Tom Scott-Gatty

First, let me share some information about health among the homeless in Devon and the UK. Homelessness has reached epidemic levels in the UK in recent years. The number of rough sleepers has trebled since 2010 and this only represents the "tip of the iceberg" and the most acute need. Numbers of those in temporary accommodation or vulnerably housed have risen by 71% since 2010. Now there are 82,000 households in this precarious situation including 130,000 children. Official figures of homelessness in Torbay and Exeter were 55% higher than the national average at the 2018 count. Levels of malnutrition in sheltered accommodation in England are 22% higher than that seen in hospital inpatients. The bureau of investigative journalism have been counting the number of people dying on the streets. There were 800 between October 2017 and March 2019, which represents a 24% increase on 5 years ago. Shockingly 1/3 of these deaths were deemed preventable, for example simple infections which could have been easily treated with proper medical care. The life expectancy of the general population in the UK is about 80. Being homeless cuts your life expectancy down to 47 for men and 43 for women.

These individuals typically have had tragic lives with many of them having suffered from childhood abuse and being taken into care at a young age. As a result they suffer from problems with mental health and addiction. Research shows that 80% of this group report poor mental health and 45% have a diagnosis of a severe mental illness. Suicide risk is between 4-6 times higher than that of the general population. "Mental and behavioural disorders" is the second highest cause of death listed for this group of patients after infections. Much of these are deaths related to drug and alcohol misuse which is a maladaptive coping strategy many of these people resort to in order to escape the horrors of their past and present existence. 70% of the residents at the hostel in Torquay are intravenous drug users at a time when addiction funding has been cut 18% in 5 years and drug deaths are up by 50% since 2010. The UK has the highest number of drug deaths in Europe- more than double that of Germany which is the second highest. Funding for the drug and alcohol service in Torbay has been cut by £100,00 this year and we have lost our only inpatient detox unit in Devon (Broadreach) this year due to funding shortages. Unfortunately access to mental health services is not easy nationwide- especially for this hard to reach group. It is a problem I regularly come up against and much of my work is trying to get these patients in touch with the right service. With the help of the community mental health team in Torbay we are improving access but even when we succeed, it is often a long wait to access crucial psychological therapies. Personality disorders are common due to the high rates of childhood trauma. This is a condition for which psychological therapy is a key part of treatment. While they sit on a waiting list their distress and substance use escalates and sooner or later many need admission to a psychiatric unit. 10% of hospital admissions among the homeless are to psychiatric units compared with 1-2% for the general population.

The Leonard Stocks Centre is a homeless hostel on Factory row in Torquay. It has 25 beds for vulnerable homeless adults with complex mental, physical and social needs. It was intended as a short stay facility but due to a shortage of social housing many residents have been there for over a year. In reality it supports many more people than just those 25. It is a place where rough sleepers can come to see a GP or benefit from the experience and consolation of the staff as well as being the only place many of them can feel part of a social group. Funding is an ever present concern and Westward Housing have recently pulled out of joint funding with Shekinah.

Much of what I do with the homeless in Torquay is trying to give them better coping strategies. Just listening is a powerful tool but trying to help them to move on depends on helping them to develop the skills they need to cope with everything that life has thrown at them. When I asked the hostel staff what would be a good use of the money raised they suggested something that would connect the residents and staff with the natural world- a terrarium of frogs! Using animals as a form of therapy is well established and a systematic review of 7 studies in 2015 showed that it is "of benefit to a wide range of individuals, including children with autism, and adults with psychological disorders, including schizophrenia". This would also help to promote the hostel as a "psychologically informed environment", a place which takes into account the thinking, emotions, personalities and past experience of its participants in the way that it operates.

Thankyou for taking the time to read this and fingers crossed that all that training on Dartmoor pays off!

Tom Scott-Gatty