Homelessness is leading to a health crisis

Heidi Pullig
Still from 'From the Cubby'

Two hundred and eight-two thousand people are considered homeless in England, and the problem is predicted to get worse as 1.7 million households could be pushed into homelessness this winter due to the cost of living crisis.

The grim forecast shared by homeless charity Crisis brings to light the reality of the homelessness emergency the UK is facing this winter. Considering the severity of the issue, and the number of families who could be facing destitution this Christmas, Joe Spence, a doctoral researcher from the University and co-director of a new film which exposes the reality of homeless people suffering disease, explains that that homelessness is also leading to a health crisis.

He said: ‘Emergency accommodation is a minefield that many people arriving off the streets aren’t able to navigate, and so they find themselves evicted and often even more deeply entrenched. As an alternative, housing first initiatives, with intensive wrap around support, have been shown to be more effective. Housing first takes on the principle that before somebody can address an addiction, or other health issues, they first need a stable, secure, properly furnished, and permanent space to rebuild from.’

Last year alone, more than 1,200 people in the UK died while homeless. The challenges that are faced by homeless people who become unwell with diseases such as tuberculosis are depicted within Joe’s new three-part feature length film From the Cubby, which is co-directed with Nick Chamberlain – the protagonist of the film.

Nick said: ‘Our homeless communities should be given options. Person-centred support should be provided for as long as it is needed, and people should have opportunities to tailor services to their needs. To my mind, many people with experiences of homelessness are also experts of their own lives, and therefore should be included in decision making process.’

Based on five years of documenting a community in Kent which suffered from an outbreak of microbacterium africanem (a strain of tuberculosis) in 2017, From the Cubby demonstrates tuberculosis’ enduring and escalating threat to public health, the social contexts that help it to thrive, and the broader challenges of eradicating it globally.

Nick and Joe created the three-part documentary film to propose and advocate towards new health and social care interventions to better protect those sleeping rough, including the ‘Housing First’ principles for people who have experience homelessness, which champions stability as the first port of call for supporting homeless people with chronic health and social care needs.

The film makers are also encouraging that new approach is taken to the addiction problem associated with homelessness by implementing harm reduction interventions for drug users such as supervised injection centres, which aim to reduce the acute risks of disease transmission through unhygienic injecting.

Part 1 of From the Cubby ­- ‘The Travellers Tale’ – was launched at Kent’s Canterbury campus on Friday 9 December. From the Cubby is directed by Joe Spence and Nick Chamberlain, whose personal experience of tuberculosis disease and homelessness is featured in the film itself.

Earlier this year a research and development screening was hosted at Canterbury Cathedral, which was attended by 150 guests representing 40 organisations from across Kent. Since the screening the From the Cubby production team have been developing the series in line with the feedback from stakeholders and participating organisations.

Joe Spence’s research addresses tuberculosis among patients experiencing treatment barriers such as drug addiction and homelessness. It takes form as a written dissertation and a feature documentary film called From the Cubby . Based on years of fieldwork, it addresses the 1984 Public Health Control of Disease Act and the prospect of implementing Part 2A Court Orders as a resort to achieving compliance when patients are unable or unwilling to comply with authorities and self-administer medication.

Joe’s ethnographic works have been produced collaboratively with healthcare providers and former patients, among them a man called Nick. In 2017 Nick was an entrenched rough sleeper, addicted to heroin and suffering from the early symptoms of tuberculosis. In the year that followed Nick was hospitalized and then discharged into unsupported emergency accommodation with the duty to self-administer a six-month course of daily antibiotics. Complex and interrelated circumstances made it difficult for him to keep appointments and maintain his doses, leading to deteriorations of health, potential drug resistance, and the risk of infecting others. The situation escalated to the extent that Nick ended up being prosecuted by his local authority and forcibly detained in treatment facilities under Part 2A of the Public Health (Control of Disease) Act 1984. His case study provides unique insight into the use of legal controls such as Part 2A Orders as a mechanism towards disease control.

Working in a creative partnership, Joe and former research participants aim to contribute a resource that can be of practical assistance to service providers, to share lived experience of communicable disease and the attendant challenges of finding, diagnosing and treating ‘hard to reach’ populations. The overarching aim is to build a platform for patient-led research, advocacy and action. “From the Cubby” and its integrated ethnographic dissertation will be premiered in December 2022 and toured nationally as part of a programme of dedicated outreach events.