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 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 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.
Keywords: Homelessness; acute psychiatric admission; inpatient; mental health; psychosocial needs.