Homelessness, emergency care and mental health. Inner-city emergency department psychiatry referrals: a retrospective de
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BRIEF REPORT
Homelessness, emergency care and mental health. Inner-city emergency department psychiatry referrals: a retrospective descriptive analysis Aoibheann Mcloughlin 1
&
Anna Feeny 1 & John Cooney 2
Received: 10 May 2020 / Accepted: 24 September 2020 # Royal Academy of Medicine in Ireland 2020
Introduction Since the advent of COVID-19, the vulnerability of people who are homeless has come into sharper focus. The risk posed by sleeping rough or staying in emergency/temporary accommodation exposes homeless people to a high risk of transmission due to compromised access to isolation spaces and adequate hygiene facilities [1]. This situation is compounded by the fact that homeless people are a medically at-risk population more likely to become seriously ill and to experience health inequities across a broad spectrum of health conditions [1, 2]. Worldwide, homeless groups encounter markedly disproportionate mortality rates relative to general, housed, or low-income populations [3–6]. In Ireland, findings from a 5-year study of a cohort of homeless people in Dublin found that the standard mortality rate was 6–10 times higher in homeless women and 3–10 times higher in homeless men when compared with the general population [3]. In line with increased physical morbidity, homeless people are significantly more likely to have drug and alcohol dependence than the general population in Western countries. The prevalence of psychiatric disorders is also elevated [7], and although there is significant heterogeneity between studies, meta-regression analysis shows an increased prevalence of personality disorder and psychotic illness in homeless studies [8]. Furthermore, homeless populations with a history of a psychiatric order represent a high-risk group of death by unintentional injury and suicide [9]. High rates of homelessness among the mentally ill have already been identified in the Irish remand prison context. In * Aoibheann Mcloughlin [email protected] 1
Psychiatry Registrar, St. Patrick’s Hospital, Dublin 8, Ireland
2
St. James’s Hospital, Dublin 8, Ireland
a recent study of 3 years of committals to the main Irish remand prison, 35% of all episodes taken on to the psychiatric service caseload were homeless between 2012 and 2014 [10]. This figure represented an increase from 2006 to 2011, when 23.4% of this service’s caseload were classed as homeless [11]. Homelessness has now reached a crisis point in Ireland. In July 2019, there were 10,275 people officially documented as homeless nationwide, with 6497 adults and 3778 children accessing state-funded emergency accommodation during this time [12]. This represents more than a doubling of those seeking emergency shelter over the past 6 years (see Fig. 1). However, these numbers may under-estimate the extent of homelessness as they do not represent those sleeping rough, in direct provision centres, domestic violence refuges, couch surfing, or homeless people in hospitals or prisons [13]. The majority of homeless people (66%) in Ireland are located in
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