Gold Coast Hospital and Health Service, Mental Health and Specialist Services, Gold Coast, QLD, Australia.
Int J Soc Psychiatry. 2021 Sep;67(6):713-719. doi: 10.1177/0020764020970239. Epub 2020 Nov 6.
Homelessness is correlated with significant mental illness. Homelessness is a key psychosocial issue leading to significant use of hospital resources outside medical intervention.
This study examines the characteristics, post-discharge pathway and length of stay of individuals presenting with homelessness in an acute young adult psychiatric ward.
Prospective chart audit was conducted to assess the demographic information, acute presentation, clinical risk and length of stay for homelessness referrals to Social Work. Participants ( = 88) were aged 18 to 25 years old and admitted to a tertiary level psychiatric ward specifically for this age group. Acute risk presentations of all psychiatric conditions, such as Schizophrenia, Emotionally Unstable Personality Disorder, Bipolar Affective Disorder, Drug Induced Psychosis and Anorexia Nervosa, may be admitted to the unit. Descriptive statistics, one sample -tests and Pearson's correlations were completed.
No homeless patient was accommodated by local area services due to lack of availability. Change in homelessness status tended to worsen during hospitalisation, with 24% having worse accommodation upon discharge compared to 13% who improved. Length of stay was significantly longer for homeless patients compared to non-homeless patients, but not when excluding the length of time spent attempting to address homeless risk. Homeless patients presenting with an eating disorder acute presentation spent longer time in hospital, and those with psychotic acute presentations had more dynamic risk factors. Length of stay and static risk factors were positively correlated with government mental health community follow-up.
Hospitalisation is not an effective intervention for homelessness and the Gold Coast Mental Health units are not resourced or linked to provide accommodation outcomes in a positive or economic manner. Future consideration should be given to health and community resources around homelessness, including health-specific housing interventions and community mental health teams incorporating homelessness risk vulnerability into their ongoing clinical risk mitigation.
无家可归与严重的精神疾病密切相关。无家可归是导致大量医疗资源被用于非医疗干预的关键社会心理问题。
本研究考察了在一家急性青年精神病病房中，患有无家可归症的个体的特征、出院后途径和住院时间。
前瞻性图表审查用于评估向社会工作转介的无家可归者的人口统计学信息、急性表现、临床风险和住院时间。参与者（ = 88）年龄在 18 至 25 岁之间，被专门收治这个年龄段的三级精神病病房收治。所有精神疾病的急性风险表现，如精神分裂症、情绪不稳定人格障碍、双相情感障碍、药物引起的精神病和神经性厌食症，都可能被收治到该病房。完成了描述性统计、单样本检验和 Pearson 相关分析。
由于缺乏可用性，没有无家可归者被当地服务机构收容。在住院期间，无家可归状况的变化往往恶化，出院时 24%的人住宿条件更差，而 13%的人有所改善。与非无家可归者相比，无家可归者的住院时间明显更长，但不包括为解决无家可归风险而花费的时间。因急性进食障碍就诊的无家可归者在医院停留时间更长，因急性精神病就诊的患者则具有更多的动态风险因素。住院时间和静态风险因素与政府心理健康社区随访呈正相关。
住院治疗对无家可归问题无效，黄金海岸精神卫生单位没有资源或联系，无法以积极或经济的方式提供住宿结果。未来应考虑围绕无家可归问题的卫生和社区资源，包括专门针对无家可归者的住房干预措施以及将无家可归风险脆弱性纳入其持续临床风险缓解的社区心理健康团队。
