benefits from it. It recognises that the vulnerable communities are supported to the optimal level for reducing homelessness. The solution of homelessness in Manchester is loosely based on the diversification of the population in the city and considers the strengths of housing, community and voluntary sector partnerships. The strategies are therefore developed while taking the inputs of the various valued partners. The strategy is a sufficient response to the concern of homelessness and the diversified challenges faced by the population. The potential of the communities have been realised in this regard, and changes have been adapted to for using these opportunities. The three foundation stones on which the strategy is based on are economic growth, the support provided to people and investment in people, development of neighbourhoods for making it a suitable place to live in (Leng 2015).  

According to Swain (2016), the strategies addressing the issue of homelessness in Manchester have outlined a number of priorities upon which the steps are based. The first priority is  engagement with partners. It is ensured that prevention of homelessness is achieved through this measure and strategic commissioning and collaboration with the partners are effective in delivering efficient services for those who are homeless. The services provided are accessible to and targeted to the diverse needs of the population and provide innovative as well as flexible solutions. The second priority is the improvement of range of options available for housing to this section of the population and those who exhibit high risk of the same condition. Working with partners is considered for the development of innovation and creation of creative solutions that tend to increase the access of these people to housing. Priority three is to ensure that services for the homeless are effective for all citizens. This is usually done by developing suitable services for those who are disproportionately vulnerable to this condition.

The fourth priority is to work with partners to seize chances for synergies across homelessness and health and fulfil the shared outcomes that improves the health and well-being of homeless people. These include improvement of access to treatment and healthcare and reduction of unplanned admission to any healthcare setting, as well as the establishment of appropriate care and accommodation after getting discharged from the healthcare settings. The last strategy is to help the homeless population with access to opportunities for training, education and employment. This vulnerable population is to be supported and raised with proper nurturing so that they can meet the aspirations (Sasson 2016).

The outcome of the recent review on homelessness has highlighted that preventative services across the city have achieved success in the prevention of homelessness in the last five years. Manchester at present is not witnessing the increase of homelessness as compared to some other parts of the country. The strategies addressing the needs of the homeless people are based on the right decisions as they drive the necessary reforms used for strengthening the leadership approach. This encompasses the lobbying for responsibilities and powers the government has for continual reduction of the homelessness condition. The plan has been successful in identifying the key stakeholders responsible for completion of particular tasks and within a certain span of time. The Homelessness Prevention Driver Group (HPDG) reports to the Neighbourhoods Scrutiny Committee and is responsible for overseeing the delivery of the strategies. Members of the HPDG include Strategic Regeneration, Strategic Housing, Integrated Commissioning Managers, and the Chair of the Manchester Multi-Agency Homelessness Forum. The Manchester Multi-Agency Homelessness Forum (MMAHF) supported by the Rough Sleepers Forum is responsible for the regular monitoring of the delivered services and measure the progress achieved at regular intervals of time. The way the organisation work is remarkable and appropriate for addressing the needs of the people (manchester.gov.uk, 2017).

At the core of the aim of the organisation is to attempt providing secure accommodation to those who are urgent needed. They have launched the Bond Guarantee Scheme under which the private landlords are to receive a guarantee from social organisations to the value of the normal tenancy deposit. This would cover any damage or loss done at the end of the tenancy in a manner that is similar to the traditional deposit. The scheme is to provide financial support along with a wide array of support systems (Abbit 2017).

Multiple organisations are being set up with the purpose of helping the homeless population and are making rapid improvement in the job they are doing. One such organisation is the Barnabus. Barnabus is a Christian Homeless Charity based in the City of Manchester and at present stands to be a lifeline to almost 500 visiting homeless people alongside those who are vulnerable at each week. Many of this group suffer from severe mental health issues and sever addictions. Spiritual, emotional and physical needs of these people are addressed, and all efforts are given to make sure that they can get back to the mainstream society. Though the organisation does not receive government funding and rely entirely on donations, the organisation has reached high levels of success (barnabus-manchester.org.uk, 2017).

Homeless Link is a national membership charity for organisations in England that works directly with those who are homeless. The charity aims to maker services for these people better and strives to bring policy changes for helping these people. The vision is to have a country free from homelessness as everyone would get a place to live. The charity works with the national and local government for improving the policies. The preconceptions about homelessness are challenged to a considerable extent. Sharing of good practices from the members who work on the front line is a positive aspect of the charity. In addition, the charity helps other to bring significant improvements in their work. The regional teams establish links between agencies, offer support to these agencies and provide advice, training and consultation to the homeless people. Another striking feature is an exploration of new and novice methods by which homelessness can be tackled. The products of the charity are targeted towards the end of homelessness (homeless.org.uk, 2017).  

Recommendations

• Manchester City Council and the major partners have made an attempt to make a significant impact on the prevention of homelessness in the city. However, a lot more is to be done in the near future. Services are to be commissioned that directly contribute towards meeting the aims and objectives set out in the initial phases of the strategies.
• Alignment of investment and resources with the particular outcomes across the different strategic partners would be beneficial. Based upon the strong regular analysis of intelligence and need, the strategies are to have the focus on the evidence-based interventions. This needs to be guided by early prevention and help. The citizens are to be put at the centre of commissioning while skills and work are to be embedded across the domains of incentivises for health and wellbeing (Pleace et al. 2015).

