‘Disproportionate levels of illness and addiction’ among homeless people

One in three homeless people in Ireland has attempted suicide, and this figure increases to one in two among those with a mental health condition.

These were some of the stark findings from a new survey of homeless people’s health, presented at the 10th annual International Street Medicine Symposium, in Dublin recently.

The study, by the Partnership for Health Equity, which is a collaboration between the HSE, the North Dublin City GP Training Programme and the University of Limerick, surveyed 601 homeless people in Dublin and Limerick in 2013, and found that 89 per cent had been diagnosed with a mental or physical health problem.

It also found that 81 per cent of the survey group had been diagnosed with a physical health problem, and 58 per cent had at least one mental health condition.

Mental health morbidity was extremely prevalent among the homeless population, with 52 per cent reporting that their mental health condition was affecting their daily lives and 60 per cent of those with a mental health condition were on prescribed medication.

Depression was the most frequently reported mental illness, at 52 per cent, followed by anxiety at 40 per cent; and 11 per cent had been diagnosed with schizophrenia or psychosis. The study also found that women, and current and past drug users, were more likely to have at least one mental health condition.

Almost 40 per cent of those surveyed reported engaging in self-harm and 56 per cent reported having suicidal thoughts. More than one-third, or 36 per cent, reported attempting suicide in the past and 10 per cent of those said they had attempted to take their own lives in the past six months.

Attempted suicide

The study’s lead author, Dr Fiona O’ Reilly, who is senior research fellow with the Partnership for Health Equity, said drug users, people under 45, and women were more likely to report attempted suicide.

However, she said “the biggest association with suicide attempts was people with a reported mental health problem and, in this case, one in two people with a mental health problem had reported attempting suicide at some stage, which I think is a very stark finding”.

She also said that dual diagnosis, which was where someone had both a mental health condition and an addiction problem, was “the norm rather than the exception” among the homeless population surveyed, and suicidality was highly prevalent in this group.

With regard to physical health, the survey, which was funded by the HSE and Safetynet, a network that provides free primary care services to homeless people and other marginalised groups in Ireland, found that one in two homeless people reported their health to be “fair or poor” compared with one in 10 of the housed population.

According to the survey, poor health was associated with getting older and using specialist services such as dedicated homeless health services.

It also found that homeless people with poor health were more likely to have a diagnosis of poor physical and mental health, to be heavy drinkers, injecting drug users, on methadone, had had an inpatient stay and/ or attended an emergency department in the past six months.

Changes over time

The 2013 homeless health study is the third such study to take place; this group was surveyed in 1997 and 2005, which enabled the researchers to compare some of the findings and track changes over time.

However, the earlier studies looked only at the homeless population in Dublin and did not include suicidality.

In comparing the findings from previous studies, there was some good news in relation to access to healthcare for the homeless population in Dublin.

For example, in 2013, 77 per cent had a medical card compared with just 55 per cent in 2005 and in 1997 when the Irish economy was much stronger.

The 2013 survey also found that more than 90 per cent of the homeless population in Limerick were registered with a GP and almost 90 per cent had a medical card.

According to O’ Reilly, the availability of specialist healthcare services such as the Safetynet programme was improving access to healthcare services for the homeless population.

While there had been some improvements in relation to access, Dr O Reilly said that homelessness was “a very unhealthy state”.

“Homeless people are suffering disproportionate levels of illness and addiction. There has been better identification, more treatment and better access to services . . . [the] high level of mental health problems and suicidality is the most striking thing to come out of this,” she said.

According to Dr O’ Reilly, homeless services need to “wrap around” the homeless person rather than trying to fit the person into the services, and all health services for the homeless should incorporate stable accommodation as a treatment goal.

She also said there was a need for a specialist liaison service for homeless people in emergency departments, as well as a dedicated suicide-prevention and crisis centre, and a coherent mental health strategy that targets dual diagnosis.

Commenting on the study, Dr Austin O’Carroll, a Dublin GP and director of Safetynet, said there was “a huge level of illness and severity of illness among the homeless population”.

“Homelessness distills ill health through a concentration that you would just not see in the normal community. The good news is increased access to health services, particularly primary care services and hospital services.

“The only part that worries me is the mental ill health . . . We do have mental health services for homeless [people] but I think they are swamped and they just can’t cope with the huge quantity.

“We need significant resources in particular for people with dual diagnosis with both drug addiction and mental ill health. They are the population who are probably the most marginalised of all groups.”

While O’ Carroll said he was pleased that the Safetynet service was making a difference, he said to address health fully, homelessness needed to be addressed as well.

Help available

Pieta House, the centre for prevention of suicide and self-harm, can be contacted on pieta.ie or email: mary@pieta.ie

Samaritans Ireland offers free and confidential emotional support 24 hours a day and can be contacted at 116 123.

Aware offers a listening ear for people with depression, and their families. Tel: 1890 303 302; aware.ie