Homeless persons' experiences of health‐ and social care: A systematic integrative review

Abstract

Homelessness is associated with high risks of morbidity and premature death. Many interventions aimed to improve physical and mental health exist, but do not reach the population of persons experiencing homelessness. Despite the widely reported unmet healthcare needs, more information about the barriers and facilitators that affect access to care for persons experiencing homelessness is needed. A systematic integrative review was performed to explore experiences and needs of health‐ and social care for persons experiencing homelessness. The following databases were searched: AMED, ASSIA, Academic Search Complete, CINAHL, Cochrane library, Nursing and Allied Database, PsycInfo, PubMed, Scopus and Web of Science Core Collection. Twenty‐two studies met the inclusion criteria of empirical studies with adult persons experiencing homelessness, English language, and published 2008‐2018. Fifty percent of the studies were of qualitative and quantitative design, respectively. Most studies (73%) were conducted in the United States (n=11) and Canada (n=5). The analysis resulted in three themes Unmet basic human needs, Interpersonal dimensions of access to care, and Structural and organizational aspects to meet needs. The findings highlight that persons in homelessness often must prioritize provision for basic human needs, such as finding shelter and food, over getting health‐ and social care. Bureaucracy and rigid opening hours, as well as discrimination and stigma, hinder these persons’ access to health‐ and social care.

Prevalence of mental disorders among people who are homeless: an umbrella review

“…Homelessness is a growing population health concern worldwide (Omerov, Craftman, Mattsson, & Klarare, 2020). In the United States, a total of 552,830 people experienced homelessness on a single night in 2018 (Henry et al, 2018).…”

“…In homelessness, the rate of mortality is nearly eight times higher than the average for men and 12 times higher for women, with an average age for death at 52 years (Aldridge et al, 2019(Aldridge et al, , 2018. This can be attributable to the fact that homeless individuals experience enormous health inequalities and have a higher prevalence of various medical conditions (Omerov et al, 2020). This burden increases among aging people who are homeless.…”

“…This burden increases among aging people who are homeless. They often experience multiple health problems, which become worse in the presence of a lack of access to healthcare services, poor social ties, and continued effects of other social determinants of health (Omerov et al, 2020). In most cases, such problems are not prevented or diagnoses at earlier stages resulting in increased use of acute care services and higher cost to the health systems (Omerov et al, 2020;Rosenheck & Seibyl, 1998).…”

“…In addition to addressing residential challenges and physical health problems, it is necessary to improve the mental health of people who are homeless (Altena, Brilleslijper-Kater, & Wolf, 2010;Dickey, 2000). Psychosocial stressors like impaired interpersonal relationships, lack of hope, loneliness, and poor social capital affect the mental health and wellbeing during homelessness (Omerov et al, 2020). Another challenge is the deinstitutionalization of mental illness in many countries like the United States, which resulted in a reduced number of beds in indoor psychiatric facilities without strengthening community shelters and models of care (Yohanna, 2013).…”

Pharmacist Led Homeless Outreach Engagement and Non-Medical Independent Prescribing (Rx) (PHOENIx) Intervention for People Experiencing Homelessness: A Non- Randomised Feasibility Study

“…5,6 Access to primary care services remains challenging due to stigma, discrimination and bureaucratic barriers. 8,9 Unmet health needs are common. 10,11 Mental illness, pain and addictions may be poorly managed 12 with evidence suggesting under prescribing and low rates of prescription adherence 13,14 Patterns and reasons for emergency healthcare utilisation differ between people experiencing homelessness and those who are housed: ED visits, hospitalisations and readmissions are higher.…”