Tackling homelessness following a hospitalization is possible, but it will take a concerted community effort to lessen the ongoing burden to the health-care system and local emergency shelters, according to the findings of a Western-led study.
Nursing and Psychiatry professor Cheryl Forchuk shared results from the No Fixed Address strategy at community symposium on health care and homelessness Tuesday in London. The nine-month study looked at the supports many patients need during the crucial transitional period between being discharged from the hospital and re-integrated into the community.
The approach was initially tested for mental-health patients across the city, with this project extended to medical units at University and Victoria hospitals in London.
“Many of our patients with lived experience of homelessness were saying their journey started with a hospital discharge,” said Forchuk, an Assistant Scientific Director at Lawson Health Research Institute and project lead. “They were often experiencing major transitions in their lives and then experienced a hospital stay. Normally a relatively short visit, they aren’t able to gather the information and make a plan to be able to leave the hospital with somewhere to stay.”
Over the nine months of the study, 74 people experiencing medical issues accessed the No Fixed Address program. Of those, 54 per cent were also experiencing mental-health challenges. While all of the participants were in imminent danger of homelessness, Forchuck said half arranged housing before being discharged through the supports provided as part of this research study.
No Fixed Address helped participants discover how to go about finding proper housing, meeting with landlords, income stability, setting up banking and even issues around transportation needs. It was simply that ‘helping hand’ they deemed most important in trying to maneuver the housing market in London, Forchuk added.
“We were able to help a lot of people. But we’re not totally satisfied with that. There is more we can do,” she said. “With the results and feedback we received, we learned a lot about how we can make the program even better.”
Community partners – including Canadian Mental Health Association Middlesex, Ontario Works in the City of London and the Salvation Army’s Housing Stability Bank – played “a huge role” in assisting the participants.
“It’s not just a hospital problem; it’s not about the individual; it’s about the system not working. It’s important to start as soon as possible with the discharge process,” she said, noting getting people housed reduces substance abuse, increases quality of health and means fewer visits to hospitals. Homeless individuals are four times more likely to be readmitted within a month.
“The people across the sectors that need to come together aren’t coming together. It’s related to housing market, hospitals, accessibility, employment. It can only be solved by pulling together these points of disconnection across the community and working together.”
Gordon Russell, Director of Shelters for Mission Services London, said while the care in the hospital is important, what happens after being discharged is just as important.
“Where they go next is key in their recovery. Shelters are not designed to take care of that process,” he said. “It’s an extremely difficult place to be. There is no medical staff. We’re not a recovery centre; we’re an emergency shelter. It’s not a place to discharge people. We need to find another way.”
One-third of the participants in the study had never experienced homelessness. For them, the shock can be even greater.
“Many things that can happen. There has been a deteriorating situation with the person physically or mentally. If someone’s health is bad they may not have dealt with life situations, such as not paying their rent, while dealing with that situation,” she said. “Maybe a relationship breaks up, or now they need a wheelchair or walker and cannot go back to where they were.
“For some, homelessness literally happened with the hospitalization.”
In the project’s previous phase involving psychiatric-care patients in London, homelessness was prevented in 95 per cent of cases.
“Going into the medical units, we found that people have highly complex needs that often involved mental-health challenges. By simply using the same approach we did for those in psychiatric care, we helped half of the people find housing. To best serve the needs of everyone, we want to follow them after discharge.”
The team sees a solution in having a housing support worker provide transitional, wrap-around services that follow the person. They would continue to meet and work together after the hospital stay, helping to access community programs.
“This role would be embedded in both the health-care system and the homeless-serving system, supporting individuals who have complex physical and mental-health issues as they are also navigating homeless resources,” Forchuck said.