Homelessness, Health and Housing Participatory action research in East London, the E15 Report

Its findings reflect extremely high levels of hidden homelessness; serious physical and mental health issues arising or being exacerbated as a result of insecure housing, and an apparently systemic attempt to remove vulnerable people from the borough.

Out-of-borough placements are not new and there is evidence from as far back as 2007 that this was a strategy that boroughs have used to cope with the growing housing crisis. However, out of borough placements have intensified steadily between 2010 and 2015 (Hancox 2015), exacerbated by the benefits cap, rising rents in London and enabled by the Localism Act (2011), which has allowed councils to discharge duty of care to homeless residents. Such out-of-borough placements are particularly high in Newham (Watt and Bernstock, 2017).

Newham Council has the highest numbers of residents in temporary accommodation in London and appears also to be one of the boroughs placing the highest number of homeless people outside the capital (Spurr 2015). This research was an attempt to understand the experiences of those facing potential displacement and to develop an understanding of the human experience of the phenomenon behind the statistics.

Methodology

A structured interview tool, using questions designed to elicit both quantitative and qualitative data, offering the opportunity to provide more narrative information, was designed in collaboration between housing campaigners who are at the forefront of hearing stories of homelessness in Newham (Focus E15) and the authors.

This tool was piloted and amended in line with suggested changes in order to access the necessary data and to ensure completion by participants. This interview tool is available publicly and free to use for all housing justice campaigners and we strongly encourage activists and researchers to adopt, adapt and amend it (email t.a.gillespie@shef.ac.uk).

Peer interviewers were used to recruit participants using a number of recruitment methods. First, individuals were approached leaving council housing offices in Newham (Bridge House and East Ham). This enabled interviewers to identify individuals who were not previously known to them and who had approached Newham Council for support. Second, non-random purposive sampling was then used to interview people currently living in hostels run by Newham.

While this range of recruitment and sampling methods means that a range of respondents have been included in the research, however, it should also be noted that the figures presented here are reflective of the sample collected, rather than necessarily being representative of those in general facing homelessness in Newham as a whole.

Such an approach, does mean, however, that the research has captured some of the most vulnerable who would not otherwise be represented, particularly in large existing datasets or in studies focused on more established communities, such as on existing estates. In other words, the mobile nature of the research sampling faithfully reflects, and arguably better captures, the “increasingly nomadic” (Watt, cited in Ponsford, 2016) nature of homelessness in contemporary London whereby individuals and families find themselves forced into mobility.

Where possible, interviews were recorded, resulting in a total of 32 recorded interviews. The intensity of flux in people’s lives and the complications they faced brought about insecure and constantly changing housing situations which made it complex to capture data. To some degree, the complex nature of flux and insecurity was better captured through qualitative analysis of the recorded interviews.

The extreme instability faced by people facing homelessness made it extraordinarily difficult to collect and analyse the data and to accurately capture people’s experiences. This was due to the sheer complexity of their situations and the various institutions involved, as well a combination of significant confusion and lack of information, poor mental health amongst some respondents, often making it difficult to generate a coherent narrative.

Findings

People

The key demographic finding is that the vast majority (97%) of respondents had one or more of the following: dependents (children under 16); health or disability needs; dependents with health and disability needs or a combination of these. While these individuals may not be considered statutorily ‘vulnerable’, it is clear that those facing the hardest edge of the housing crisis are some of the most at risk groups of people with specific sets of needs.

Sometimes these needs were pre-existing, while others appeared to have been exacerbated by their housing situations. This suggests that this homelessness is affecting some of the most vulnerable sections of society.

Women were disproportionately represented in the sample, as 67% (42) were female. White (including all census defined ‘White’ categories) people make up 38.7% of those interviewed (compared to 29% of the population in Newham), while Black Asian and Minority Ethnic people made up 61.3% (compared with 71% in Newham).

The vast proportion were British (70%), with 9% EU nationals 20% non-EU nationals. Most respondents (59%) have dependents (mainly children, but also elderly family members or pregnant partners). Amongst dependents, seven had a disability and 20% had a health condition.

