The Quality of Mental Health Care Received by Homeless Inpatients

Background: Homeless individuals are among the most vulnerable to mental health difficulties yet their access to, and utilisation of, mental health services are poor. When they do access and utilise services, their mental health needs often remain unmet, suggesting potential issues with the quality of mental health care provided to this population. This thesis aimed to compare the demographic and clinical profiles of homeless and housed service users admitted to hospital for treatment of anxiety and/or depression. It then aimed to examine the quality of care received by homeless and housed service users, including referrals for psychological therapy, and investigate demographic and clinical predictors of referrals of homeless service users for psychological therapy.

Method: A secondary analysis of existing data compared homeless (n=223) and housed (n=3572) service user groups on demographic, clinical and quality of care variables using Pearson Chi-square tests. The demographic and clinical characteristics of homeless service users referred for psychological therapy were compared with those of homeless service users who were not referred. A logistic regression was performed to establish predictors of referral of homeless service users to psychological therapy.

Results: The demographic and clinical profiles of homeless service users differed significantly from those of housed service users. Homeless service users were significantly more likely than housed service users to be male, younger, of ethnic minority background and unemployed. Over half were diagnosed with stress- related disorders (52.2%), more than one third had comorbid substance-related disorders (35.4%), planned admissions were infrequent (4%) and they fared worse than housed service users on nearly all quality of care variables from assessment to post-discharge. Homeless service users (27.8%) were significantly less likely than housed service users (39.7%) to be referred for psychological therapy, though there were no significant differences in the characteristics of homeless service users who were and were not referred. The logistic regression yielded no significant predictive effects of age, gender or primary diagnosis on referral of homeless service users for therapy.

Conclusions: This thesis reviewed the quality of mental health care received by homeless service users from admission to post-discharge. Results underscore that homeless service users fare worse than housed service users across multiple quality of care indicators; such inequality represents a violation of the human right to health. There is a moral obligation for services to meet the needs of this marginalised faction of our communities and to address the health inequalities it faces.