Health Patterns Reveal Interdependent Needs of Dutch Homeless Service Users

Coline van Everdingen; Peter Bob Peerenboom; Koos van der Velden; Philippe Delespaul

doi:10.3389/fpsyt.2021.614526

Health Patterns Reveal Interdependent Needs of Dutch Homeless Service Users

Front Psychiatry. 2021 Mar 25:12:614526. doi: 10.3389/fpsyt.2021.614526. eCollection 2021.

Authors

Coline van Everdingen¹, Peter Bob Peerenboom², Koos van der Velden³, Philippe Delespaul^{1

4}

Affiliations

¹ Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands.
² Tangram Health Care consultancy, Doetinchem, Netherlands.
³ Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands.
⁴ Department of Adult Psychiatry, Mondriaan Mental Health Trust, Heerlen, Netherlands.

Abstract

Background: Homelessness is an increasing problem in Western European countries. Dutch local authorities initiated cross-sectional reviews to obtain accurate health and needs information on Homeless Service (HS) users. Methods: The Homeless People Treatment and Recovery (HOP-TR) study uses a comprehensive assessment strategy to obtain health data. Using a naturalistic meta-snowball sampling in 2015-2017, 436 Dutch HS users were assessed. The lived experience of HS users was the primary data source and was enriched with professional assessments. The InterRAI Community Mental Health questionnaire and "Homelessness Supplement" provided information in different areas of life. The approach for mental health assessments was transdiagnostic. Raw interview data were recoded to assess health and needs. The positive health framework structured symptomatic, social, and personal health domains relevant to recovery. Results: Most subjects were males, low educated, with a migration background. The majority were long-term or intermittently homeless. Concurrent health problems were present in two domains or more in most (95.0%) subjects. Almost all participants showed mental health problems (98.6%); for a significant share severe (72.5%). Frequent comorbid conditions were addiction (78%), chronic physical conditions (59.2%), and intellectual impairments (39.9%). Conclusion: The HOP-TR study reveals significant concurrent health problems among Dutch HS users. The interdependent character of different needs requires an integrated 3-D public health approach to comprehensively serve symptomatic, social, and personal dimensions, required to facilitate recovery.

Keywords: comorbidity rates; homelessness; inclusion health; interRAI community mental health questionnaire; marginalization; mental and physical health; public mental health; transdiagnostic approach.