Why Should We Think About Trauma in Homelessness Services?

In our last blog we discussed that at least 47% of the general population have experienced trauma and Adverse Childhood Experiences (ACEs). When we look at people experiencing homelessness however, that number jumps to around 92% (Irving & Harding, 2022).

In this blog, we will look at the prevalence of childhood and ongoing trauma for people experiencing homelessness, as well as the long-term physical and mental impact of trauma and think about why we need to consider this when designing and delivering homelessness services. 

Prevalence

In their study Irving and Harding (2022) asked 115 people accessing homelessness services in the UK to fill out questionnaires to better understand their experiences. Almost two-thirds of the people who responded said that they had experienced four or more traumatic events in their lifetime, and 70% reported that trauma had a significant negative impact on their lives. 

High levels of trauma have been reported in earlier studies. Liu et al. (2021) pooled the results of several studies and found that 89.8% of people experiencing homelessness had experienced one or more ACE, and 53.9% had experienced four or more ACEs. 

Homelessness itself represents further trauma for many people. For example, Westaway et al. (2017) interviewed hostel residents who had experienced frequent moves between services. They spoke about layers of traumatic loss which made it difficult to have hope for the future. Many of them spoke about hostels offering “just the basics”, which exacerbated their feelings of not belonging and having no community. 

The physical and mental impact of trauma

The physical impact of trauma is often overlooked. Early trauma has a significant impact on how our brains form. When we are born, our brain has millions of potential connections which get “pruned” during our early years. The pathways which aren’t used, don’t form and those which are used a lot become more rapid and automatic - ‘Neurons that fire together, wire together.’
If a person’s early experiences are full of violence, deprivation, and loss, the brain becomes wired to expect these experiences in the first instance. The brain is primed for threat, constantly looking for potential violence, trying to survive. 

If you’ve ever heard something go bump in the night, or had to do something which terrifies you, you will understand the impact of this heightened “threat mode” on your body. We call this “fight or flight”, when your heart is beating faster, your breathing becomes shallower, and your body is flooded with adrenaline and cortisol to enable you to fight or run. 

The problem comes when the body is chronically in “fight or flight”, and constantly experiencing higher levels of these hormones. This chronic activation, as a result of trauma, has been linked to increased risk of heart disease, strokes, hypertension, chronic pain and even conditions such as diabetes. 

This is before we consider the emotional impact of trauma. The learned beliefs about ourselves, others and the world around us as scary, violent, abusive or neglectful. Some more commonly discussed experiences are things like flashbacks, nightmares and low mood or anxiety, but there are a multitude of other emotional difficulties left in the wake of trauma.
People might have a fragmented sense of self, feeling that they are “all over the place” or experiencing rapid changes in feelings, thoughts, and behaviours. People might have difficulty building trusting relationships, communicating their needs to others, or seeking support. 

The emotional impacts of trauma vary, usually according to what sense the person made of their experiences at the time. This can often be difficult to verbalise because these understandings were formed in childhood and stay with us as core beliefs about ourselves and others. This is why it’s important to give time to developing a relationship with the person you are working with, to really understand why they might behave or react in certain ways or believe certain things about you or your service. 

For  the reasons mentioned above, we must consider the role of trauma when we design and deliver services for people experiencing homelessness. We need to understand, approach with compassion and be flexible to ensure that we can meet the needs of our clients and avoid further re-traumatisation. 

If your team could use some help to think about this, get in contact and talk to us about how we can support you to understand and consider the impact of trauma in your work.