Background to the Research

• The Salvation Army is an international Christian church and registered charity working in 118 countries organised around the globe into territories and is one of the largest providers of social welfare in the world. The Seeds of Exclusion research project offers an important insight into the complex needs of people using The Salvation Army's centres in Belfast and in Dublin. Part of a wider research programme, this report aims to increase understanding of key issues that concern a vulnerable section of our society, to inform those designing policy, delivering and funding services and programmes to address social exclusion and homelessness, and to encourage wider debate.

Research Approach

• The wider research programme involved in-depth interviews and validated questionnaires with 967 homeless people between January 2006 and April 2009 at Salvation Army centres within the UK and Republic of Ireland. The study involved self-reporting, screening and diagnostic assessments of respondents to review their early life experiences, the nature and quality of their relationships now and in childhood, the main reasons for their homelessness, mental health issues, levels of substance misuse and abuse and their use of statutory support services. This summary concentrates on those findings relating to Belfast, with percentages given referring to that sample.
  

Main Findings

Underlying drivers of social exclusion

• Respondents attributed relationship breakdown and the lack of supportive relationships as the main reason for their homelessness (51%). Substance abuse and mental health issues compound the problem. One of the tasks for the research is to try and understand the extent to which they draw people into homelessness and social exclusion, perhaps with a greater role than those interviewed are prepared to recognise, and the extent to which they are the consequences of homelessness, but make it more difficult for people to re-establish themselves.

Relationship problems in childhood

• Many respondents all over the UK and Ireland did not have positive relationships with either friends or family. A large proportion of respondents (74%) currently had no relationship with their father. Around half (53%) of interviewees in Belfast, for example, reported some type of abuse or neglect as children.
• Traumatic experiences were more likely to be reported by respondents who had been homeless as children. More than a quarter (28%) of participants who were interviewed were homeless before the age of 18, with 60% of this sample reporting being homeless for at least one year.

Substance misuse

• More than three-quarters (78%) of respondents had a dependency on alcohol or drugs in the month before using Salvation Army services. More than two-thirds (68%) of interviewees with either a drug or alcohol dependency did not recognise that they had a problem.

Clients with both substance misuse and mental health issues

• Belfast had a high proportion of respondents with a dual diagnosis of both mental health disorders and substance dependency (49%). Only around one fifth (19%) of people in Belfast who had a dual diagnosis were receiving treatment for mental health conditions, 6% were in treatment for substance misuse, while 3% were treated for both conditions.

Impact of childhood homelessness on adult outcomes

• Being homeless as a child increased the likelihood of experiencing substance dependency and/or mental health issues in adult life: 80% of such respondents had substance misuse problems, 80% were found to have one or more mental health disorders and just under two thirds (65%) screened for dual diagnosis.

Comparisons of Belfast and Dublin findings with other capital cities in The Seeds of Exclusion research

• Significantly higher levels of posttraumatic stress disorder were found in Belfast and Cardiff than the other cities (Dublin, London and Edinburgh). Generalised anxiety levels were higher in Dublin and Belfast. Reported levels of depression were also greater in Edinburgh and Belfast.
• Risk of suicide was identified as part of a diagnostic Mental Health tool and was calculated from reports of past attempts and current thoughts of suicide. The levels of risk varied considerably, with the highest risks being identified in Cardiff and Belfast.

Conclusions

• The Seeds of Exclusion study revealed the profound impact and long-lasting effects of homelessness and negative experiences in childhood associated with outcomes in adulthood, including substance abuse, mental and physical health and the inability to form positive relationships and strong social networks. Being homeless as a child significantly increased the risk of developing multiple complex needs related to dual diagnosis. This was particularly the case in young adults, a trend which could increase in future years. A greater understanding of this trend should be monitored by long-term longitudinal studies.
• It is of concern that only a minority of the high proportion of respondents with substance misuse and mental health issues appeared to be receiving appropriate support from statutory services. This highlights the need for careful identification of such health issues, using appropriate screening and assessments, to ensure appropriate interventions are offered.
• Based on this research, a number of recommendations are made. As far as possible, people who are homeless should take part in a process of several interviews over time, so that more can be learned about pathways through homelessness - to inform better help. Specific staff training in areas of mental health, substance misuse and dual diagnosis would enable them to identify and better support the majority of homeless people, and improve links to other services. People under 18 years of age have a range of different needs, and may need specific programmes. Further research with families, including young children, who become homeless, is a priority for preventing longer term homelessness and poor physical and mental health.