Women: Homelessness, Domestic Violence and Social Exclusion

Baroness Tyler of Enfield Excerpts

Thursday 6th November 2014 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the noble Baroness, Lady King, for having secured this vital debate, focusing on one of our most socially excluded groups, which demands our attention. The complex and interrelated needs of women who are homeless are frequently rooted in early traumatic experiences, which all too often lead into chaotic adult lives, characterised by instability, insecurity and despair. I declare an interest as chair of the Making Every Adult Matter coalition of charities, helping adults with multiple needs.

Helping women to escape and recover from homelessness and rediscover hope in their lives often needs to be about responding to the traumatic experiences of abuse, violence and separation from a child, as well as dealing with feelings of stigma and shame. In our recent debate on social justice I spoke about a visit that I made earlier this year to a women’s hostel run by St Mungo’s Broadway in north London, where homeless women are supported with a range of needs, including health, substance abuse, employment and family relationships. I want to keep stressing the importance of this type of women-only support and space that help women feel safer and in a better position to start their recovery from homelessness, a theme that has already emerged in today’s debate. To be clear, this does not have to mean investing significant amounts of money in new women-only accommodation services, but ensuring that mixed services are so designed that they still enable women to access support in a single-sex environment, such as a separate area or perhaps floor of a mixed hostel. It is not rocket science.

There are notable differences between the experiences of homeless women and homeless men. Today we are focusing on the former. It is in homeless women’s experience of domestic violence and mental ill-health that we can start to see some of their particular vulnerabilities. I hope I may be permitted a few statistics. The 2014 St Mungo’s client needs survey is illuminating about the causes and consequences of female homelessness. It included responses from 530 women, of whom 31% said domestic violence contributed to their homelessness, compared to 10% of men; 51% have experience of family violence, compared to 15% of men; and 41% have experienced violence from a partner, compared to 6% of men.

As other noble Lords have said, domestic violence is without doubt a major contributing factor to women’s homelessness. So I ask my noble friend the Minister for an update on the Government’s thinking about practical steps that can be taken to ensure that local homelessness services give women a choice between women-only or mixed services.

We have already heard that homelessness is more than just a housing issue. I am sure others will speak about that and the lack of affordable housing, which is a real problem, but I would like to turn our attention briefly to homeless health. Sleeping on the streets or in unstable accommodation can be both the cause and consequence of health problems for many homeless women. Multiple physical and mental health problems, alongside substance use, are common. Many homeless people experience long-term and chronic conditions. Infectious diseases such as tuberculosis, hepatitis C and HIV disproportionately affect women who are homeless, and homelessness can make those conditions extremely hard to manage.

I was recently made aware of Fiona’s story. She is a woman who has received help from the hostel I mentioned earlier. Fiona is not her real name, but the story is hers. Fiona suffered from bipolar disorder and paranoid schizophrenia from a very young age. Her mental health deteriorated while she was sleeping rough and sofa-surfing for a number of years. Her issues with drug and alcohol use hit rock bottom; she developed cirrhosis of the liver and pancreatitis, and now suffers from epileptic fits.

Fiona explained that even simple things that most of us take for granted become health risks when you are homeless. She said, “You can’t just brush your teeth when you’re on the road”. Her feet also suffered from wearing poor-quality shoes and from constant walking. However, when Fiona first became homeless, she found it difficult to access the healthcare she needed because she did not know who to turn to. She struggled to access a GP because she had no fixed address and had substance use issues. As she put it, “They didn’t want to know me. They wouldn’t touch me. It really knocked my confidence. It was quite a while until I managed to walk into another doctor’s surgery and ask for help because I thought they were going to turn me away”.

I do not believe I am being melodramatic when I say that ultimately homelessness kills. The average age of death for men who are homeless is 47; for women it is just 43. I think that is scandalous. However, as the Faculty for Homeless and Inclusion Health notes:

“When homeless people die they do not commonly die as a result of exposure or other direct effects of homelessness, they die of treatable medical problems, HIV, liver and other gastro-intestinal disease, respiratory disease, acute and chronic consequences of drug and alcohol dependence”.

It is not unreasonable to think that with increased access to healthcare for homeless people, many of these deaths could be avoided.

If we turn back to the recent St Mungo’s client needs survey that I mentioned, there is a notable difference between the experiences of mental ill-health of homeless men and women. Separate research by the Salvation Army found that 53% of homeless women have attempted suicide at least once, compared to 34% of homeless men. Despite the Government’s very welcome investment in the Improving Access to Psychological Therapies programme, which I strongly support, people who are homeless consistently miss out on mental health care as the services available are often not suitable for those with complex needs.

We know from Fiona’s story that substance use and mental health issues are often closely linked, with drugs or alcohol used to block out mental health issues but exacerbating them at the same time. It is not uncommon to find that both problems are rooted in the same trauma.

Despite their close relationship, experience of both mental health and drug and alcohol problems often prevent people from getting the help they need, since both services can only deal with one issue and refuse to treat people with both.

I very much welcome this debate and I look forward to hearing the Minister outline the Government’s plans to ensure more joined-up commissioning of services and other steps to get help to homeless women at the right time.