LAST UPDATE | 7 Sep 2023
NEW RESEARCH HAS shown that while admissions to psychiatric inpatient wards in Ireland have been on a downward trend in recent years, the number of homeless people being admitted has risen steadily.
A study published in the Irish Medical Journal found that the number of general admissions to psychiatric wards continued to decrease each year between 2017 and 2021.
The opposite is true for homeless people, however. Between 2017 and 2021, 1,442 homeless people were admitted to psychiatric wards. Admissions of homeless people increased from 243 in 2017 to 284 in 2021.
In the same period, there were a total of 81,567 general admissions to psychiatric inpatient wards, with a decrease year on year (from 16,743 admissions in 2017 to 15,723 in 2021).
Homeless people are also more likely to stay in wards for a shorter period of time, and to be admitted for more severe conditions.
While the general population is more likely to be admitted to psychiatric wards for depression, the most common mental health issues experienced by homeless people who are admitted are schizophrenia and drug related issues.
Homeless people are also more likely to be admitted to psychiatric wards at a younger age.
Almost 50% of homeless people admitted to these units In Ireland between 2017 and 2021 were under 35, while for the general population, this figure stands at roughly 32%.
In general, people admitted to psychiatric inpatient units are most likely to be unemployed single men.
Homeless people are also more likely to be involuntarily admitted to a psychiatric ward than the general population, as 31% percent of admissions were involuntary for people with no fixed address, compared to just 14.9% overall.
Stephen Guilfoyle, a young doctor who carried out this research during his studies, said that its findings show that it continues to be the case that homeless people are not getting the same access to primary mental health care, and are therefore more likely to reach a crisis point before receiving treatment.
“There are a lot of challenges in accessing mental health care when you don’t have a permanent address, even just down to not having somewhere for appointment letters to be sent.
“The toll that being homeless takes on someone is also a factor. It is also possible that homeless people are more likely to experience more severe mental health issues that warrant admission to an inpatient unit. There is a well documented relationship between homelessness and mental illness.
“It’s complex, because being homeless is both a contributing factor to, and sometimes a result of, experiencing homelessness.
“The number of admissions to psychiatric units has been decreasing every year since they started recording data in 1960; it is the inverse for homeless people, it has mostly been steadily rising every year,” Dr Guilfoyle explained.
He said that it is common knowledge that homelessness is on the rise in Ireland, but said that that alone doesn’t explain the rise in psychiatric admissions:
“Among the general population, a lot of mental health problems can be managed through a GP or in the community. However, for homeless people there are many barriers to accessing these services, and that is probably why we are seeing this rise in admissions.”
Dr Guilfoyle said that there are many benefits to early intervention in mental health treatment for individuals, and noted that from a cost perspective, psychiatric inpatient care is “very expensive” for the State, compared to primary care.
“When we carry out this research we hope it can be useful for decision makers. In the Government’s ‘Shared Vision’ document, it sets out there should be dedicated mental health services operating an outreach model in urban areas, working with homeless people in their own environments, with the aim of linking their care back to community mental health teams.
“I know that there are primary care clinics, but we are still seeing volunteers plug the gaps in these services, and we are seeing more and more people being admitted to inpatient wards,” he said.
Dr Guilfoyle added that it would be beneficial for services to start recording data on how many times people are readmitted to psychiatric wards.
Mark Ward, the Sinn Féin spokesperson on Mental Health said that a multi-agency response is needed to help homeless people who are admitted, and subsequently discharged from inpatient units.
“There are some good primary care services in place, the HSE do provide a dental service to homeless people and people with addiction, which is a fantastic service.
“What we need is a bespoke mental health service that can meet homeless people where they are at. It is really difficult to access these services when you are living a chaotic lifestyle.
“If there isn’t access to community healthcare when people get discharged, they end up getting admitted again. We’ve already seen that with other institutions, like the prison population. It’s the same for people coming out of psychiatric wards,” Ward said.
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