Comparison of homeless clinic attenders with and without psychotic illness

Abstract

Aim: To compare the characteristics of clinic attenders in inner city homeless hostels with and without a diagnosed psychotic illness. Method: A cross-sectional study of homeless people attending psychiatric clinics in three inner city homeless hostels over a period of 8 years. The demographic characteristics, comorbid conditions, pathway to homelessness and pattern of homelessness of clinic attenders with a diagnosis of psychosis were compared with those who were not known to have psychotic illness. Results: 2389 homeless people attended one or more of the clinics in the 8 years of the study, of whom 1222 (51.2%) had a diagnosed psychotic illness, mostly schizophrenia. Those with psychosis were less likely to have been married (23.2% vs 45.5%), were less likely to have worked for more than a year (47.4% vs 74%) and were more likely to have been discharged from hospital to homelessness, to receive the Disability Support Pension (72.2% vs 38.3%), or be under financial management orders (12.0% vs 2.6%). Homeless people with psychosis were also more likely to have been homeless for more than a year, sleep in the open, and were less likely to have a current substance use disorder, problem gambling or a history of early life or recent trauma. A high proportion of those with psychosis (29.5%) had been released from prison to homelessness and a surprising number (22%) reported the loss of public housing tenancy. Conclusion: The results demonstrate the homeless with psychotic illness are particularly disabled and disadvantaged, often have multiple comorbid conditions, and many have been unable to maintain public housing tenancy. The inability of many of the homeless mentally ill to maintain public housing tenancy suggests the need for more supported housing to help the chronically homeless with psychotic illness maintain tenancy.

Physical and mental illness comorbidity among individuals with frequent self-harm episodes: A mixed-methods study

“…Studies also reported an association between substance abuse and violent ( 53 ) or lethal self-harm ( 54 ). Inconsistent with other studies, ( 55 , 56 ), a coexisting psychosis was not associated with HLSMs in the current study. However, notably, the prevalence of psychosis was relatively lower in the study samples.…”

Health service use and predictors of high health service use among adults experiencing homelessness: a retrospective cohort study

“…In the current study, 47.5% of index admissions and 54.1% of emergency re‐admissions were for mental and behavioural disorders, which is not entirely surprising, as the cohort was drawn from attendees at psychiatric clinics and about half were diagnosed with a psychotic illness 29 . People experiencing homelessness who have a mental illness are frequent users of hospital services 30 and often require emergency admissions, largely due to crisis management of their illness 2 .…”

“…In the current study, 47.5% of index admissions and 54.1% of emergency readmissions were for mental and behavioural disorders, which is not entirely surprising, as the cohort was drawn from attendees at psychiatric clinics and about half were diagnosed with a psychotic illness. 29 People experiencing homelessness who have a mental illness are frequent users of hospital services 30 and often require emergency admissions, largely due to crisis management of their illness. 2 Issues with medication adherence to treat mental illness are likely to play a role in frequent hospital use, including prescription filling and medication storage, 4,20 which may not be possible with the unstable living conditions experienced by people who are homeless.…”

Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey

“…However, PEH with SMI have incredibly high needs and health disparities. [2][3][4][5][6][7][8][9][10] Little is known about similarities and differences in pathways to homelessness for patients with and without psychiatric illness. One study suggests that PEH with mental illness have similar pathways to homelessness as their peers without psychiatric problems.…”

“…1 Unfortunately, patients experiencing homelessness (PEH) with SMI have high rates of chronic disease, increased morbidity/mortality, fragmented service use, poor primary care experiences, and social isolation. [2][3][4][5][6][7][8][9][10] Regardless of housing status, patients with SMI often struggle to navigate medical care 2,7 ; they may report dissatisfaction with access to primary care and the coordination of services received. 11 In light of perceived discrimination reported by PEH in primary care, 12,13 and the central role of primary care in addressing the mortality gap for persons with SMI, 14 there is a pressing need to identify clinic paradigms that optimize care experiences for PEH with SMI.…”