Factors associated with homelessness referrals for an acute young adult psychiatric unit
Why is this research important?
With limited research examining the relationship between eating disorders and homelessness, which share a range of risk and maintaining factors, this study makes a valuable contribution within the context of acute psychiatric admission for young people aged 18-25. It analyses the key characteristics and care trajectories of a group of young adults admitted to an inpatient psychiatric unit on the Gold Coast, Queensland, over a 46-week period in 2019-20.
While many of the findings are presented in aggregate form, a specific finding for eating disorder patients was that they had the longest length of hospital stay post-medical clearance. That is, even after they were deemed well enough for discharge, eating disorder patients remained on ward longer than patients with any other psychiatric presentation. This indicates that these patients needed more time than other homeless patients to work with the hospital social worker on social issues related to their homelessness. Possible reasons for this are not provided and may be a useful focus for further research.
General findings for the cohort across all diagnostic presentations included the finding that hospital admission made the person’s homelessness situation worse in 27% of cases, and improved it in 13% of cases. In the specific ward included in the study, no patient was discharged from hospital into a housing or homelessness accommodation service. The authors note the need for further investigation into the links between health and homelessness services, and also point to a range of opportunities for homelessness prevention among at-risk young people. It is interesting to consider these opportunities alongside opportunities for eating disorder prevention and early intervention.
Authors: Alexander Dymond and Grace Branjerdporn
Background: Homelessness is correlated with significant mental illness. Homelessness is a key psychosocial issue leading to significant use of hospital resources outside medical intervention.
Aim: This study examines the characteristics, post-discharge pathway and length of stay of individuals presenting with homelessness in an acute young adult psychiatric ward.
Method: 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 (N=88) were aged 18 to 25years 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 t-tests and Pearson’s correlations were completed.
Results: 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.
Conclusion: 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.
Citation: Dymond, A., & Branjerdporn, G. (2021). Factors associated with homelessness referrals for an acute young adult psychiatric unit. International Journal of Social Psychiatry, 67(6), 713–719. https://doi.org/10.1177/0020764020970239