Homeless people at disadvantage in mental health services.

OBJECTIVE: The aims of this study are threefold: to depict characteristics of homeless at discharge from a psychiatric hospital; to describe the utilisation of inpatient care and treatment measures during hospitalisation; and to analyse to what extent psychiatric disorders and clinical variables contribute to the risk for homelessness at discharge.

METHODS: Based on case register data we analysed all 28,204 people consecutively referred in 1996-2001 to psychiatric hospitals of a well-defined catchment area in Switzerland.

RESULTS: 1% (N=269) of all admissions were homeless at discharge (mean age: 32.0 years; women: 27.9 %). Compared to other psychiatric inpatients, we found among the homeless more males, more people with younger age and lower education. Regarding treatment measures during the inpatient stay, homeless received less often psychopharmacotherapy, ergotherapy and physiotherapy, but more vocational training, occupational therapy and support by social workers. There was no difference between homeless and others regarding compulsory medication or seclusion. Homeless had a shorter length of inpatient stay. Risk factors for being homeless at discharge were: being homeless at admission, not living in a relationship, having a multiple substance abuse or a dual diagnosis, low clinical improvement during inpatient treatment and discharge against medical advice.

DISCUSSION: To prevent homelessness at discharge, it is important to consider all independent contributors, i. e. the living situation before admission, health care inequalities during inpatient treatment (care received, low clinical improvement, discharge planning) and psychopathology.