In this bi-weekly blog series, I explore recent research on homelessness, and what it means for the provision of services to prevent or end homelessness. Read the first blog here.
At times I feel a bit dismayed when reading another descriptive research article on people experiencing homelessness. Perhaps another article on rates of mental illness among shelter occupants, maybe one on the unmet support needs of homeless families, maybe it’s the correlation between intimate partner violence and women experiencing homelessness. The ones that are the hardest to see are those on life expectancy, average age of death, or survival rates of those experiencing chronic homelessness. We know the numbers will be bad, so do we need another description of these numbers? Or do we need more intervention research that helps people find home?
Because, ultimately, homelessness is a palliative condition unless treated with housing.
This is illustrated in a recent article by Amanda Stafford and Lisa Wood out of Perth, Western Australia. The article opens with the same discouraging statistics that we see worldwide on high morbidity, barriers to health care, high use of emergency services, and poor life expectancy. At the same time, Stafford and Wood confront and contest the natural response to these statistics: provide people experiencing homelessness with more healthcare services. They query that perhaps this medical model approach is too short-sighted and downstream?
To answer the question, then, of how to respond to the poor health outcomes of people experiencing homelessness, they present three in-depth case histories of two men and one woman accessing primary care and housing support. The case histories include not just detailed health and social histories, but also service utilization and cost estimates. All three individuals scored a 14 on the VI-SPDAT (a high acuity score on this measure of acuity) and utilized an average of $100,000 of health care services.
Three clear lessons are presented through these cases:
- There is a low degree of effectiveness in treating the health needs of people experiencing homelessness then simply sending them back to the conditions that compromise their health.
- While current health services are a valuable use of money in terms of preserving life, a more comprehensive approach would involve funding better access to housing with appropriate supports, thus mitigating downstream costs of homelessness and providing enhanced quality of life.
- The personal stories of experiences of homelessness demonstrate how social policy and social conditions create risks of homelessness, at times in contrast to public perceptions of homelessness being simply an individual experience.
While the case study methodology involves an intentionally small sample, the story is very clear. Medicine is an insufficient response to the health needs of homelessness and must go hand in hand with enhanced public policy and social programs to ensure access to affordable housing with adequate supports. This is the treatment needed to reverse the palliative nature of homelessness.