What leads to homeless shelter re-entry? An exploration of the psychosocial, health, contextual and demographic factors

Abstract

OBJECTIVES: A longer duration of homelessness is associated with poorer health outcomes. Following this logic, policies that aim to reduce repeated episodes of homelessness by addressing its root causes can result in better long-term health. This paper explores how many people return to the shelter in a Canadian context and examines factors related to returns to homelessness. METHODS:The sample included 634 adult men who participated in transitional programming at a large homeless shelter in Montreal, Quebec between 2011 and 2014. Descriptive statistics, survival analysis and multinomial logistic regression techniques were used to examine how psychosocial elements, demographic characteristics and contextual factors were related to returns to the shelter over a one-year follow-up period.RESULTS: Approximately 38% of the sample returned to the shelter within a year of program departure. A return was positively associated with a lack of support from friends and family (p < 0.05) and an imposed departure from the shelter (p < 0.05). Poor support was also associated with a faster time to return (p < 0.05) to the shelter, as was an imposed departure (p < 0.01). CONCLUSIONS:Building social networks and altering programs to accommodate those at high risk of an imposed departure may lead to fewer returns to homelessness and subsequently better health outcomes.KEY WORDS: Homelessness; returns; psychosocial; policy La traduction du résumé se trouve à la fin de l'article.Can J Public Health 2016;107(1):e94-e99 doi: 10.17269/CJPH.107.5271 H omeless persons are prone to poor health and a longer duration of homelessness has been associated with worse health outcomes. 1-3 Unfortunately, repeated episodes of housing instability are common and serve to increase the overall duration of homelessness. [4][5][6] Health is influenced by a variety of social factors beyond our individual control and homeless people are especially vulnerable in this regard.7 For example, compared to the general population, the homeless population has higher rates of mental illness, 2,8,9 experiences more victimization, 10 and has higher rates of incarceration and legal issues, 11 poverty, 12 unemployment 13 and social isolation.14 For a variety of reasons, little research has been done to rigorously analyze the relative effect of these social determinants of health on returns to homelessness. While some studies have explored factors contributing to long-term homelessness, [15][16][17] few have controlled for a comprehensive list of psychosocial vulnerabilities in their analysis. Therefore the direction and the strength of the relationships between longer duration of homelessness, psychosocial vulnerability and health are unclear. This information is critical when designing interventions and preventive services. Furthermore, at the time of this writing, there has been no exploration of this kind for a Canadian population.This study seeks to understand the relationship between psychosocial vulnerabilities, mental illness, substance abuse and repea...

Homeless population: characterization and contextualization by census research

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