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Abstract
Background: Homeless mentally ill people are more likely to return to the streets after psychiatric inpatient treatment if discharged to unstable accommodation and if they disengage from aftercare. Inpatient treatment alone may improve housing stability, especially for street homeless people suffering from psychoses. Designated inpatient services for this group could therefore provide well co-ordinated discharge planning. Aim: To assess whether admission to a designated ward for the homeless mentally ill improves outcome 12 months after discharge in terms of housing stability and engagement with services. Method: A prospective controlled design was used. All clients of a specialist community mental health team for the homeless admitted to hospital during a 12 month period were included. One year after discharge housing stability and engagement with services were compared for clients admitted to the designated ward and those admitted elsewhere. Results: Fifty clients were admitted during the study period, 29 to the designated ward (cases) and 21 elsewhere (controls). Cases were more likely to be street homeless at admission (p = .02) and had moved more frequently than controls in the preceding 12 months (p = .04). Both groups were equally likely to be discharged to stable accommodation (p = .29) and 12 months later there was no difference in their housing stability (proportion in stable housing, p = .46; mean days in stable housing, p = .51). However, there was greater improvement in engagement for cases (mean diff. 4.5, p < .001) compared to controls (2.2, p = .01) and factors influencing medication non-compliance improved only in cases (p < .0001). Conclusions: A designated ward for the homeless mentally ill encourages admission of street homeless clients and those who are most mobile. At discharge, stable housing can be arranged and sustained as successfully as for those with less entrenched homelessness. Other benefits include improvement in engagement with services and reduction in factors influencing medication non-compliance. Declaration of Interest: None.