Homelessness can take many forms – including rough sleeping or “chronic homelessness”, which is associated with very poor health outcomes. They tend to be predominantly male, of white ethnic origin, and have mental health problems or be substance abusers. Most concerning is the impact on life expectancy, as the average life expectancy of a homeless person can be 30 or 40 years less than average. This inequality in health means that many homeless people have a life expectancy equivalent to that of a person living in England over a hundred years ago, a life span of maybe only 40 or 50 years (see page 35 of the 2011-12 Devon Annual Public Health Report[http://www.devonhealthandwellbeing.org.uk/aphr/2011-12/]).
These complex health and care needs can make engagement with health, social and welfare agencies difficult. They do not often meet the threshold for an intervention from statutory services, however combined with other issues including lack of accommodation and poor social skills, some individuals are caught in a cycle of chronic exclusion, unable to get the support needed to cope with basic functions of everyday life[http://www.devonhealthandwellbeing.org.uk/wp-content/uploads/2011/07/Homelessness-Health-Needs-Assessment-2011.pdf]. Public Health Specialist Nicki Glassbrook carried out a detailed health needs assessment of the homeless population which explored the complexities of this population’s needs and this requires a different approach, such as the Making Every Adult Matter (MEAM) programme, which is now being piloted in Devon.