Data Insight: Homelessness and other severe disadvantages during pathways to adulthood

In this Data Insight, the ADR Wales Housing & Homelessness research team explore experiences of ‘severe disadvantage’ among young people in Wales. These include homelessness, alcohol and drug misuse, and mental ill-health. 

Using linked administrative data, the team created a population-level cohort of young people. They then looked at the healthcare and other records of cohort members from their 16th birthday for a period of up to nine years. The analysis identified when young people were first recorded as experiencing each of the four severe disadvantages of interest. The findings help us understand how often severe disadvantages occur, how young people sometimes experience multiple different forms of disadvantage, and their timing as part of pathways to adulthood.

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Findings at a glance

• Roughly 1 in 18 young people experienced multiple (two or more) forms of severe disadvantage.  
• The most frequent combination of severe disadvantages experienced was mental ill-health and substance misuse (whether drug or alcohol related).  
• Among people experiencing youth homelessness, other severe disadvantages were (on average) experienced before their first episode of homelessness, if they were experienced at all. 

Data used

Though severe disadvantage can take different forms, in this analysis we focused on: 

• Mental ill-health 
• Drug misuse 
• Alcohol misuse 
• Youth homelessness 

Experiences of these disadvantages were identified in healthcare and substance misuse datasets, including: 

• Welsh Longitudinal General Practice Dataset (WLGP) 
• Patient Episode Database for Wales (PEDW) 
• Outpatient Database for Wales (OPDW) 
• Emergency Department Dataset (EDDS) 
• Substance Misuse Dataset (SMDS).

What we found

The final study cohort contained 61,237 young people who had their 16th birthday between 1 April 2014 and 31 December 2015. 

Scale and overlap of disadvantages 

Roughly three out of every 10 young people in the cohort (17,948 / 61,237) had experienced severe disadvantage. The most common form of disadvantage recorded was mental ill-health (27%), followed by drug misuse (5%), alcohol misuse (3%), and finally homelessness (1%). In terms of combinations of severe disadvantages recorded among young people: 

• 71% (43,289 / 61,237) experienced no severe disadvantages. 
• 24% (14,582 / 61,237) experienced only one form of severe disadvantage. 
• 5% (3,366 / 61,237) experienced two or more severe disadvantages, or Severe and Multiple Disadvantage (SMD). 

See Figures 1 and 2 in the full publication to learn more about the overlap of disadvantages.

Timing of disadvantages

For all young people in the cohort, the median age at which severe disadvantages were first recorded was:  

• 19.3 years old for mental ill-health, 
• 19.6 years old for youth homelessness, 
• 19.6 years old for alcohol misuse, and 
• 19.7 years old for drug misuse. 

Figure 3 (see full publication) focuses on young people who experienced homelessness and visualises the median age at which the four severe disadvantages were first recorded. The timing of disadvantages suggests a slightly more differentiated chronological ordering than the whole cohort, building up to youth homelessness. This pattern indicates that mental ill-health (if it occurred) typically preceded homelessness by more than one year. 

A similar ordering was found when looking at the 25th and 75th percentiles of ages, with mental ill-health emerging earliest, followed by substance-related issues, and youth homelessness occurring last. 

Why it matters

Developing a better understanding of SMD helps in the delivery of targeted, cross-sector interventions. Whereas most studies of the scale of SMD in the UK have looked at the adult population, our study finds that many people (in Wales at least) experience severe disadvantages before they turn 20 years old. This shifts the onus for preventing SMD onto youth related services. 

Our approach also moves beyond the static picture of youth homelessness provided by ‘point-in-time’ surveys and counts. By following a group of young people over time, we recognise that experiences of homelessness are dynamic and sometimes linked with other disadvantages as part of people’s pathways to adulthood. Our findings suggest that, if they occur, interactions with public services because of mental ill-health and substance misuse precede homelessness—something also found among people accessing low threshold services for those experiencing social exclusion. 

Though our analysis was not causal, when combined with the sheer scale of mental ill-health among the cohort (one in five young people), it suggests that addressing mental health issues at an early age may be an important part of preventing homelessness. Where any young person is supported by public services for substance misuse reasons, these interactions may form points at which later homelessness could be prevented.