by Dr John Barry
Around 85% of rough sleepers are men (St. Mungos, 2016). The reasons for homelessness are many and complex, but the most frequently cited reasons for male homelessness are relationship breakdown, substance misuse, or leaving an institution (e.g. prison, care or hospital) (Brown et al, 2019).
At any one time in the UK there are around 5000 rough sleepers (Ministry of Housing, Communities & Local Government, 2017). This isn’t counting the group often called the ‘hidden homeless’, a much larger number of people – at least 250,000 – with no stable accommodation (Shelter 2016). We know that almost half of rough sleepers have mental health needs (Combined Homelessness and Information Network, 2017), but these figures don’t identify the other type of ‘hidden homeless’ – people with autism.
Autism effects 1% of the population (Brugha et al, 2016). Autism exists on a spectrum of severity (Autistic Spectrum Disorder, or ASD). There are some interesting gender differences that might lead to underestimates of ASD in females (van Wijngaarden-Cremers, 2019), but most estimates suggest that more severe cases are four times more common in males, and the less severe form (Asperger Syndrome) is nine times more common in males (Barry & Owens, 2019).
Given the fact that most homeless people are male, we would expect a larger proportion of homeless people to have autism. In the first study on this topic published in a peer-reviewed journal, Churchard et al (2019) found that autism is at least 12 times more common in homeless people than the general population (or probably more, if it was possible to identify the ‘hardest to reach’ homeless people). This figure far exceeds the rate you would expect if autism in homeless people was simply due to both autism and homelessness being more common in men. So if gender doesn’t fully explain the over-representation of autism in the homeless population, then why are so many autistic people homeless?
Well, substance abuse does not explain it, because people with autism are less likely to have problems with substance abuse than other people (Butwicka et al, 2017). However Churchard et al (2019) suggest that the greater levels of social isolation experienced by people with autism might be the key; autistic people often have fewer people to turn to if things go wrong in their lives, such as their housing being threatened. People with autism are also less likely to be employed, so might slip into the poverty trap more easily (Calsyn & Winter, 2002). Churchard et al also suggest that because people with autism are more likely to experience sensory difficulties (e.g. finding noise distressing), this makes living in shared accommodation or a hostel virtually impossible. Also for those with cognitive impairments to abilities such as planning, everyday independent living might become virtually impossible.
Although the current level of knowledge regarding homelessness and autism is very basic, there has been some progress by a group called Homeless Link (2015), who have created practical guidelines on how to identify autism in homeless people, and how to communicate in a way that best facilitates support for the homeless person.
This article only scratches the surface of mental health issues in homelessness. Other issues that impact the general population of homeless people include a history of childhood abuse and neglect, seen in 80% of homeless people (Torchalla et al. 2012). This type of history creates special problems for housing homeless people, because they may have learned to associate home with abuse and neglect (Duffy & Hutchison, 2019). Trauma prior to homelessness is also common (e.g. military-related PTSD), as is trauma as a result of life on the street (Buhrich et al. 2000).
More research is needed to identify the scale of the problem of autism in homelessness, and to develop evidence-based methods of helping these vulnerable people. There can be little doubt that homeless autistic people should be one of the key issues for anyone interested in Male Psychology.
About the author
Dr John A. Barry is a Chartered Psychologist and Associate Fellow of the British Psychological Society, Honorary Lecturer in Psychology at University College London, clinical hypnotherapist, and author of over 60 peer-reviewed publications on a variety of topics in psychology and medicine. John is a professional researcher and has taken an interest in improving the teaching of research methods and statistics. He has practiced clinical hypnosis for several years and is a member of the British Association of Clinical and Academic Hypnosis. His Ph.D. was awarded by City University London, on the topic of the Psychological Aspects of Polycystic Ovary Syndrome, which is also the topic of his forthcoming book (Palgrave Macmillan, 2019). He is co-founder of both the Male Psychology Network and the Male Psychology Section of the British Psychological Society (BPS).
Barry JA and Owens B (2019). From fetuses to boys to men: the impact of testosterone on male lifespan development, in Barry JA, Kingerlee R, Seager MJ and Sullivan L (Eds.) (2019). The Palgrave Handbook of Male Psychology and Mental Health (pp. 3-24). London: Palgrave Macmillan. DOI 10.1007/978-3-030-04384-1
Brown, J. S., Sagar-Ouriaghli, I., & Sullivan, L. (2019). Help-Seeking Among Men for Mental Health Problems. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 397-415). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1
Buhrich, N., Hodder, T., & Teesson, M. (2000). Lifetime prevalence of trauma among homeless people in Sydney. Australian and New Zealand Journal of Psychiatry, 34(6), 963–966.
Butwicka, A., Langstrom, N., Larsson, H., Lundstrom, S., Serlachius, E., Almqvist, C., … Lichtenstein, P. (2017). Increased risk for substance use-related problems in autism spectrum disorders: a population-based cohort study. Journal of autism and developmental disorders, 47(1), 80-89.
Churchard, A., Ryder, M., Greenhill, A., & Mandy, W. (2019). The prevalence of autistic traits in a homeless population. Autism, 23(3), 665-676.
Combined Homelessness and Information Network. (2017). CHAIN annual report: June 2015. The Greater London Authority.
Duffy, J., & Hutchison, A. (2019). Working with Homeless Men in London: A Mental Health Service Perspective. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 533-556). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1
Homeless Link (2015). Autism and Homelessness: Briefing for frontline staff. https://www.homeless.org.uk/sites/default/files/site-attachments/Autism%20&%20HomelessnesOct%202015.pdf
Ministry of Housing, Communities & Local Government. (2017). Rough Sleeping Statistics, Autumn 2017, England. London: Author.
Shelter. (2016). Green book 50 years on: The reality of homelessness for families today. http://www.shelter.org.uk/__data/assets/pdf_file/0003/1307361/GreenBook_-_A_report_on_homelessness.pdf.
St. Mungos. (2016). Stop the scandal: An investigation into mental health and rough sleeping. http://www.mungos.org/documents/7021/7021.pdf.
Torchalla, I., Strehlau, V., Li, K., Schuetz, C., & Krausz, M. (2012). The association between childhood maltreatment subtypes and current suicide risk among homeless men and women. Child Maltreatment, 17, 132–143.
van Wijngaarden-Cremers, P. (2019). Autism in Boys and Girls, Women and Men Throughout the Lifespan. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 309-330). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1