Chief Medical Officer for Scotland’s Annual Report summary 2017-2018: annex

Priority 1 – A Scotland Where We Live in Vibrant, Healthy and Safe Places and Communities

The places where we live, work and play, the connections we have with others and the extent to which we feel able to influence the decisions that affect us all have a significant impact on our health and wellbeing.

Health and Homelessness

Homelessness is an issue that is directly relevant to healthy communities and is a good illustration of the huge impact that social circumstances can have on health. While health inequalities across Scotland are well evidenced, the Health and Homelessness in Scotland project links homelessness and health datasets for the first time at a national level to explore the relationship between homelessness and health.^[4]

The study shows the importance of considering homelessness and health together. One of the key findings is that at least 8% of the Scottish population (as at 30 June 2015) had experienced homelessness at some point in their lives.

The study considered 436,000 people who had been in households assessed as homeless or threatened with homelessness between June 2001 and November 2016. These households had been assessed by Scottish Local Authorities under section 28 of the Housing (Scotland) Act 1987. These people formed the Ever Homeless Cohort (EHC). Each person in the EHC was matched on age and sex to a non-homeless individual from the 20% least deprived areas of Scotland and to a non-homeless individual from the 20% most deprived areas of Scotland. This formed two control cohorts – the Least Deprived Cohort (LDC) and the Most Deprived Cohort (MDC). Each cohort had the same number of people and the same age-sex distribution. In total, the study contained over 1.3 million people.

Of those who had experienced homelessness at some point:

• Almost half (49%) had evidence of health conditions relating to drugs, alcohol or mental health. This was much higher than in the control groups (where there was evidence in 26% of the MDC and 14% of the LDC).
• Around 30% had evidence of a mental health problem at some point during the study period (with no evidence of drug or alcohol-related conditions at any point). This was higher than in the control groups (MDC 21%, LDC 13%).
• There was evidence of drug and/or alcohol-related interactions for the remaining fifth of people (19%), higher than in the control groups (MDC 5.1%, LDC 1.2%). Of these, the vast majority (94%) also had evidence of mental health issues.
• Around 6% of people experiencing homelessness had evidence of all three of the following conditions – a mental health condition, a drug-related condition and an alcohol-related condition – although not necessarily at the same time. This was much higher than in the control groups (MDC 1%, LDC 0.2%). The figure was markedly higher for those experiencing repeat homelessness (11.4%).

For a variety of health services, increased interactions with health services preceded people becoming homeless, compared to the control groups. A peak in interactions with health services was seen around the time of the first homelessness assessment.

For those who had been homeless on only one occasion, health activity eventually returned to the pre-homelessness levels. However, for people who were homeless on multiple occasions, levels of health activity remained high. It is not possible to say that health activity following homelessness is the direct consequence of homelessness itself. It could be due to further crises or health problems such as drug or alcohol related conditions, or a mental health condition.

Figure 3 shows the picture for males. The picture for females is detailed in the full report.^[4]

Figure 3: Health activity before first homelessness assessment for males in Scotland

Source: Health and Homelessness in Scotland project^[4].