Housing situations

The majority (81%) identified as having been homeless at some point in the last five years and 86% said they had to sofa-surf. In a subjective question about their housing status, 53% identified as currently homeless and 47% as currently having a place to live and therefore either under threat of homelessness or living in ongoing temporary accommodation.

Eviction was a common experience, as 73% of respondents had been evicted at some point in the last five years, while 41% had been evicted two or more times. Reasons for eviction included rent rises, cuts to benefits leading to rent arrears and family breakdown. Private landlords, the council and family members were all identified as having evicted respondents.

Transitions into homelessness were extremely complex and were frequently constituted by multiple intersecting processes including job loss, cuts to social support, rent arrears, eviction and family breakdown.

Disability and health conditions

A significant proportion of respondents had a disability (22%) or health condition (48%) which affected their housing needs. More than half (51.9%) of the people interviewed either had an issue with health or disability themselves or had a dependent with such needs. Mental health problems constituted the most common issue amongst respondents (n=18); with diabetes (n=5); arthritis (n=4); heart conditions (n=3); high blood pressure (n=2); terminally ill, HIV positive status, pneumonia and dissociative seizures (1 each) also mentioned.

Insecurity, displacement and housing conditions had an extremely destablising effect on people’s mental health, as 89% mentioned worsening mental health as a result of their housing situation. Specifically, 66% mentioned worsening depression and 25% were suffering from insomnia.

Most worryingly, in an open question about health 9% stated that they had suicidal thoughts and 9% mentioned self-harm. This compares with 4.3% of the general population reporting suicidal thoughts in the last year in response to a direct question relating to suicidal feelings in the Adult Psychiatric Morbidity Household Survey (HCSIC 2007).

For some respondents, their experiences of homelessness led to reduced self-esteem and addiction relapses. Billy (41, white-British) who was currently street homeless, had recently been evicted from temporary housing, having originally

been evicted from his father’s council house when he died. He described how being homeless had “got me back on the drugs, being homeless. If no-one cares about me, why should I care about myself?” He had refused the out-of-borough housing that he had received, as he felt it would exacerbate his substance use and remove him from key sources of support:

They offered me a place on Harold Hill, in Essex … There are too many drugs down there. They said it’s the only pace. I have drug counseling in Newham. I don’t want to leave that and go to somewhere where there are a lot of drugs … I told them to call me when they can offer me a proper place in Newham.

For others, the conditions in which they were currently living were further exacerbating physical health problems. Bruno, 57, was the legal guardian to two children from a previous relationship in which his girlfriend had died. One child has mental health issues. Bruno worked full time as a cleaner, but couldn’t keep up rent payments when his housing benefit was stopped. He was currently living in a bed and breakfast with his family. The cramped conditions were worsening his own health:

[I have] arthritis. [I] can’t soak, [as] I can’t use the bathroom. [I’m] diabetic, I need to be able to go to the bathroom when I need to. There are 8/9 peope in the house – I have to use a bucket in my room … I feel like I’m turning mad.

Emma (24, white-British) had similarly been living in a bed and breakfast with her two young children for over a year and a half. Reductions in income support had also led her to fall behind in paying her rent. Although she identified severe health needs as a result of her current living conditions, she did not want to report these due to fears that it would lead to the removal of her children:

I’ve got scabs from scratching and welts all over my body, I get cold sores and rashes due to stress. I don’t want to get out of bed in the morning (depression). I don’t want to tell social services how much I’m suffering because I don’t want them to take my children away. Then they would stop my housing benefit and I would never get a property and would never get my children back.

The family had initially been relocated as a result of Olympic development in the area.

She was initially evicted by a private landlord who changed the tenancies and replaced her with higher paying tenants. Having approached numerous councils, she eventually “put myself in rehab just to get a roof over my head”. She was currently living in a hostel run by Newham Council and had had to move four times in five years. Like many others, she described her living conditions as greatly exacerbating her health conditions:

I have asthma, chronic obstructive pulmonary disease and now since living in new place, early stages of emphysema. I’ve got welts all over my body which open up all the time due to the stress, I can’t stop scratching them, I’m covered in them. [It has affected my] mental health, [I am] depressed, anxious, suicidal.

