Access to Mental Health Services For People who are Homeless Across the EU

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Access to Mental Health Services For People who
are Homeless Across the EU

• FEANTSA
• Workshop Bratislava Barriers preventing access
  to services for people with mental health problems

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FEANTSA

•  La Féderation Européenne des Associations
  Nationales Travaillant avec les Sans-Abri 
  (FEANTSA)
• A Federation of over 100 organisations working
  with homeless people mostly umbrellas of
  service providers
• Core-funded by the European Commission
• Mission  To be/create the most effective means
  of ending homelessness in Europe. 

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Homelessness and Housing Exclusion

• Homelessness Arriving at a shared European
  understanding - The ETHOS Typology of
  homelessness and housing exclusion
• Roofless and Houseless
• Bad health and homelessness cause and effect
• Complex and Multiple needs
• Insecurely / Inadequately housed
• Damp and cold, Overcrowding, Accidents and fire,
  Indoor air quality, hazardous substances, housing
  dissatisfaction and insecurity, lack of amenities
  and public transport.

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FEANTSAs contribution

• FEANTSAs contribution to this workshop draws on
  the experience and practices of its members
  across the EU, drawn from annual theme work in
  2006.
• Mental health and homelessness
• Multiple needs and dual diagnosis
• Barriers to Access to Healthcare
• Challenges to break down barriers to mental
  health services for homeless people
• Some particular challenges in new member states

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Mental Health and Homelessness
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Prevalence of Mental Health Problems among
Homeless People

• A far higher rate of mental health problems than
  the general population
• Rough sleepers high prevalence of severe and
  enduring mental health problems, also depression,
  anxiety and learning difficulties
•  In homeless populations, mental illness
  commonly presents in the form of schizophrenia,
  depression and other affective disorders,
  psychoses (including drug-related psychosis),
  schizophrenia, anxiety states or personality
  disorderTwenty per cent of homeless people with
  mental ill-health are dually diagnosed with
  substance dependence. Less than one third of
  homeless people with mental illness actually
  receive treatment.

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Multiple Needs

• A definition of multiple needs A typical
  homeless or ex homeless person with multiple
  needs will often present with three or more of
  the following, and will not be in effective
  contact with services
• mental health problems
• misuse of various substances
• personality disorders
• offending behaviour
• If one were to be resolved, the others would
  still give cause for concern. These needs may be
  further complicated by previous negative
  experience of the healthcare system.

• borderline learning difficulties
• disability
• physical health problems
• challenging behaviours
• vulnerability because of age

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Dual Diagnosis

• Mental health problems may be provoked or
  aggravated by substance abuse.
• Abuse of drugs and alcohol can be an attempt to
   self-medicate  unmet needs.
• It renders each problem all the more difficult to
  treat
• Services are generally not tailored towards dual
  diagnosis, but towards one problem or the other,
  meaning treatment will fail.

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Mental Health and Insecure and Inadequate Housing

• Housing insecurity a threat of eviction threat
  of domestic violence or abuse
• Unsafe housing overcrowding, dilapidation, noise
  and generally poor conditions constituting a
  source of stress and ill-health.
• These conditions take their toll on mental health
  and wellbeing

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Barriers to Healthcare for People Who are Homeless

• Problematic health situation is worsened by
  difficulties in accessing quality healthcare.
• Administrative and Financial barriers
• Complex administrative procedures
• Out of pocket payment
• Gap between homeless and hospital life
• shame and stigma, previous negative experiences,
  inflexible appointment procedures, certain
  services are inadequate and do not reach homeless
  people (mental health, dental services, detox),
  cultural/linguistic barriers
• Lack of knowledge about entitlements
• Lack of support and social networks

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Challenges to break down barriers to mental
health care for homeless people

• Alternative routes into care and tailoring care
  to meet multple needs, dual diagnosis
• low-threshold and outreach health services - a
  vital gateway into the mainstream healthcare
  system flexible with multi-disciplinary focus
• Overcoming financial barriers
• Tailor public health insurance packages and do
  away with need for out-of-pocket payments.
• Homeless services as mediator and partner
• Support homeless people to put administrative
  procedures in train and engage with healthcare

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Some Particular Challenges in New Member States

• Healthcare system under strain
• There may be little will to invest in expensive,
  tailored services such as multiple needs and dual
  diagnosis units that tackle mental health
  problems in a joined up way.
• The pressure to reform can mean the introduction
  of higher co-payments, making healthcare less
  accessible for vulnerable groups that need it
  most.
• Deinstitutionalisation
• This is a process that is happening in many new
  member states. Without adequate previsions and
  good services, it can be a pathway into
  homelessness
• Making social reintegration part of the approach
  to mental health
• Making social reintegration a focus and outcome
  of treatment is a major challenge to mental
  health care. It needs to encompass issues like
  housing and employment as well as mental health

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Some Particular Challenges in New Member States

• Not to lose the focus on  talking therapies 
• With greater availability of new drugs for mental
  health problems, it is also important to maintain
  a focus on  talking therapies , which are vital
  for people who are homeless and need to be part
  of mental health care
• Dilapidated Housing Stocks
• As was mentioned previously, bad housing brings a
  range of health risks, including mental health.
  Housing problems have to be addressed as part of
  an approach to meeting these.

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Reducing and eliminating health inequalities in
the EU

• All EU countries have expressed their support for
  building equitable access to health, underpinned
  by principles of universality and solidarity.
• Underpinned by Human Rights Commitments EU
  Charter and ESC
• This requires adaptation of healthcare system and
  the safeguarding of the needs of vulnerable
  groups in all reforms and planned developments.

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Scope for European Processes to Reduce Health
inequalities

• OMC to promote mutual learning around the issue.
  DG Sancos work around health inequalities to
  generate political will to prioritise and tackle
  this problem.
• Work to improve quality and financial
  sustainability should not be at the expense of
  equity of access guard vulnerable groups as
  part of reforms.
• Consideration of health inequalities in work to
  develop an internal market framework no
  jeopardisation of general interest aims.
• Use the expertise of civil society and bring it
  into the debate and policy processes.

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Further Resources from FEANTSA

• Annual theme 2006 European and national reports
  on access to health for people who are homeless
  http//www.feantsa.org/code/en/theme.asp?ID35
• Research Observatory Report on barriers to
  healthcare (shortly available http//www.feantsa.
  org/code/en/pg.asp?Page455
• FEANTSA magazine Winter 2006
• Contact dearbhal.murphy_at_feantsa.org