Our research focus at the Centre for Homelessness and Inclusion Health is on the multiple and complex ways that health care professionals, homelessness services and people who experience homelessness interact to improve or limit health care outcomes. The heart of our work is around:
- Staff wellbeing, compassion and communication
- Women’s health
Women’s health is under-researched in the homelessness field as much of the focus is on rough sleepers, most of whom are men. Our research focuses on the intersections between maternal health, gender-based violence and homelessness.
Professor Stewart Mercer has experience in researching complexity and multimorbidity in relation to deprivation. There have been relatively few publications on multimorbidity in the area of homelessness. Staff wellbeing seems to be relatively under-researched in homeless services, though anecdotally on the ground there are major issues with retention and burn-out in these services.
There are cross-cutting themes that apply to these topics. Compassion and communication are important in all services but especially in those for the homeless. Compassion is becoming a focus for research, and there is a strong literature on empathy in healthcare. However, there seems to be little focus on this in homelessness. Strategically, it’s a timely them as Edinburgh University has a Global Compassion Initiative with Stanford University, which has very high-level support.
Communication is key to the integration of services and to the provider-client encounter. The type of communication skills taught to medical and nursing students and GPs/community nurses in training may be of limited utility in homeless setting, and there is a need to research and understand the skills, values, and knowledge required to communicate effectively with marginalised groups.
Transitions are also important across all themes. These can include transitions across the life-course, such as adolescence to adulthood, parenthood, ageing, and frailty. Transitions can also mean the transitions into and out of homelessness. Most people consult a GP or mental health service in the month or so prior to becoming homeless. When people move out of homelessness they are often faced with multiple barriers, such as social isolation, ongoing health problems, and the need to engage with a new set of support services (finding a new GP, etc).
Trauma is also a cross-cutting theme, and may be the underlying root cause of many of the health and addiction problems that homeless people face. Adverse Childhood Experiences (ACEs) is a ‘hot topic’ in Scotland, with ambitions to become an ‘ACE-Aware Nation’. The Scottish Government supports this work, and pilots work is currently underway by Health Scotland on ‘ACE enquiry’ in GP consultations in deprived areas. The Edinburgh Access Practice (EAP) is included in this and we work closely with staff there.