ObjectiveTo calculate standardised mortality ratios (SMRs) for a cohort of homeless people in the Dublin region over a 5-year period and to examine leading causes of death.SettingHomeless services reporting deaths from homeless persons in their care across the Dublin Homeless Region.MethodsDeath data among people who experience homelessness was acquired from the Dublin Region Homeless Executive (2011–2015) and validated from both death certificates and records from the Dublin Coroner’s Office.ParticipantsTwo hundred and nine deaths were recorded; of these 201 were verified (n=156 males, 77.6%). Deaths that could not be verified by certificate or coroners record were excluded from the study.ResultsSMRs were 3–10 times higher in homeless men and 6–10 times higher in homeless women compared with the general population. Drug and alcohol-related deaths were the leading cause of death, accounting for 38.4% of deaths in homeless individuals. These were followed by circulatory (20%) and respiratory causes (13%).ConclusionMortality rates among homeless persons are exceptionally high. Services and programmes, particularly housing and those targeting overdose and alcoholism, are urgently needed to prevent premature mortality in this vulnerable population.

Arising out of a decade of economic recession and austerity, Ireland is currently in the grip of a severe housing crisis marked by weak housing supply, rapidly rising house prices and rents and a dramatic increase in homelessness that is placing severe pressure on the State's emergency accommodation system. This article utilises data from a national homelessness services database (PASS system), which captures live information on service user interactions for all state funded NGO and local authority homeless services, to examine the patterns of emergency accommodation use by the homeless population in Dublin City. The paper applies a k-means cluster analysis to determine different subgroups of Dublin's homeless population (n=12,734) and analyses their rate of movement through homeless services between the years 2012 and 2016. A temporary cluster (78%) experienced a small number of homeless episodes for relatively short periods of time, while an episodic cluster (10%) experienced multiple homeless episodes also for a short period of time. The chronic cluster (12%) experienced a small number of homeless episodes but with long stays in emergency shelter. Results for Ireland show patterns similar to those reported in the US, Canada and Denmark, where a small number of chronic users of homeless accommodation account for a disproportionately large share of resources (i.e. 50% of total bed nights). The findings have implications for the operation of emergency homeless accommodation in Ireland and, in particular, the targeting of interventions and the redirecting of resources away from emergency accommodation responses towards a more effective emergency accommodation system for all stakeholders