homelessness

Health Implications: People experiencing homelessness (PEH) often face significant health challenges, including a higher risk of frailty at an earlier age, both physically and cognitively ¹. They are also at increased risk of premature death, particularly those with mental health conditions who miss appointments ¹. Common health issues encountered in PEH include respiratory conditions (asthma, COPD, chest infections, tuberculosis), cardiovascular issues (heart failure, post-MI secondary prevention, stroke), anaemia, chronic pain, obesity, dental problems, skin conditions (scabies, head lice), smoking, alcohol and opioid dependence, and various mental health conditions such as depression, anxiety, bipolar disorder, and PTSD ¹. Missed appointments are a significant risk marker for all-cause mortality in this population ¹.

Management Strategies:

• Access to Services: PEH have a right to health and social care services of the same standard as the general population ¹. GPs should ensure PEH can register without an address and consider offering longer appointments, appointment cards, and text reminders ¹. Practices can appoint a 'homelessness lead' and ensure staff are trained to manage PEH ¹.
• Assessment: A comprehensive assessment is crucial, including health screening (e.g., using the QNI Health Assessment tool), mental health, substance use, and social care needs ¹. It's important to reassess needs regularly, especially when circumstances change ¹. Consider psychologically informed environments and trauma-informed care ¹.
• Integrated Care: Commissioners should plan and fund integrated multidisciplinary health and social care services for PEH, involving other sectors as needed ². Local needs assessments should inform service planning ².
• Outreach: Multidisciplinary outreach services should be provided in non-traditional settings to identify health problems earlier, promote health, and support engagement with care ². This includes support for primary healthcare, drug and alcohol, and mental healthcare needs, especially for those who fear engaging with services ².
• Support and Navigation: Care navigation is essential to help PEH overcome barriers to accessing services ². Support should be provided for transitions between settings (e.g., hospital to community) ². Voluntary and charity sector services are also vital resources ¹.
• Prevention and Screening: Encourage PEH to participate in national screening and routine vaccination programmes ¹.
• Specific Considerations: Recognize that PEH may require tailored long-term care due to potential frailty ¹. For those nearing the end of life, discuss and provide coordinated palliative care ¹.
• Referrals: GPs should consider referring PEH to specialist primary healthcare centres for homeless people or homelessness multidisciplinary teams if available and preferred by the patient ¹.
• Record Keeping: Improve the recording of housing status to better meet needs and improve services ².
• Inclusion: Ensure PEH are treated with dignity and do not face discrimination ².