Homelessness and extreme psychological sickness are intently linked, forming a cycle of marginalisation. Within the UK, the proportion of homeless people with a psychological well being prognosis rose from 45% in 2014 to 82% by 2021 (Homeless Hyperlink, 2021). Inside this group, the experiences of homeless ladies are sometimes neglected. Disaster (2023) discovered that 64% of homeless ladies face psychological well being challenges, ceaselessly associated to trauma comparable to home abuse, sexual violence, and youngster loss. They’re thrice extra prone to expertise psychological well being issues than ladies within the common inhabitants, and their common age of loss of life is simply 43, in comparison with 83 years nationally (ONS, 2022).
Regardless of these stark realities, entry to care stays fragmented. Ava Phillips’ Psychological Elf weblog highlights how each people who find themselves homeless and hostel employees battle to navigate well being and social care programs, typically feeling excluded and unsupported.
The present research responds with a phased housing mannequin tailor-made to the complicated wants of homeless ladies (Conger, 2025). Performed in Bengaluru, India, the research aimed to supply a framework for bettering psychological well being assist and housing stability for homeless ladies that would inform follow extra broadly.
Ladies who’re homeless are thrice extra prone to expertise psychological well being issues than ladies within the common inhabitants, and their common age of loss of life is simply 43.
Strategies
Conger et al. employed an progressive qualitative design to develop and validate a supported housing programme for homeless ladies with extreme psychological sickness. Information have been collected via semi-structured interviews with homeless ladies with extreme psychological sickness (HWSMI; n=14) and psychological well being professionals (n=18), alongside observational visits to related organisations. They shortlisted 6 organisations working on this space and with this inhabitants to discover their working practices and the present points they confronted.
Thematic evaluation (Braun and Clarke, 2006) was used to determine key themes, and a Concept of Change mannequin (Breuer et al, 2016) was developed and reviewed by 7 nationwide and three worldwide specialists together with social employees, psychologists and psychiatrists.
Outcomes
Conger’s analysis crew recognized 5 main themes and 80 subthemes, which knowledgeable the event of a three-phase supported housing programme. Almost all HWSMI members reported a number of hospitalisations, household rejection, and experiences of violence or abuse. Professionals famous that present housing schemes have been ill-equipped to assist ladies with complicated psychiatric and social wants.
First, the research recognized the causes of homelessness and protracted boundaries to reintegration, together with household rejection, stigma, poverty, and systemic gaps in psychological well being companies and housing provision.
Second, the impacts of homelessness have been documented, together with a lower in total wellbeing and each day dwelling expertise, alongside a rise in vulnerability to abuse and social isolation.
Third, an examination of present service fashions highlighted the significance of steps in the direction of independence, incorporating transitional housing, everlasting supportive housing, and community-based rehabilitation.
Fourth, the facilitators of profitable reintegration, have been recognized. They included peer assist networks, skill-development initiatives, entry to healthcare and co-ordinated multi-sector motion.
The research additionally emphasised the necessity for safe housing, psychosocial assist, vocational alternatives, and authorized help, grounded in dignity, autonomy, and selection.
These themes have been then mapped to three phases of intervention:
1. Tertiary Care Part
- Targeted on stabilisation and psychiatric therapy inside institutional settings.
- Obstacles included lack of discharge planning, stigma, and absence of community-based alternate options.
- Professionals reported difficulties reintegrating ladies resulting from household rejection and security issues.
2. Transit Residence Part
- Proposed as a short-term, structured setting bridging hospital and neighborhood dwelling.
- Emphasised skill-building, psychoeducation, and gradual autonomy.
- Members highlighted the necessity for trauma-informed and gender-sensitive assist.
3. Neighborhood Part
- Deliberate as impartial dwelling with ongoing psychosocial assist.
- Challenges included housing discrimination, monetary insecurity, and restricted entry to psychological well being companies.
- Professionals harassed the significance of peer assist and neighborhood engagement.
Almost all homeless ladies on this research reported a number of hospitalisations, household rejection, and experiences of violence or abuse.
Conclusions
The research concludes {that a} phased, gender-sensitive supported housing programme can considerably enhance outcomes for homeless ladies with extreme psychological sickness. By integrating tertiary care, transitional housing, and neighborhood reintegration, the mannequin addresses each medical and social determinants of restoration.
The authors conclude:
A supported housing programme tailor-made to the wants of homeless ladies with extreme psychological sickness is possible and essential to advertise sustained restoration and social inclusion.
Whereas additional feasibility testing is required, this intervention provides a promising framework for psychological well being companies in low-resource settings and highlights the pressing want for policy-level assist.
This research concludes {that a} phased, gender-sensitive supported housing programme can considerably enhance outcomes for homeless ladies with extreme psychological sickness.
Strengths and limitations
Conger et al.’s research provides a beneficial contribution to the sector of neighborhood psychological well being, notably inside low-resource settings. Its strengths lie in a sturdy multi-source qualitative design, incorporating interviews with each service customers and professionals, alongside observational visits to related organisations. This triangulation of knowledge sources enhances the credibility and depth of the findings. A Concept of Change mannequin was developed to map the intervention’s logic, outlining inputs, actions, outputs, and supposed outcomes. Validated by specialists, it enhanced the programme’s conceptual robustness. The wealthy narrative knowledge illuminated systemic gaps and repair consumer wants, and positions the intervention inside a broader programs framework, which is particularly necessary in complicated social care environments.
Nevertheless, a number of methodological limitations warrant nearer scrutiny. Regardless of the research’s deal with among the most structurally oppressed and intersectionally deprived people, moral concerns will not be completely addressed. Whereas knowledgeable validation of the ToC mannequin is famous, there is no such thing as a proof of participant involvement in shaping or reviewing the framework. This lack of significant coproduction implies that the intervention might not adequately replicate the lived experiences of these it goals to assist, and excluding these voices probably limits the transformative potential of the intervention.
