A new study by researchers with Simon Fraser University suggests that mental-health care for the homeless in Vancouver falls short of desired outcomes and often fails to prevent repeat trips to the hospital.
The team of academics led by health-sciences professor Julian Somers focused on homeless people who were admitted to hospital for a psychiatric reason and sought to determine whether or not follow-up care provided in the community reduced the likelihood that patients would be re-admitted to hospital for another mental-health issue.
Their findings were discouraging.
"Timely outpatient follow-up after each hospital discharge doesn’t help reduce the risk of subsequent re-hospitalization among people experiencing homelessness and mental illness," reads a media release accompanying the June 2018 study's publication in Health Services Research Journal. "Instead, each patient cost taxpayers on average $60,000 year over year, with hospital admissions accounting for much of the total."
From there, the researchers' attention turned to housing. The paper's conclusion states that without adequate housing, mental-health services for homeless people who struggle with a mental illness—even follow-up mental-health services that meet patients where they live—are insufficient in significantly improving health outcomes.
"In contrast to evidence from nonhomeless samples, we found no association between timely outpatient follow-up and the likelihood of rehospitalization in our homeless, mentally ill cohort," it reads. "Our findings indicate a need to address housing as an essential component of discharge planning alongside outpatient care."
Along with Somers, the researchers—Lauren Currie, Lawrence McCandless, Akm Moniruzzaman, and Michelle Patterson—examined the lives and health data of 433 study participants who had previously enrolled in the Vancouver At Home project. Of that group, 53 percent were hospitalized for a psychiatric reason within one year of a previous hospital visit.
"Neither outpatient medical services nor laboratory services within 7 days following discharge were associated with a significantly reduced likelihood of rehospitalization," they found.
The paper acknowledges that the group's results differ from those of similar studies.
"Several studies have found that when patients are discharged and make connections with community health services within the first week postdischarge that outcomes improve in a wide variety of health domains, including psychiatric indicators," it reads. "Within our sample, however, these relationships were not replicated. Rather than questioning the importance of community follow-up, our results may indicate that timely postdischarge care is a necessary, but not sufficient means of reducing the risk of readmission among those who are homeless and mentally ill."
Without adequate housing, people with a mental illness will continue to require emergency care, the study concludes.
"While continuity of care has been shown to be a valuable and effective mechanism for promoting recovery in the general population, for those without adequate and stable housing the same benefits may not be realized," the paper reads. "The findings presented in this study indicate a compelling need to address housing as an integral component of hospital discharge planning."