Evaluating referrals to three urban specialist mental health services for people experiencing homelessness over a 1-year period

Abstract

Background: There are high numbers of people experiencing homelessness (PEH) in Ireland. PEH have complex needs, and have higher rates of mental disorder than their housed counterparts. To date, there has been limited research conducted on this population, and their specific needs.

Aims: In this study, we explored the demand for the three specialist mental health services for people experiencing homelessness (MHSPEH) in Dublin by evaluating all referrals received over a 1 year period.

Methods: Participants included all persons referred to the three (MHSPEH) over 1 year between 1st July 2022 and 30th June 2023. We examined several key aspects of psychiatric service provision for the population including; population characteristics, psychiatric and Medical History, referral outcomes, alternative pathways and complex health needs.

Results: In total 284 referrals were analysed in the study across the three teams. One third of referrals were accepted overall. Many of the referrals declined did not meet referral criteria, either due to paucity of information, or insufficient evidence of serious mental illness within the referral. Of the referrals accepted, more than half had a previous diagnosis of major mental illness, and 59% were found to be actively psychotic on initial assessment. The majority of those accepted had previous contact with mental health services. One third of the cohort had specific vulnerabilities including: intravenous drug use, international protection applicants and recent release from prison. There were high rates of co-morbid substance and alcohol use in the referrals that were accepted and declined. The majority of referrals were from other psychiatry teams.

Conclusions: There are high rates of mental illness and co-morbid vulnerabilities found in this population. Appropriately addressing the needs of this population will require an integrated, multisystem approach.

Keywords: Homelessness; community mental health services; mental illness; psychiatry.