Far from extreme cases, the examples provided above are typical of the answers provided by respondents during the structured interviews.

Only 54% of respondents had contacted their GP to discuss their health problems or housing. This is suggestive of under-reporting of health issues and appears to contradict assumptions by the Department of Health that people in temporary accommodation ‘will not generally have significant problems in accessing primary health care’ (Department of Health 2010).

The relationship between poor housing and poor health indicators is well known, including by the World Health Organisation (WHO). There is also growing recognition of a mental health crisis ushered in by austerity measures undertaken in the last eight years. This research, however, demonstrates the ways in which statutory bodies, rather than responding in order to improve health through housing, are creating and exacerbating health problems through both insecure housing and also displacement within or from London.

Budget cuts to mental health services combined with widespread displacement of people creates a perfect storm which can create new health problems and exacerbate existing conditions. This increases costs to state services (including the NHS), as well as to local authorities. Perhaps most worryingly, many people are avoiding contact with health services due to fear of the involvement of social services in relation to custody of their children. This lays the basis for health problems to worsen in the absence of appropriate care, creating more serious needs and vulnerabilities in the near and more distant future.

Employment and income assistance

Amongst the respondents 19% were employed, 6.3% were self-employed and 12.5% ‘other’. The remainder of the sample stated that they were currently unemployed. Current jobs included cleaning (3); office and administrative work (2); NHS receptionist (1); University counselling support officer (1); head waiter (1); school support office (1) hairdressing (1); market trader (1); and care work (1). Seven respondents were students in further or higher education.

Lisa (white-British) an 18 year old woman who currently was working part time and sofa surfing, had been evicted by her parents. She said she:

went to Newham council, [they had] no place for me to stay because I’m not pregnant, mentally ill or elderly … I asked for B&B they refused. I said I was 18 and would be sleeping on park benches. They said because I’m 18 they can’t do anything, if I went five days ago I would have got help. I was 18 five days ago.

Michael (25, African-Caribbean British) was working full time as charity fundraiser for a major charity, he explained that he felt he had been given inaccurate or misleading information:

I applied as homeless in Newham, eventually got put in a hostel. Then when I got moved to [a homeless hostel] I was told I was gonna get nominated for a place – a council place. So I was told not to bid, but that has now proved to be untrue. They told me my tenancy would be for 9 months and then I would get a 1 bed flat. Then they told me you have to be here for 2 years minimum before you get a place. Now the council has taken over the building, [a lettings agent] are putting in temporary accommodation tenants. Now all I’m entitled to is a room in a shared house.

Since 91% of the sample received some form of income assistance, the majority of people in the study were liable to being impacted by recent changes in the level of state provision and the conditionality attached to it. Almost half (49%) said that changes in assistance they received had affected their housing situation. Ahmed (26, British-Asian), had been evicted twice, the first time because he had no official contract and couldn’t keep up the rent:

I got sanctioned last year. I missed an appointment because of a funeral. I started getting into rent arrears because of that, with council tax. I had to put it on a credit card. At that stage I nearly got evicted due to that one sanction. The service charge and interest were massive. There was a 2 week period where I literally had nothing. It was difficult, I was trying to budget, but once sanctioned it was too much, really hard.

Having been told he was not a priority by the council, he was about to sleep on the streets, Newham council placed him in a hostel. He now faces eviction by the council from the temporary hostel he is currently housed in and therefore currently faces the prospect of being street homeless once more.

Displacement and out-of-area housing offers

A majority of respondents (58%) had either been offered housing outside of the borough or told to look for it themselves. Some respondents had been repeatedly offered housing outside of the borough over a number of years. Respondents reported being offered out of borough placements as far back as 2005, with 20% of the sample stating that they were offered housing out of borough between 2005-2008.

That is, before the Coalition government, financial crisis, cuts to housing benefit and the Localism Act (2011). As such, this is a process which has been occurring for over a decade, but which has gathered pace as a result of drastic changes to social support. It is clear that out of borough offers are now systemic in Newham.

