Homelessness among psychiatric inpatients in North Rhine-Westphalia: a retrospective routine data analysis

Abstract

Background Within the last five years the number of homeless persons in Germany has more than doubled, with many suffering from mental illnesses that require treatment. Whether the mental illness itself led to losing shelter or whether the state of being homeless increased the likelihood of developing symptoms of a mental disorder remains unclear. The current study assessed the interaction of homelessness and mental illness from a care provider perspective. Methods We conducted a retrospective analysis of inpatient routine data from 20 psychiatric hospitals in North Rhine-Westphalia (NRW), Germany, over a period of four years (N = 366,767 inpatient treatment cases). Patients were considered “homeless” if they had no fixed unique address. Results About 2.4% of the analyzed cohort was classified as homeless, with increasing tendency over the study period (+14% from 2016 to 2019). The percentage of homeless patients varied broadly between the hospitals (0.2–6.3%). Homeless patients were more often male and on average eight years younger than patients with a fixed address. Homeless patients experienced more involuntary measures (admission and restraint), had a shorter course of treatment and were more often discharged within one day. Every second homeless case was diagnosed with a substance use disorder and every third homeless case with a psychotic disorder, whereas affective disorders were diagnosed less frequently in this group. Psychiatric comorbidity occurred more often in homeless patients whereas somatic diseases did not. Conclusions Multiple patient-related sociodemographic and local factors are associated with homelessness of psychiatric inpatients. In addition, clinical factors differ between homeless and non-homeless patients, pointing to more severe mental illness and treatment complications (e.g., coercive measures) in homeless persons. Thus, homelessness of psychiatric inpatients can imply special challenges that need to be considered by healthcare providers and politicians, with the goal of optimizing mental and social care and the mental health outcomes of homeless persons.

Homelessness and associated factors over a 13-year period among psychiatric in-patients in Berlin, Germany: routine data analysis

“…23 Other factors, such as involuntary admissions and shorter lengths of stay, are also consistent with this study. 23 Young age is considered a risk factor for homelessness in psychiatric patients according to a Danish study. 34 An explanation for the younger age of homeless patients is the considerably increased risk of death and association with high mortality, as shown by Nilsson et al 35 Another meta-analysis from high-income countries shows that homeless individuals are more likely to suffer from severe somatic illnesses, which lead to lower life expectancy.…”

“…The homeless population in this study shows similar demographic characteristics to the homeless population of North Rhine–Westphalia, Germany. 23 Here, too, patients experiencing homelessness were significantly younger and more often male. 23 Other factors, such as involuntary admissions and shorter lengths of stay, are also consistent with this study.…”

“…23 Here, too, patients experiencing homelessness were significantly younger and more often male. 23 Other factors, such as involuntary admissions and shorter lengths of stay, are also consistent with this study. 23 Young age is considered a risk factor for homelessness in psychiatric patients according to a Danish study.…”

“…22 Another German study found a 14% increase in homeless patients between 2016 and 2019 in a routine data study among psychiatric in-patients in North Rhine–Westphalia. 23 Homeless people are a socially disadvantaged group that frequently experiences stigma and discrimination when trying to access psychosocial and healthcare services. Homeless individuals’ access to health and social care is hindered by bureaucratic procedures, inflexible operating hours, discrimination and stigma.…”

Involuntary medication in psychiatric units at Landspitali University Hospital in the years 2014-2018

“…22 Ný þýsk rannsókn sýnir einnig að sjúklingar sem eru heimilislausir fái frekar þvingaða meðferð en þeir sem eru með fasta búsetu. 28 Styrkur rannsóknarinnar felst í að úrtak hennar naer líklega að telja alla sjúklinga sem fengu nauðungarlyfjameðferð vegna bráðra einkenna á rannsóknartímabilinu og því gefa niðurstöðurnar raunsanna mynd af umfangi nauðungarlyfjagjafa á Landspítala. Helsti veikleiki rannsóknarinnar er að hún byggir á gögnum úr sjúkraskrám og því er ekki tryggt að skráning sé að öllu leyti áreiðanleg.…”