R9.2 THE HEALTH NEEDS OF HOMELESS PEOPLE: COMPARISONS WITH THE GENERAL POPULATION

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1 R9.2 THE HEALTH NEEDS OF HOMELESS PEOPLE: COMPARISONS WITH THE GENERAL POPULATION This table summarises available data which has been published on the health needs of the general population. This allows comparison with the data collected from the homeless health needs audit. Sources vary, and some are based on different years. As such, comparison should be approached with caution. However, this provides a useful estimate and can be helpful to highlight where homeless people experience particularly high and disproportionate levels of need. For the latest data, you may wish to check the source for any updates provided since the publication of this guide. Alongside national data, local authority based data is provided by Public Health Observatories. This covers broader health than is included in the health audit, but does provide comparative data on health issues including smoking rates and healthy eating. You can search for your area at The majority of the below figures are based on prevalence rates ie the number of people experiencing a need at any one time. The figures for people who are homeless are also based on prevalence rates. They are based on the data from the 727 individuals who took part in the pilot of the Health Needs Audit across nine PCT areas in England (November 2009-March 2010). HEALTH NEED/ISSUE GENERAL POPULATION HOMELESS PEOPLE SOURCE OF GENERAL POPULATION STATS PHYSICAL HEALTH AND WELLBEING Proportion of people 21% who smoke (over 16, 2007) *please note local smoking rates are published by the Public Health Percentage of smokers who want to quit No. who eat five or more pieces of fruit and veg per day Observatories, link above. 67% (2008/9) 29% (27% men, 31% female: 29% overall) (2007) 77% NHS Information Centre _England_2009.pdf p.7 55% NHS Information Centre _England_2009.pdf p.8 7% NHS Information Centre %20final.pdf, page 106 Percentage long term physical health need 29% report one or more long standing illness (2008) 56% ONS General Lifestyle Survey 2008, p.7, available

2 Percentage with diabetes Percentage with physical conditions* 4.9% all adults (2006) 4% NHS Information Centre D_TABLES_2008_to_IC5.xls 2008 General Lifestyle Survey, 2008, Condition % General % Homeless population population musculoskeletal 13% 38% (joint/muscular) Respiratory system 6% 32% (chest/breathing) Heart and circulatory 10% 12% (circulation/clots) Digestive 3% 17% (stomach) Skin complaints 1% 14% (skin infection/wound) Eye complaints 1% 25% (eye problems) *Please note the general population figures are for CHRONIC (ie long term) need, whereas the audit data is based on both short and long term need. The revised audit tool separates this to allow more direct comparison. The variance in terminology is also highlighted so direct comparison should be approached with caution. MENTAL HEALTH Percentage with mental distress (closest equivalent definition of a mental health need as used in the audit) 30% 300 people out of 1,000 will experience mental health problems every year in Britain 102 of these will be diagnosed as having a mental health problem 24 of these will be referred to a specialist psychiatric service 6 will become inpatients in psychiatric 72% (recorded as any mental health need as self reported by client) Based on figures from Goldberg, D. & Huxley, P, 1992, Common mental disorders a bio-social model, Routledge.) See below table for neurotic symptoms Source: ONS, 2000, Psychiatric morbidity among adults living in private households in Great Britain. Asterix denote comparable figures from health data. Diagnosis and rate Female Male All (past week) Sleep problems * Fatigue Depression * Depressive ideas

3 Proportion with a diagnosable mental health problem at any one time Percentage of people who experience depression Percentage of people who experience anxiety Percentage personality disorder Percentage people with bipolar disorder Percentage people with schizophrenia hospitals. Anxiety * in 6 (1 in 4 among unemployed people) 7 in 10 *please note not directly comparable as needs reported in the health audit could include problems which fall beneath threshold for diagnosis 10%. 37% mild 17% severe (49% with either severity). Obsessions Phobias Compulsions Panic* The Office for National Statistics Psychiatric Morbidity report (2001) available via Mental Health Foundation website: According to the ONS, depression occurs in 10% of the population in Britain at any one time, matching closely figures from other studies. Estimates of lifetime prevalence vary from 1 in 6 to 1 in 4. More severe depression gives a figure of 1 in 20 people at any one time who suffer major or 'clinical' depression. Source: Mental Health Foundation, quoting the Office National Statistics Psychiatric Morbidity report (2001) Further detail also quoted on Mind website: General anxiety at 4.7% 41% reported often anxious Office National Statistics (ONS) quoted on Mind webstie 4.4% 5.4 per cent for men and 3.4 for women. Estimates vary 3-13% This has been added as a category in the revised audit ONS quoted on Mind website 1-2%lifetime prevalence 5% ONS quoted on Mind website 0.2% 4% ONS quoted on Mind website

4 Percentage people who self harm Percentage people who experience sleep problems SUBSTANCE USE Percentage adults who are drug users 4% (400 in 100,000) UK rate, % Self-poisoning and self-injury in adults, Clinical Medicine (2002) cited in Samaritans Self Harm and Suicide 29% 50% 10% one or more illicit drug in last year (16-59 year olds) (2008/9) 3.7% class A (2008/09) 52% overall drug use _Misuse_England_2009_revised.pdf p.2 Percentage adults who use cannabis Drug related hospital Average weekly alcohol consumption Cannabis (7.9%) 29% _Misuse_England_2009_revised.pdf p.2 Where a primary diagnosis of 9.8% A&E related to poisoning by drugs was recorded, drug use in audit _Misuse_England_2009_revised.pdf p.3 11,090 s were reported during 2008/09, an increase of 47.2% from 1998/99 In 2008/09, there were 5,668 s to hospital with a primary diagnosis of a drug-related mental health and behavioral disorder units 16.8 units for men and 8.6 units for women. ACCESS AND USAGE OF SERVICES Reasons for A&E A&E by primary diagnosis: (where comparable data exists) Stomach: 3% Breathing problems: 2.6% Injury (combining laceration, dislocation, sprain, contusion): *not a direct comparable. This would need to be extracted from your local PCT using NFA coding as a best estimate. Not direct comparable. In the audit, 34% clients said they drank more than 10 units each time they drank. 20% clients drink more than 4 times per week, the amount considered harmful by DH. Reason for most recent A&E Stomach: 9.4% Breathing problems: 15.6% Injury: 38.6% England_2010.pdf p.7 ance%20tables%20%28experimental%20statistics%29%202008%2009%2 0v2.xls For more detail access and view appendix 3.

5 16.5% % who see a dentist 53.8% (based on 24 month period ending March 2009) Average number of GP visits per year (average came at 2.7 times in past 6 months so assumption this rate continue over 12 months) 34% (within last 6 months) stats0809/nhs_dental_statistics_for_england_2008_09_report.pdf General household survey 2008 table 7.18 based on age group. Average number of visits to nurse per year This figure likely t be conservative as did not specify frequency over 5 times 1.5 (practice nurse) 2.5 (national average 1.2 times past 6 months) This figure likely t be conservative as did not specify frequency over 5 times % admitted to hospital 7% in previous 12 month period 31% (within last 6 months) % attending outpatient or casualty 13.5% (previous 3 month period) 42% (casualty) 27% (outpatient) (within last 6 months) (data for general population does not distinguish) % registered with a GP See right. Analysis for the general population is by registration numbers rather than percentage based and does not distinguish between temporary and permanent). Basic rates could be calculated based on 85% This also has registered numbers by SHA and PCT area. numbers of your local population. OTHER DATA Disability 1-2% learning disability 4.3% df (Learning Disability information)