A Supreme Court ruling in 2015 meant that councils ‘must now provide evidence of a search for accommodation inside and near to their local authority for homeless households’ (Douglas 2015).

However, many of our respondents appear to have been offered or ‘suggested’ to look outside both the borough (58%) and London (44%) without the relevant evidence provided to demonstrate a lack of housing inside London.

Experiences out-of-borough

Bethany (24, White-British) was housed in a hostel in Newham, according to her this was on the basis she would be offered a council property. After three years, Newham Council began to offer her places outside of London. Despite trying to resist these placements, she argues that she was told “if you don’t accept that, we’re not going to offer you anything else”. She eventually accepted a property in Hastings. The conditions in her new flat are extremely poor.

Despite these conditions, Bethany argues that she would accept these in order to be nearer to her family:

I’d like to be where my family are, I’d like to be able to just ring someone and be like ‘do you want to come round for a cup of tea?… I find myself calling my mum for no reason, or I’ll make up a reason to have to ring her and speak to her, and like same for my nan – I’ll make up a reason like did you just see that thing on the telly? She’ll be like no I wasn’t watching it and I’ll be like “oh alright then”.

Placement out-of-area has further detrimental financial implications. For those in temporary accommodation, they frequently need to pay for storage for belongings or buy entirely new furniture. Constant moving also means that individuals oscillate between purchasing expensive new items and having to pay for storage. Some individuals had lost all of their belongings when they had been unable to pay for storage:

The landlord upped the rent … My husband passed away and my immigration case was going through, it was very difficult... I was in our own place, but it got repossessed when my husband died … I found the next place myself. It was a single room for me and my son in shared accommodation … I was there for 1 year and 2 months. The rooms were empty when we arrived, had to buy everything, I was sleeping on the floor. Now I have had to take everything to storage when we moved to [a hostel]. It’s very expensive. I was told it would be one month, it’s been five.

Many in temporary accommodation are expected to continue to pay for utilities. Jose is living in two studio flats with his wife and four children. He was faced with bailiffs from the Hertfordshire town council, where he is currently housed by Newham Council, for unpaid council tax, as he expected to pay for both properties.

Those in work often struggled to sustain their jobs, having been placed so far outside the city: ‘We have to go to London, we can’t afford it. Because they don’t take into consideration that almost half of the wages go into commuting. Are you supposed to fly to work?’ (Jose, 55, white-Portuguese). Others had had to give up their jobs as they were located too far away from their current employment.

Some had explicitly been told to give up their jobs in order to accept housing outside the city. Cassandra described being forced to be permanently available to travel back into the city to attend housing appointments: ‘I don’t live temporary life even though I’m in temporary accommodation’.

Out of borough placements are also having a detrimental effect on children. Anita (17, black- Portuguese) was evicted as part of a family of seven when her landlord said that her family had built up rent arrears.

My mum has a brand new born baby. We had to sleep at my cousin’s house – all seven of us. We came back here [to the housing office], they found us a temporary house in Leytonstone. My school is Newham … I have to get up at 5 am to get to school, and so much money goes on travel.

The National Homelessness Advice Service (NHAS) is a partnership between Shelter and Citizens Advice, funded by the Department for Communities and Local Government has issued best practice advice (PDF), which includes advice to “equip families with complete info”, provision of support with travel and ensuring thorough suitability screening. It appears that many of these principles are not being followed, leaving individuals and families in unsuitable housing with little support in order to continue their education or employment, with severe knock-on effects on their futures as a result.

Policy recommendations

1. Ending the practice of out of borough placements in light of detrimental social, economic and health impacts on affected individuals
2. Undertake equalities impact assessment due to disproportionate effect on women
3. Home seekers advised to bring advocates to housing meetings
4. All meetings between council housing representatives and residents to be audio recorded
5. Consider people facing eviction automatically as at higher risk of mental health problems, with attendant referrals for services
6. Full and immediate counselling offered to those approaching the council for help with housing and homelessness

More information