Co-producing a systematic review about the impact of trauma during homelessness on mental health (including drug and alcohol use)

Emma Adams is an ARC Mental Health Research Fellow with the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC), and is based at Newcastle University. She is one of the recipients of an individual research career development award through the Three NIHR Research Schools’ Mental Health Programme. Here, she discusses the focus of her career development award.

I want to tell you a story about someone I will call Andy. Andy had quit his job and was living with his dad in council housing. When the initial lockdown rolled out across England in response to the pandemic he was scared, but knew with his dad for support everything would be okay. In the summer things took a turn for the worse when his dad suddenly passed away. Before he knew it he was being kicked out of the place he had called home. Andy had become homeless. He hopped from couch to couch, but ended up in a hostel and it wasn’t like anything he had expected, as he found himself being beaten and bullied. He started to drink to cope with all his grief and anxiety. Andy’s story represents many of the experiences shared within my NIHR School for Public Health Research funded study around access to mental health and substance use support during the pandemic for people experiencing homelessness. Unfortunately, stories like Andy’s are far too common in the conversations I’ve had over the last 18 months.

Trauma can be an experience (physical or emotional) that is life-threatening, harmful, or out of the ordinary that has lasting impacts on all aspects of mental health and wellbeing (SAMHSA, 2014). The European Homeless Federation (FEANTSA) states homelessness and trauma are interlinked through pathways into homelessness, during homelessness, and the experience of homelessness itself (FEANTSA, 2017). Much of the information we know about trauma within homeless populations focuses on events in childhood. However, there is a need to understand how trauma during homelessness impacts mental health if we want to ensure people experiencing homelessness have access to the right support at the right time. If we look at Andy’s story, he experienced the loss of his dad which immediately led him to experience homelessness and once in a hostel he found himself experiencing violence. For many people experiencing homelessness, they will experience similar types of traumas to Andy or others such as sexual or psychological abuse. We also are seeing increasing rates of drug related deaths, so it is not unimaginable that a lot of people experiencing homelessness are watching or hearing about their friends dying.

Over the next year, I am working with four people with lived experience to identify all the qualitative evidence that exists, which share experiences of trauma amongst people experiencing homelessness and their thoughts on what impact it has on their mental health. We have just had our first meeting and kicked off the project. Something that came up in the conversation was that experiences of trauma and its impact on mental health can cause people to remain homeless for longer periods of time. We have co-developed our definitions of homelessness (which is inclusive of the entire spectrum of experiences), trauma, and mental health impacts. We are currently refining our review protocol and plans for involvement across the rest of the review. We are exploring how to make involvement as accessible as possible to ensure the voice of lived experience is at the forefront in our identification of relevant material and our key findings. This is a new experience for many of us and we are excited to navigate many firsts together and learn how we can work better together to figure out what the evidence tells us about trauma during homelessness.

If you’d like to learn more about the systematic review, you can contact Emma directly emma.adams@newcastle.ac.uk  

References:

FEANTSA. Recognising the link between trauma and homelessness: European Federation of National Organisations Working with the Homeless. 2017. Available from: https://www.feantsa.org/download/feantsa_traumaandhomelessness03073471219052946810738.pdf

Substance abuse and mental health service administration (SAMHSA). SAMHSA’s working concept of trauma and framework for trauma-informed approach. Rockville, MD; 2014. Available from: https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf