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Homelessness and Mental Illness: A Literature Review and a Qualitative Study of Perceptions of the Adequacy of Care

Institute of Community Health Sciences, Barts & The London School of Medicine, Queen Mary University of London; Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London, Charterhouse Square, London EC1M 6BQ. k.s.bhui{at}qmul.ac.uk

Lisa Shanahan

Barts & The London School of Medicine, Queen Mary University of London.

Geoff Harding

Institute of Community Health Sciences, Barts & The London School of Medicine, Queen Mary University of London.

Background: Homelessness and mental illness together confer significant morbidity and mortality because of physical health problems. Healthcare provision is undergoing significant review, and, as part of the Department of Health's policy reforms, the service user's view is central to the future restructuring of NHS services.

Material: A literature review of homeless service users' perceptions of services for homeless mentally ill people was supplemented by a qualitative in-depth survey of 10 homeless people. This article reports on their views about the services they receive. Mismatch between expectations and provision, disputes with healthcare providers, dissatisfaction with the degree to which they have choice in their care, and suspicions about the intentions of health professionals demonstrate the extent to which powerlessness and social exclusion are replicated in healthcare economies. The inadequacy of hostels and their staff are also emphasised, with some recommendations for services.

Discussion and conclusions: There are few data on homeless people's perceptions of services for mental health problems. Homeless people have strong views about the adequacy of services to meet their needs. They were particularly concerned about stigma, prejudice and the inadequacy and complexity of services that they have to use. This article reports their recommendations for change.

International Journal of Social Psychiatry, Vol. 52, No. 2, 152-165 (2006)
DOI: 10.1177/0020764006062096


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