Health for the homeless

'Maria' started taking drugs just at the weekends, but her habit grew until she was spending all her wages on drugs. Eventually she lost her job and her flat. She slept in parks and churchyards, and her health deteriorated.

Maria's story is not unusual: homelessness and poor health go hand in hand. One recent study in London found 64% of homeless people had a physical health problem and 70% had mental health issues. More than 60% had problems stemming from the use of drugs or alcohol.

It's not uncommon for a homeless person to have several untreated health conditions at the same time. Maria, now living in a St Mungo's hostel, had hepatitis.

Homeless people tend to have limited access to healthcare, and often don't seek help early when a problem arises. They are more likely to attend A&E or be admitted to hospital than the general population.

And of those homeless people admitted to hospital, around 70% will be discharged with nowhere to go.

Getting healthcare to those on the street

But many organisations working with homeless people are acting to get better healthcare access for those on the street and in hostels and other temporary accommodation. Some have formed fruitful partnerships with the NHS - one example is St Mungo's.

Mainly working in the south of England, St Mungo's is one of the country's biggest homelessness charities. It provides support to get people back to mainstream living, and helps prevent rough sleeping.

The charity runs more than 100 projects - many in conjunction with NHS services - and helps thousands of homeless people every year.

It's clear such partnerships can bring better care for patients while reducing pressure on some NHS services. For example, one St Mungo's initiative provides intermediate care services in hostels. 

With a full-time senior nurse, a health support worker and support from several GPs, St Mungo's wanted to prevent unnecessary hospital admissions, make arrangements for discharges from hospital, and ensure hostel residents got the specialist services they needed.

In the hostel service's first year, there was a 77% reduction in hospital admissions and a 52% reduction in A&E attendances among the hostel population, and only one death compared with seven the previous year.

"There's no doubt that if you make healthcare 10% of your effort in a social care situation, such as a homeless hostel, the benefits can be enormous," says Peter Cockersell, St Mungo's director of health and recovery.

Hostel-based substance dependency service

In partnership with the NHS in north London, St Mungo's set up the country's first substance dependency service in a homeless hostel. It provided a consultant psychiatrist and a nurse practitioner to mainly work with injecting drug users.

"This brought a load of people into healthcare who otherwise wouldn't have engaged with it," says Peter. "We also got a 100% response to the needle exchange scheme that was part of the service. And there was a welcome side effect in that we saw a 30% increase in engagement with other services among the hostel residents."

Maria believes access to such services has certainly helped her. She is on a methadone prescription to cut down her drug use and has a support worker to help as she aims to quit altogether.

She said: "I have put on weight and my health is improving - I had hepatitis A and B, but no more. I can sleep and I eat now. I can also go to see the doctor and the dentist when I need to."

St Mungo's also runs about 100 psychotherapy sessions each week to help people deal with mental health issues, which is often the key to resolving the wider problems that lead to homelessness.

And it demonstrates that partnership with the NHS is a two-way street. "We work with some NHS teams to provide this," says Peter Cockersell, "but we also provide the service to the NHS where it isn't already available locally."

"Maria" has been a St Mungo's client since April 2013 - her name has been changed for this article.

Article provided by NHS Choices

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