Extra readability on the recruitment technique is required round inclusion and exclusion standards or sampling strategies as there’s a danger of choice bias; notably if members have been chosen primarily based on accessibility or eloquence. This may increasingly skew findings in the direction of these extra in a position to have interaction, inadvertently excluding people with extra extreme psychological well being points or communication boundaries.
Though participant numbers are acceptable for a qualitative research, the absence of element on how relationships between researchers and members have been managed weakens transparency. Moreover, the research lacks a reflexive account of the researchers’ positionality and the affect this had on knowledge assortment and interpretation. Observer bias can form thematic evaluation, particularly in delicate contexts. The absence of participant validation or member checking additional limits the research’s robustness. Additionally, no conflicts of curiosity or funding sources are disclosed, which restricts our skill to evaluate institutional bias, which is especially necessary given the research’s coverage implications. Nevertheless, the bidirectional hyperlink between homelessness and psychological sickness is well-established, a multi-source method and knowledgeable validation lends weight to the findings. Total, the research addresses a key hole in neighborhood reintegration fashions for this inhabitants.
Given the vulnerability of those members, working co-productively and explicitly outlining moral safeguards would strengthen this research’s high quality.
Implications for follow
This research gives proof that supported housing programmes tailor-made to homeless ladies with extreme psychological sickness will not be solely possible however urgently wanted. From a medical standpoint, the phased mannequin proposed – spanning tertiary care, transitional housing, and neighborhood reintegration – aligns with recovery-oriented ideas and trauma-informed care. It addresses the persistent gaps we see in follow: ladies discharged from inpatient items with nowhere protected to go, biking via shelters, hostels, or the streets, typically re-traumatised and re-hospitalised.
Key facilitators for profitable reintegration included:
- Entry to transitional housing
- Gender-sensitive assist programmes
- Neighborhood-based psychological well being companies
- Authorized and monetary advocacy
These findings knowledgeable the design of a culturally related, trauma-informed supported housing programme with potential for adaptation in different low-resource settings. As a psychological well being skilled with 20 years of expertise, I’ve witnessed firsthand how housing instability undermines restoration. And not using a steady, protected setting, therapeutic positive factors made in hospital are shortly eroded. The research’s mannequin provides a sensible and humane various that centres dignity and continuity of take care of marginalised and under-served ladies.
From a coverage perspective, this analysis ought to immediate a basic re-evaluation of how housing is positioned inside psychological well being companies. Housing must be recognised as a core part of care, not an afterthought. Within the UK, this implies integrating supported housing into discharge planning, commissioning gender-specific transitional houses, and funding community-based psychological well being assist that continues past hospital partitions. The present fragmentation between well being, housing, and social care programs fails these most in want.
The research additionally suggests new avenues for analysis:
- Feasibility and end result evaluations of the proposed mannequin in numerous cultural contexts
- Longitudinal research on restoration trajectories of HWSMI in supported housing
- Co-production fashions that contain service customers in designing housing interventions
Importantly, Conger et al’s work reminds us that restoration is relational and environmental. It’s not nearly symptom discount; it’s about dignity, security, and belonging. For frontline practitioners, this implies advocating for housing as a therapeutic intervention and listening deeply to the lived experiences of these we serve.
There may be an moral crucial for public and neighborhood well being employees to maneuver away from passive commentary, in the direction of actively difficult programs that criminalise poverty and neglect psychological well being wants (Padgett, 2020). Silence and neutrality within the face of housing injustice perpetuates bodily and psychological hurt. Well being professionals have a remit to interact in coverage advocacy, an obligation of care to push for inclusive housing insurance policies, and to amplify the voices of individuals with lived expertise. The foundation causes of homelessness are complicated, and the affect on weak individuals is devasting – new methods of working extra holistically which assist well being and social care professionals reply successfully are to be welcomed.
Housing must be recognised as a core part of care, not an afterthought, however the present fragmentation within the UK between well being, housing, and social care programs fails these most in want.
Assertion of pursuits
No conflicts famous.
Hyperlinks
Major paper
Conger, L.R. (2025). Improvement and validation of a supported housing programme for homeless ladies with extreme psychological sickness. Asian Journal of Psychiatry, 85, 103654.
Different references
Braun, V., & Clarke, V. (2006). Utilizing thematic evaluation in psychology. Qualitative Analysis in Psychology, 3(2), 77–101.
Breuer E, Lee L, De Silva M, Lund C (2016) Utilizing principle of change to design and consider public well being interventions: a scientific overview. Implement Sci: IS 11:63.
Disaster (2023) Ladies and homelessness: Experiences, boundaries and psychological well being. London: Disaster UK (Accessed: 15 August 2025).
Homeless Hyperlink (2021) Well being Wants Audit: Psychological well being and homelessness. London: Homeless Hyperlink (Accessed: 15 August 2025).
Workplace for Nationwide Statistics (2022) Deaths of homeless individuals in England and Wales: 2021 registrations. Newport: ONS. (Accessed: 15 August 2025).
Workplace for Nationwide Statistics (2023) Individuals experiencing homelessness, England and Wales: Census 2021. Accessible at: (Accessed: 15 August 2025).
Padgett, D.Ok. (2020) Homelessness, housing instability and psychological well being: making the connections. BJPsych Bulletin, 44(5), pp.197–201.
United Nations Normal Meeting. Common Declaration of Human Rights 1948. United Nations Normal Meeting, 1948.
United Nations. (2025). Objective 11: Make cities and human settlements inclusive, protected, resilient and sustainable. United Nations Sustainable Improvement Targets. (Accessed 15 Aug. 2025).
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