Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

Abstract

BackgroundHomelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland.MethodsThe study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs.ResultsDuring the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9–20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5–9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4–10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3–31.2) and SUDs (11.5, 95% CI 5.7–23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes.ConclusionsDual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.

Nurse‐led primary health care for homeless men: a multimethods descriptive study

“…There was a high rate of mental health problems, consistent with previous studies (Stenius‐Ayoade et al. ). Around one‐third were in contact with mental health services, suggesting many men are receiving their mental health care from the clinic and not specialists.…”

“…; Stenius‐Ayoade et al. ) and often use acute health services at high rates (Moore & Rosenheck ). The provision of primary health care (PHC) to this population has the potential to improve health and reduce costs (Mitchell et al.…”

Common mental disorders and resilience in homeless persons

“…The mean age of participants in this study was 34.93 yearssimilar data were obtained from a study of 594 homeless persons in Ottawa, Toronto and Vancouver, where 24.4% respondents were aged between 30 and 39 years (16) . Regarding the prevalence of homeless males, it corroborates other studies (17) .…”

Mental and behavioral disorders in the population of homeless patients admitted to hospital emergency departments

“…In the study conducted by Stenius-Ayoade et al in a group of 158 homeless residents of shelters in Helsinki, only one-tenth did not suffer from any mental disorders [16]. Among the most common disorders, the authors mentioned: disorders associated with the use of psychoactive substances, including addiction to alcohol (58.9%) in the first place, narcotics (15.2%), as well as depression (19.6%) and other mental disorders (12%), personality disorders (9.5%), systemic and behavioral disorders (4.4%) [16]. In turn, in the study by Gałka carried out among the population of homeless people living in shelters in Poland, 84% suffered from personality disorders, and 86% were addicted to alcohol [18].…”

“…Researchers emphasize frequent occurrence of mental disorders, including addiction to alcohol and other substances, among people who have no place of residence [11][12][13][14][15][16][17][18][19]. The occurrence of mental and behavioral disorders in homeless people is affected by living in stressful conditions, under constant threat, in high mental burden, insecurity, as well as loneliness and isolation to a large extent [20][21][22][23].…”