Debt is highly prevalent within the homeless population. This narrative review makes use of a varied literature to explore the relationship between debt and homelessness, focussing particularly on ...organisational (systemic) and individual factors and formulating the relationship between the two. A number of forms of debt and the causes of that debt are explored, in terms of individual factors such as motivation and organisational factors such as inflexible rent protocols. These factors are considered within the context of the cash economy operated by people who are homeless, together with the survival behaviours that drive such a way of operating. Conclusions are drawn about the nature of interventions and how individual psychological approaches to motivation need to be taken into account.
A review of the literature investigating the role of psychological factors in the relationship between financial hardship and mental health was completed. The review sought to identify which factors ...have been most consistently and reliably indicated, and the mechanisms by which these factors are proposed to contribute to the association between hardship and mental health. Although the review identified that a broad variety of factors have been investigated, skills related to personal agency, self-esteem and coping were most frequently and reliably associated with the relationship between financial hardship and mental health outcomes. Just over half of the studies reviewed concluded that the psychological factor investigated was either eroded by financial hardship, increasing vulnerability to mental health difficulties, or protected mental health by remaining intact despite the effects of financial hardship. The remaining studies found no such effect or did not analyse their data in a manner in which a mechanism of action could be identified. The methodological quality of the research included in the review was variable. The valid and reliable measurement of financial hardship, and conclusions regarding causation due to the use of predominantly cross-sectional design were areas of particular weakness.
•A number of studies suggest that financial hardship impacts mental health.•A range of psychological variables appear to be related to this relationship.•The greatest evidence is for a role for personal agency, self-esteem and coping.•Studies are limited by poor measurement of finances and cross-sectional design.
Psychological therapies have been significantly developing in terms of theory and evidence over the past 30 years. They can be categorized into four broad families, defined by distinct theories of ...the person, psychopathology and change. These are cognitive behavioural, psychodynamic, person-centred and family/couples therapies. The underpinning theory and therapeutic approach of each form of therapy are briefly described, together with current outcome evidence with key references. Appropriate electronic resources are cited for each of the approaches described, and the wider literature on psychological approaches and current UK NHS planning is briefly covered.
Purpose
The COVID-19 pandemic has affected many industries, and reports indicate that this includes the illicit drug market. Recent research suggests that the homeless are particularly vulnerable ...during the pandemic, and the UK Government has acted to house rough sleepers. Research is scarce regarding homeless people’s experiences of the illicit drug market. This study aims to explore homeless people’s experiences of the drug supply in the UK during COVID-19.
Design/methodology/approach
Eight homeless people who use illicit drugs, residing in hostels for homeless people in Southampton, participated in semi-structured one-on-one telephone-based interviews.
Findings
A thematic analysis revealed five themes: availability of drugs, presence of dealers, quality of drugs, finances and personal experiences. Participants reported varying experiences of the drug supply, with lockdown measures expressed as the main reason for reduced supplies, as users found it difficult to find dealers and generate income for purchasing drugs.
Research limitations/implications
The results may lack generalisability to the wider population, such as rough sleepers and drug dealers, suggesting a need for further research into people’s experiences of the drug supply during COVID-19. Research on this topic could be more in-depth through the use of research methods that are convenient for the homeless population.
Practical implications
Services should invest in harm reduction services and encourage homeless people who use drugs to engage in substitution treatment. Homeless services should provide psychological support for homeless people who use drugs.
Social implications
The changes in homeless people’s behaviour following the pandemic may have implications for their interactions with the rest of society (e.g. begging in town centres may reduce). These changes in behaviour may also change the way society can best support homeless people.
Originality/value
The results are partially consistent with other research findings about the illicit drug supply; however, they also suggest that some individuals experienced minimal change in the illicit drug supply.
Individualised Placement and Support (IPS) is a tailored, client-centred employment intervention for people with chronic health conditions. It involves the integration of vocational advisers within ...health teams to optimise return-to-work strategies. The intervention aims to get clients into employment by complementing traditional job searching skills with placements, and one-to-one mentoring alongside a work-focused health intervention.
To explore the concept of IPS for individuals with chronic pain.
A multi-method qualitative study was designed to explore stakeholder views of IPS for individuals with chronic pain in southern England.
Fourteen semi-structured interviews and three focus groups were conducted with current recipients of IPS (clients), employment support workers (ESWs), and healthcare professionals (HCPs). All data were audio-recorded, transcribed, and analysed using thematic analysis.
