Experience of homelessness during the COVID-19 pandemic in Tower Hamlets, London: a health needs assessment

BACKGROUND: The COVID-19 pandemic has affected people experiencing homelessness in multiple ways. The Everyone In initiative during 2020 was initially transformative in providing short-term accommodation for this group but was accompanied by major disruptions to treatment and support services. Understanding how these changes have affected health needs of people experiencing homelessness in the inner-city London Borough of Tower Hamlets can inform future service commissioning. METHODS: We conducted a focussed health needs assessment of people experiencing homelessness in Tower Hamlets. Quantitative data were gathered from the Combined Homelessness and Information Network (CHAIN), local authority housing services, primary care datasets, and substance dependency services. These data were combined with qualitative data from stakeholder meetings, facility visits, and lived experience insight from service users through interviews and focus groups. Analysis was targeted towards identifying gaps in existing commissioning. FINDINGS: We gathered data from 80 service users experiencing homelessness in Tower Hamlets between Sept 1 to Dec 31, 2021. Participants reported the largest impact of the pandemic being on their mental health. For people registered with specific homeless primary care services, 26·3% were experiencing depression and 12·8% other severe mental health issues. Service users with lived experience of homelessness described feeling let down by mental health support systems, describing that, despite positive experiences of individual staff, they felt the system as a whole was not well integrated. Specific issues were identified in hostel-based accommodation, where poor psychological and physical safety during lockdowns contributed to declines in mental health. INTERPRETATION: Using a health needs assessment, a necessity was identified to support the mental health of people experiencing homelessness in Tower Hamlets emerging from pandemic restrictions. People with lived experience of homelessness attributed deteriorations in mental health to extended time in inadequate accommodation, and reported that environments that take account of emotional and psychological needs were required. Provision of psychologically-informed accommodation environments and improved support service integration must be priorities for future local authority commissioning. FUNDING: None.