Our homes are making us sick: scenes from a medical conference on homelessness

The risk that a damp and mouldy home poses to our health was brought into horrible relief by the death of two-year-old Awaab Ishak, who died from prolonged exposure to mould in a housing association flat in December 2020. 

At the end of June this year, a coroner concluded that mould could have contributed to the death of Jane Bennett, who died from lung disease in her council house in Nottinghamshire in 2023. Numerous other cases have emerged where residents have developed asthma and other respiratory problems as a result of damp and mould in their homes. 

But what are the less visible health impacts of the housing crisis? As Inside Housing calls on the new government to Build Social, how has the national failure to build enough social homes taken its toll on the mental and physical health of those in insecure, substandard housing?

Living in precarity

“Beyond the physical conditions of disrepair, the way in which disrepair is managed also affects the health of tenants very deeply,” says Mr López Botey. 

Increases in anxiety, depression and stress have all been linked to unaffordable rents, temporary accommodation and overcrowded housing.

A 2019 study by researchers Amy Clair and Amanda Hughes, Housing and health: new evidence using biomarker data, tracked instances of the C-reactive protein (CRP), a biomarker associated with infection and stress that indicates worse health.

The study controlled for direct influences of housing on health – low temperatures leading to infection, for example – to focus on indirect effects such as the physiological impact of stress brought on by living in insecure housing. It found that private renters and those who want to stay in their current home but are worried they might not be able to had a higher level of CRP.

Speaking to Inside Housing a few days after the conference, Dr Rebecca Farnbury*, a doctor who is retraining as a psychiatrist, says that every mental health issue gets worse with the stress of housing insecurity. “I have a patient who gets very stressed every time her housing contract is up for renewal,” she explains. “Precarity is really bad for people. Not having safe, consistent housing is bad.”

Some mental health conditions, such as post-traumatic stress disorder, can get worse in treatment before they get better, Dr Farnbury says. 

“There are deep, complex therapies that delve more into your background. They can make people feel worse while you’re bringing up things from the past,” she explains. “Basically, there are some kinds of therapy where you want to have some stability.”

In some cases, patients who have engaged with therapy and are getting better find their progress is blocked when they encounter a housing issue.

“All the progress that they’ve made unravels a bit,” Dr Farnbury states. “It really should be fixable. They should be protected from this insecurity.”

During an afternoon workshop at the conference, the focus is on bringing about change for families experiencing homelessness. The audience is small, and the atmosphere is serious but friendly. One of the conference organisers tells the presenters that next year they will be given the big room, to reflect the importance of the topic.

“The mental health of children is something that we don’t talk about very much at all,” says Professor Monica Lakhanpaul, a professor of integrated community child health at University College London and a consultant paediatrician at Whittington Hospital in London.

She talks participants through the findings of the Champions project, which investigated the effects of the coronavirus pandemic and lockdown on children under the age of five in temporary accommodation. 

Researchers found that without space to play, a child’s development can be impacted physically and socially, resulting in delayed motor-skill development and weaker communication skills. It can also affect children cognitively, leading to poor mental health, poor decision-making and a lack of self-awareness.

Earlier this year, Inside Housing carried out an investigation into how many children under five were in temporary housing in the UK. Based on data received from councils via Freedom of Information requests, the investigation estimated that as of December 2023, there were more than 35,400 households living in temporary accommodation with children aged under five, with around 2,200 of them in B&B accommodation.

“Safety came up a lot in what we were doing. [Families were] unhappy, frustrated, they couldn’t have a routine for their children, and the children were having separation anxiety and a lot of attachment issues as well,” Professor Lakhanpaul says.

“We talk about adults who are homeless, then we talk about families who are homeless, and actually nobody is talking about children with complex needs”

Within the overall statistics on homeless children, one under-represented group is children with complex medical needs.

A new research project, which is still in a very early stage, is looking at children with complex health needs in north London and Essex, including those in insecure housing. SPROCKET (which stands for Systems and Process Redesign and Optimisation at Childhood Key Events and Transitions) will focus on children and young people at risk of being poorly served at particular transition points, such as moving home or during the switch to adult services.

“We talk about adults who are homeless, then we talk about families who are homeless, and actually nobody is talking about children with complex needs,” Professor Lakhanpaul says.

“We’ve heard some horrible, tragic stories. How do you have oxygen or a wheelchair in such a crowded room? Children just start to get the support they need when they have to move and start all over again, delaying the treatment and the support.”

A health system at breaking point

In a sector already stretched to its limits, health professionals are facing increased pressure to help sort out patients’ housing issues. “We’re not trained for it,” trainee psychiatrist Dr Farnbury states.

The story of community health professionals doubling as housing officers and vice versa is not new. What is still being grappled with is how to come to terms with ‘moral injury’ – the fact that often in all these roles, it is not possible for professionals to provide the quality of care a patient needs because of failures in the system.

What becomes apparent throughout the conference day is that both healthcare staff and people experiencing homelessness are caught in a culture of guilt, blaming themselves for situations beyond their control. 

Moral injury captures the cluster of negative emotions – feelings such as guilt, shame and anger – that come from suppressing or betraying moral values. Initially observed among military personnel and veterans, moral injury has been felt keenly by healthcare and housing staff, many of whom perform emotional labour and witness trauma on a daily basis. 

“You will all remember a moment that was the first time you felt that what you were trying to do just wasn’t possible,” Gill Taylor, inclusion health learning lead at Pathway, tells delegates in the opening session.
“It didn’t matter how hard you tried to do it.”

Ms Taylor is “unapologetically emotional” about the injustice and the betrayal of these moments, and scathing about the suggestion that the solution is for staff to build their individual resilience, or practice self-care. “There just is no amount of scented candles and lovely baths that can fix this,” she says.