Benefits for Health: Exploring the connection between welfare, health and homelessness

This Benefits for Health research from Groundswell, funded by us, shows the complicated relationship between health and welfare benefits for people who are homeless – making it difficult for people to move out of homelessness.

The study, carried out between 2019-2020, was led by researchers with experience of homelessness using a peer research methodology. The research engaged 242 people who are currently experiencing homelessness in London, whose stories were collected using focus groups, case studies and one-to-one survey-based interviews.

Poor health and issues with benefits are causes of homelessness and are continued challenges for people experiencing homelessness.

• Many participants (54%) reported that physical and mental health issues and/or addiction contributed to them becoming homeless and 20% cited issues with benefits as a cause of homelessness.
• Where benefits issues were cited as a contributing factor in causing homeless, 60% of participants also cited mental and/or physical health issues as contributing to them becoming homeless.
• The health profiles of the participants showed a significant proportion (83%) were either experiencing poor physical health and/or mental health.

Challenges in navigating the benefits system were common, and often ill-health or disability was a cause or contributing factor that further embedded these issues.

• The process of claiming benefits was highlighted as a key challenge by participants; 65% of participants agreed with the statement; “being able to claim benefits when I was homeless was difficult”. The application process, easements and adjustments were often not adequately explained or applied to claimants.
• Often participants felt they were not on the correct benefits for their high health and wellbeing needs.
• Unrealistic expectations were placed on participants in order to maintain benefits.
• Physical and mental health issues often exacerbated the ability to manage claims successfully. For example, participants missed or were late for appointments because of ill-health.
• Challenges maintaining claimant commitments caused sanctions. Of those who were receiving benefits, 28% had been sanctioned in the past 12 months, and over half of these were sanctioned for more than four weeks.

Welfare challenges had a significant impact on the health and wellbeing of people experiencing homelessness.

• For many participants, their income from benefits was reported not to be enough to live healthy lives. This was particularly important for those who were currently sanctioned or had deductions from their benefits. Over a third (35%) of participants reported that they received less than £300 a month.
• Often the requirements placed on claimants who are homeless do not account for individual circumstances including how being street homeless or unstably housed can impact the ability to stick to their claimant commitment
• Participants commonly shared how ‘benefits stress’ was a constant reality when homeless and are amplified due to sanctions, work capability assessments, providing proof of ill health and the stress of adhering to claimant commitments
• Sanctions and delays in payments caused participants significant stress resulting in participants not being able to eat and in some cases, engaged in activities that were not good for wellbeing. For example, some participants went hungry, stole or needed to beg.
• Participants shared examples of where the limited trust they had in the welfare system impacted on their engagement with broader health and social care system. For instance, a negative experience with the DWP influenced the perception of other support services and vice versa.

Despite high health needs, challenges in accessing healthcare were common among participants and were often exacerbated by challenges with benefits.

• Use of emergency care was common; a third (37%) having accessed accident and emergency care in the last 12 months, and 27% had been admitted to hospital in the past year.
• Misunderstandings around requirements for benefits in terms of accessing health care were common. For example, participants were not always aware of their entitlements when receiving benefits and challenges with proving receipt of benefits meant some participants were unable to access medication and other health services.
• Among all participants who had accessed or tried to access, 52% had challenges accessing dental care, 43% accessing an optician and 41% accessing prescribed medication from a pharmacy.
• Managing competing priorities in terms of health and social care support could often be a challenge. It can also mean that people experiencing homelessness may miss out on essential care and services.

The benefits and health systems could be working in a more integrated way for the benefit of the health of people who are homeless.

• Participants shared examples of where staff at the Jobcentre had been supportive. However, only 36% of participants felt the staff were knowledgeable about homelessness.
• Being in receipt of the 'right' benefits was felt to have a positive impact on the health and wellbeing of participant.
• The importance of good relationships with staff at the Jobcentre is key to maintaining trust in the 'benefits system' and also the broader social care system.

Based on the findings of the Benefits for Health research and what participants told researchers needs to change, Groundswell suggest the following recommendations for welfare and health systems to better support the health and wellbeing of people experiencing homelessness:

• The Department of Work and Pensions (DWP) and Jobcentre Plus should ensure that claimants who are experiencing homelessness are on the right benefits and have appropriate easements in place.
• Measures should be taken to improve the quality of service provided by the DWP and Jobcentre Plus to better support people experiencing homelessness.
• National government should ensure that benefits are ample to be able to support the health and wellbeing of people experiencing homelessness and wider society. Benefits should cover the cost of living.
• Health and social care workers need to be better informed of the rights and entitlements of people who are experiencing homelessness around benefit entitlements and access to healthcare.
• The Ministry of Housing, Community and Local Government and the Department of Work and Pensions should ensure that data is captured on benefits usage for people experiencing homelessness.