Mental disorders - hospitals - homeless

Mental disorders account for more than half of hospital stays among the homeless in Canada

New CIHI report offers overview of links between mental health, mental illness and homelessness

August 30, 2007—Mental disorders accounted for 52% of acute care hospitalizations among the homeless in 2005–2006 (outside Quebec), according to a new report released today by the Canadian Institute for Health Information (CIHI). In addition, the report shows that 35% of visits to selected emergency departments (EDs)—mostly in Ontario—by homeless people were related to mental and behavioural disorders, a proportion that is higher than that for other patients (3%).

The Improving the Health of Canadians: Mental Health and Homelessness report provides an overview of the latest research, surveys and policy initiatives related to mental health and homelessness and, for the first time, presents data on hospital use by homeless Canadians.

“Mental illness affects a broad range of Canadians; most people with compromised mental health are not homeless, and many people who are homeless have never been diagnosed with a mental illness,” says Dr. Jennifer Zelmer, Vice President, Research and Analysis at CIHI. “However, studies show that people who are homeless are more likely to suffer from a mental illness or compromised mental health than the general population.”

For example, the leading reasons for hospital use were different for homeless patients and others. Mental disorders were the most common diagnoses among homeless patients admitted to an acute care hospital in 2005–2006 (52% of admissions). The most frequent reasons for hospitalization among other patients were pregnancy and childbirth (13%). Likewise, 35% of visits by homeless persons to selected EDs (mostly in Ontario) were related to mental disorders; injury and poisonings were the most common reasons for ED visits among other patients (25%). Among ED patients recorded as homeless, the most common type of mental disorder was substance abuse, which accounted for 54% of visits (62% for homeless men and 30% for homeless women), followed by other psychotic disorders (20% of visits), such as schizophrenia.
Homelessness linked with stress, coping, low self-esteem, low levels of social support and suicide

The report notes many factors both at the individual and broader social level—such as housing, income and the ability to cope—that have been shown to contribute to the onset or duration of homelessness. Many of these same factors are also linked to compromised mental health.

“This report explores the complex relationship between mental health and homelessness,” says Dr. Elizabeth Votta, Program Lead at the Canadian Population Health Initiative, a program of CIHI. “People with severe mental illness may experience limited housing, employment and income options. On the other hand, people who are homeless tend to report higher stress, lower self-worth, less social support and different coping strategies, factors that are associated with depressive symptoms, substance abuse, suicidal behaviours and poor self-rated health.”

Research cited in the report indicates that the homeless often experience more difficulty coping with stress, experience lower self-esteem and have less social support than people who are not homeless. For example:

· A study in Ottawa revealed that homeless male youth reported stress levels more than twice as high as levels reported by a group of non-homeless youth.

· A study in Kitchener–Waterloo showed that street youth were more likely to engage in substance abuse and self-harm as a means of coping. Non-homeless youth were more likely to cope by talking to someone they trusted or through productive problem-solving.

· A national survey found that 2% of males and 6% of females aged 15 to 24 reported having attempted suicide in Canada. Studies report higher rates among homeless youth. For example, a 2006 British Columbia survey indicates that 15% of males and 30% of females who were street-involved and marginalized reported having attempted suicide at least once in the previous 12 months.

The report also cites many examples of research linking mental illness and homelessness. These studies, conducted across Canada with different methods and over different periods of time, tended to show higher levels of diagnosed mental illness among people who were homeless than among the population as a whole. Several studies also indicate that rates of substance abuse are higher among the homeless than among other Canadians. Research suggests that homeless individuals with both a substance abuse disorder and a mental illness diagnosis are likely to remain homeless longer than others.
Canadian Population Health Initiative

The Canadian Population Health Initiative (CPHI) is part of the Canadian Institute for Health Information (CIHI). CPHI supports research to advance knowledge on the determinants of health in Canada and to develop policy options to improve population health and reduce health inequalities.
About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.