“Combined with homelessness, it’s just a nightmare”: A Qualitative Study Exploring How People Experiencing Homelessness Perceive Mental Health and Mental Health Services

People experiencing chronic homelessness (PECH) have relatively poor mental health. Whilst trauma and psychologically informed services are becoming more commonplace and demonstrate positive outcomes, they are still underutilised by PECH. Furthermore, little is known about how PECH understand their own mental health. This qualitative study explores PECH’s perceptions of mental health, mental health services, and any perceived barriers or facilitators to access. Eleven PECH participated in semi-structured interviews. Interpretative Phenomenological Analysis was used to make sense of the transcripts, and five overarching group experiential themes were created: ‘Origins of Mental Health’, ‘Understanding of Mental Health Difficulties’, ‘Experiences of Help-Seeking and Services’, ‘Self-help and Self-preservation’, and ‘Perspectives on Mental Health Needs’. Participants understood their mental health in terms of life experiences and expressed a need for interpersonal connection over traditional psychological or psychiatric model-specific interventions, suggesting that attachment-informed support may be beneficial. Whilst policies begin to acknowledge the importance of outreach services and flexible person-centred support, as yet this does not go far enough; participants perceptions of services were based on, often negative, past experiences, with many feeling that the damage was already done. Services need to be proactive in identifying people who need support, taking a non-judgemental stance, and working to rebuild trust.