Study highlights the need for integrated healthcare and preventative services for the homeless

Birmingham’s homeless population suffers from alarmingly high rates of severe mental health problems, substance dependence and alcohol misuse, finds a study by BHP founder member the University of Birmingham.

Researchers analysed routinely collected datasets from almost 1,000 patients registered to Birmingham Homeless Healthcare Centre in the city centre. The study found that nearly one in eight had been offered support for substance dependence and one in five had been offered support for alcohol misuse. A high prevalence of infectious hepatitis C was also identified.

The study, funded by Public Health England and West Midlands Combined Authority and published in the British Journal of General Practice, also showed nearly one in three of the homeless population attended an A&E Department in the preceding 12 months. This equates to nearly 60 times the rate of A&E attendance observed in the general population.

Lead Investigator Dr Vibhu Paudyal, of the University’s School of Pharmacy, said: “The study provides compelling evidence about the health problems faced by homeless people.

“Participants, whose average age was 38 years old, had two or more serious chronic medical conditions, a rate comparable to people in their 60s.

“Substance abuse and alcohol dependency were common, as were mental health problems and hepatitis C.

“This study reinforces the need to further expand and diversify specialist services available to the homeless population, particularly preventative services.  Further work needs to be done to minimise fragmentation of services and to improve access and experiences around homeless use of mainstream general practices.

“Our previous research has shown that patients highly value the specialist and dedicated services that exist for homeless people such as the one in Birmingham city centre.

“Ill health can be both the cause and consequences of homelessness. Hence, early and opportunistic prevention and treatment of mental health, substance and alcohol dependence can prevent ill health and, for many, the repeat cycle of homelessness.

“These services should be readily accessible and where possible to be offered under one roof as many of these conditions are co-prevalent.”

Dr Paudyal said that evidence suggests that retention in long-term treatment of hepatitis C infection is greater when treatment of substance dependence is offered simultaneously. Such multi-disciplinary approach can effectively prevent disease and harm from risky behaviours, improve health outcomes and reduce demand on A&E departments, Dr Paudyal added.

The authors of this study urge GP practices to make registration of homeless people easier, and to provide signposting to specialist homelessness services, where they are available.  They want mainstream health services to be flexible and tailored to ensure this population do not face challenges and barriers in accessing care.

Shelter estimates that there are over 320,000 homeless people in the UK, and the number continues to rise.