• The citizens of Manchester need to be put at the centre of the commissioning. The strategies need to be linked to local and regional levels. High quality provision needs to be assured by the specification of outcomes through financial mechanism. It is to be further enured that there is a robust mechanism for .planned and safe decommissioning as well as remodelling of interventions and services. This is to include implementation of suitable consultations, regular risk assessments and completion of impact assessments. This would make sure that the commissioning decisions are adequately reflected in all of the changes to the plan made for the homeless (Maher and Allen 2014).

Conclusions     

Drawing conclusion from the above-discussed facts, it can be stated that homelessness is a major issue faced in the path of development in Manchester. Though the rates of homelessness have become stagnant to some level,  it has not been eliminated from the social scenario. Homelessness has multiple domains; female and male, old and young, refugees and immigrants as well as lifelong citizens of Manchester. A clear relation between poor health and homelessness has been identified. For understanding the challenges faced by the homeless population, there is a need of considering social as well a biological determinants. The implemented policies and strategies in Manchester target the area of action that was not addressed previously. Opportunities have been presented that strive to change the limit to which true needs of this population exceeds. Whether the new strategies would be implemented, depend largely on the political environment of the country. Studies have indicated that there is an urgent need of such programming that can address the social and health needs of the population and eliminate the discrimination and stigma arising against the individuals. Substantial evidence supports such policies. Intervention prescriptions encouraging improvement of social benefits of the homeless would be a well-entrenched retreat for the welfare of the society.

References

Abbit, B. (2017). True scale of Greater Manchester's homelessness crisis revealed. [online] manchestereveningnews.co.uk. Available at: https://www.manchestereveningnews.co.uk/news/true-scale-greater-manchesters-homelessness-12255784 [Accessed 16 Apr. 2017].

barnabus-manchester.org.uk. (2017). Barnabus Manchester "Bringing Hope to the streets of Manchester" > Who We Are Page. [online] Available at: https://www.barnabus-manchester.org.uk/ [Accessed 16 Apr. 2017].

Galvin, K. and Todres, L., 2011. Kinds of well-being: A conceptual framework that provides direction for caring. International Journal of Qualitative Studies on Health and Well-being, 6(4), p.10362.

Hatzenbuehler, M.L., Phelan, J.C. and Link, B.G., 2013. Stigma as a fundamental cause of population health inequalities. American journal of public health, 103(5), pp.813-821.

Herbers, J.E., Cutuli, J.J., Kolarova, L., Albu, A. and Sparks, L.A., 2017. Mental Health and Adaptation of Children Experiencing Family Homelessness. In Child and Family Well-Being and Homelessness (pp. 7-26). Springer International Publishing.

homeless.org.uk. (2017). Manchester Homeless Advice and Assessment Service. [online] Available at: https://www.homeless.org.uk/homeless-england/service/manchester-homeless-advice-and-assessment-service [Accessed 16 Apr. 2017].

Johnstone, M., Jetten, J., Dingle, G.A., Parsell, C. and Walter, Z.C., 2015. Discrimination and well-being amongst the homeless: the role of multiple group membership. Frontiers in psychology, 6.

Knight, A., La Placa, V. and McNaught, A., 2014. Wellbeing: Policy and practice. Lantern Publishing Ltd..

Leng, G., 2015. Home is Where the Health is: A Greater Manchester Programme. Representation, 51(4), pp.485-492.

Maher, C. and Allen, M., 2014. What is preventing us from preventing homelessness? A review of the Irish National Preventative Strategy. European Journal of Homelessness _ Volume, 8(2).

manchester.gov.uk. (2017). Homelessness Strategy 2013-18 | Manchester City Council. [online] Available at: https://www.manchester.gov.uk/downloads/download/5665/homelessness_strategy [Accessed 16 Apr. 2017].

Pleace, N., 2016. Researching Homelessness in Europe. European Journal of Homelessness, pp.19-44.

Pleace, N., Culhane, D., Granfelt, R. and Knutagård, M., 2015. The Finnish Homelessness Strategy–An International Review.

Sasson, T., 2016. the PRoblem oF homelessness in Post-WaR bRitain. Rescuing the Vulnerable: Poverty, Welfare and Social Ties in Modern Europe, 27, p.212.

Skosireva, A., O’Campo, P., Zerger, S., Chambers, C., Gapka, S. and Stergiopoulos, V., 2014. Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings. BMC health services research, 14(1), p.376.

Swain, K., 2016. A place to write, a place to heal. The Lancet, 388(10045), p.651.

Wexler, B. and Smith, M.E., 2014. Disaster response and people experiencing homelessness: Addressing challenges of a population with limited resources. Journal of emergency management (Weston, Mass.), 13(3), pp.195-200.