Domestic abuse, mental health and homelessness: The Housing First Model

Research has shown that domestic abuse is the most common cause of depression and other mental health difficulties in women. Alongside this, we also know that gender-based violence and abuse is a key cause of homelessness for women. The links then between experiences of abuse, complex trauma and homelessness are clear, but survivors still struggle to access affordable, stable housing that is so crucial to their recovery. It is time then, to shine a light on the fact that mental health issues, whether diagnosed or undiagnosed, act as a major barrier to accessing housing for survivors of abuse. We also need to start thinking about what it will take to begin untangling this major system blockage and look to new approaches to advocacy and support that could make all the difference.

Several studies have shown how survivors experiencing multiple disadvantage, defined as the concurrence of poor mental health, substance use, homelessness and gendered violence, struggle to access space in women’s refuges, as most are not resourced to address the complexity of these issues. Conversely, homelessness pathways and services i.e. supported accommodation, may have good links with mental health services and be better resourced to deal with issues around mental health, but be less equipped to provide support around domestic abuse, or women-only options.  A survivor’s mental health diagnoses, combined with their experiences of abuse, become a considerable barrier in both cases, leaving survivors with mental health issues with few options.

Many women present to local authority housing teams with a combination of vulnerabilities around mental health, domestic abuse, substance use or physical health and are routinely turned away, without even the opportunity to make a homelessness application, let alone be considered for statutory duty. For survivors who have experienced abuse and trauma through engagement with services in the past, and therefore already have little reason to trust services, this can be catastrophic, pushing them back into the hands of the perpetrator and with little choice but to resort to risky survival strategies to keep a roof over their head.

What is more, mental health services are all too often the ‘empty seat’ at multi-agency conferences that I have attended for survivors with mental health issues and additional, multiple needs. It is a well-known fact that many trusts knock back referrals for survivors with ‘dual diagnosis’, those with mental health and substance use issues, leaving vulnerable survivors largely unsupported. Without appropriate support from mental health services to help survivors address and manage their trauma or their diagnosis, survivors are more likely to self-medicate, be unable to work or manage their benefits. This will in turn increase their risk of eviction and eventually make it hard for them to manage a tenancy without considerable support. The fact that mental health services are so difficult to access continues to be a major issue; even if a survivor does obtain housing, they are likely to need specialist support and advocacy to help them access mental health services and get the support that they need.

All survivors – but especially those with mental health issues – need more than just a ‘roof over their heads’. A home, with the safety and security that comes with this, takes a good deal of time and support to build. A survivor of domestic abuse with mental health issues, struggling though trauma, stigma and fear might need someone to help them open their post if they are too scared to, to chase their care co-ordinator, to manage their housing benefit claim, and to be that positive relationship and source of emotional support that can make all the difference.

The Housing First model originated in New York, as a solution for people with entrenched mental health issues who were long term or recurrently homeless. It has since spread across the US and Europe, and the evidence clearly shows that providing housing and teaming it with flexible, wrap around, unconditional support works. Housing First means that a survivor of domestic abuse isn’t judged on the basis of their mental health diagnoses, and housing isn’t conditional on whether that survivor is ready for treatment. The Housing First philosophy understands the links between violence and abuse, trauma and homelessness, and is therefore an effective – although woefully underfunded – option for survivors with mental health needs.

The links between domestic abuse, trauma, poor mental health and homelessness are clear, and the women’s sector has engaged in some amazing work to highlight this point and keep it on the government’s agenda. It is time that housing providers, CCGs (Clinical Commissioning Groups) and mental health practitioners recognise their key role in preventing homelessness and promoting recovery for survivors of domestic abuse.