In total, 11 HCPs, five ESWs, and nine clients participated in the study. The analysis identified four themes. The situations of chronic pain patients were discussed, including their complex needs, multifaceted relationship with work, support from HCPs, and existing programmes that were failing to meet their needs. The intervention input was highlighted, including the recruitment procedures and role of ESWs. Programme activities and outcomes were also identified.
This study identified the complex needs and relationship with work of individuals with chronic pain. It showed that ESWs need to understand the unpredictability of symptoms for individuals with chronic pain and that clients may need additional support before a placement. The findings highlighted several activities for future IPS interventions and potential outcomes for future evaluation.
The person-centred typological approach to personality makes the distinction between overcontrolled and undercontrolled personality types. This review systematically searched for research on the ...utility of these personality types in adult mental health. A total of 43 papers were included, which were divided broadly into cross-sectional studies, longitudinal studies and studies with clinical populations. Three personality types have been largely replicated in both normal and clinical populations: resilients, overcontrollers and undercontrollers. These types show utility in predicting long-term functioning and mental health, understanding heterogeneous personalities within clinical subgroups and have implications for treatment. Some disagreement on the number of personality types deemed replicable across samples and differing methodologies do exist, with some finding a dimensional approach to personality to have greater predictive utility. These personality types have been shown to be important in a number of mental health problems such as eating disorders, which may prove helpful in developing new psychological interventions. These studies point to the importance of overcontrolled personality types as well as undercontrolled in mental health. More research is needed with a greater range of clinical populations.
•Research reviewed indicates usefulness of a taxonomy of resilient, over controlled and under-controlled personality types.•Under-controlled and over-controlled personalities are linked to more severe symptoms.•There are differences in clinical profiles based on these personality types.•More research is needed on theory and practice with a greater range of clinical populations.
In a longitudinal study of 104 participants, the psychological factors of economic locus of control, self-esteem, hope and shame were explored for their impact on the relationship between financial ...hardship and mental health. Participants completed measures of financial hardship, the psychological factors and measures of mental health three times at three-monthly intervals. A hierarchical regression analyses indicated that subjective financial hardship, hope and shame significantly predicted mental health outcomes. Mediation analyses demonstrated that hope mediated the relationship between subjective financial hardship and depression, stress and wellbeing; that shame mediated the relationship between subjective financial hardship and anxiety; and that neither shame nor hope mediated the relationship between subjective financial hardship and suicide ideation.
The homeless population has complex needs. Peers with experience of homelessness offer unique perspectives in supporting those experiencing homelessness. Peer support fostered and developed by ...professional organisations, termed intentional peer support (IPS), formalises this process. This review aims to assess the effectiveness of IPS as an intervention with young adults and adult homeless persons (including streetdwelling and those within services). PyscINFO, Web of Science, MEDLINE, and CINAHL were searched, resulting in ten studies, involving 1,829 participants. Peer support has significant impacts on quality of life, drug/alcohol use, and social support. Common elements of peer support are identified, suggesting possible processes that underlie effective peer support. Shared experiences, role modelling, and social support are suggested to be vital aspects of peer support and moderate changes in homeless clients. One study was deemed to have moderate/high quality; the remaining studies had low and moderate quality. Limitations of each are discussed.
Individual Placement and Support (IPS) is a model of vocational rehabilitation originally developed to help people with severe mental illness obtain and maintain employment. Work disability is common ...amongst people with chronic pain conditions, yet few effective interventions exist. As part of mixed-methods feasibility research and as a forerunner to a pilot trial (In STEP), we investigated the barriers and facilitators to carrying out a future randomised controlled trial of IPS set in primary care amongst people unemployed with chronic pain.
Semi-structured interviews and focus groups were conducted with: unemployed people with health conditions receiving IPS (clients), Employment Support Workers (ESWs) delivering IPS for people with chronic health conditions and primary healthcare professionals. Interviews and focus groups were transcribed verbatim and analysed with field notes using thematic analysis.
All stakeholders generally viewed a future trial of IPS positively and deemed both the intervention and treatment as usual acceptable. Themes that emerged regarding potential barriers were recruitment, the importance of recruiting people voluntarily who wanted to return to work and were motivated to do so and giving them agency in the process; a need for additional training and support of the ESWs; and a risk of over-burdening participants with paperwork. Regarding facilitators however, the themes were offering the intervention early after unemployment, the importance of relationship and continuity with the ESWs and that an employment intervention could bring a range of health benefits.
All stakeholders thought that a randomised trial was potentially feasible and highlighted some potential advantages of participation.
Study no ISRCTN30094062.
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