Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities
(2012) BMC Health Services Research — Vol. 12, n° 1, p. 222 (2012)
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- Abstract
- BACKGROUND:Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities. METHOD:Two methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them. RESULTS:Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision. CONCLUSIONS:While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic services.
- Affiliations
National University of Ireland, Galway, Ireland Health Promotion Research Centre Queen Mary University of London, London, UK Unit for Social and Community Psychiatry University of Porto Medical School, Porto, Portugal Department of Hygiene and Epidemiology National Institute for Health Development, Budapest, Hungary National Institute for Health Development Etablissement public de santé Maison Blanche, Paris, France Laboratoire de recherche Charles University, Prague, Czech Republic Department of Psychiatry, 1st Faculty of Medicine University Medicine Berlin, CCM, Berlin, Germany Clinic for Psychiatry and Psychotherapy, Charite Institute of Psychiatry and Neurology, Warsaw, Poland Institute of Psychiatry and Neurology Madrid Salud, Madrid, Spain Madrid Salud Ludwig Boltzmann Institute for Social Psychiatry, Vienna, Austria Ludwig Boltzmann Institute for Social Psychiatry University of Amsterdam, Amsterdam, The Netherlands Academic Medical Center Karolinska Institute, Stockholm, Sweden Department of Public Health Sciences Public Health Agency, Lazio Region, Rome, Italy Laziosanità ASP
Citations
Canavan, R., Barry, M., Matanov, A., Barros, H., Gabor, E., Greacen, T., Holcnerova, P., Kluge, U., Nicaise, P., Moskalewicz, J., Diaz-Olalla, J. M., Straßmayr, C., Schene, A., Soares, J., Gaddini, A., & Priebe, S. (2012). Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities. BMC Health Services Research, 12(1), 222. https://doi.org/10.1186/1472-6963-12-222 (Original work published 2012)