The rough sleeper

The term ‘rough sleeper’ seems a derogatory one to me, yet I cannot seem to find an alternative. The language we use around marginalised people matters, because pejorative terms will only serve to stigmatise individuals, reinforcing stereotypes and making it even harder to address societal challenges that result in inequality. Official estimates of people who experience rough sleeping have increased by 165% since 2010 to 4677 (Public Health England (PHE), 2019). This does not count the ‘hidden homeless’—statistics for rough sleepers include people sleeping in cars or sheds but not those who are ‘sofa-surfers’, or living in squats, for example (Combined Homelessness and Information Network (CHAIN), 2019; PHE, 2019).

The causes and consequences of rough sleeping are complex and there are clear links with poor physical and mental health. Ill health can be a cause as well as a consequence of homelessness, yet may not always be identified as the trigger. Those who sleep and live on the streets experience some of the most severe health inequalities. Many will have poor mental health and will have often experienced significant trauma in their lives. PHE (2019) reports that half of those people living and sleeping on the streets will have mental health needs, 42% have alcohol misuse needs and 41% have drug misuse needs. There are a range of poorer health outcomes that the homeless person experiences, related to being exposed to poor living conditions, challenges in being able to maintain personal hygiene, a poor diet, high levels of stress, and dependence on drugs and alcohol. Of those people who were seen sleeping in the streets in London in 2017–2018, 46% had physical health needs (CHAIN, 2019). The prevalence of infectious diseases, such as tuberculosis, HIV and hepatitis C, is considerably higher in the street-sleeping population than in the general population. They are also at higher risk of musculoskeletal disorders and chronic pain, skin and foot problems, dental problems and respiratory illness.