Re-conceptualising Approaches to Meeting the Health Needs of Homeless People

Abstract

The experience of homelessness not only affects physical health, but can also constrain access to required health care. In a number of European countries, national strategies to tackle homelessness have sought to deliver integrated solutions across housing, health and other social policy areas. This article examines approaches to meeting the health care needs of homeless people in relation to such strategies, drawing upon recent research in Norway and Scotland. The article presents a comparative analysis of approaches to service provision in relation to welfare models and the concepts of universal and specialist provision. The analysis suggests a cross-national shift in the conceptualisation of appropriate responses to the health care needs of those who experience homelessness. The provision of some specialist health services, while reflecting a selective model of welfare, need not be solely interpreted as conflicting with a more universal model of ensuring access to mainstream services. Rather, the challenge is to recognise the need for a process approach which supports an effective transition from the (sometimes necessary) use of specialist services for this group, towards (the ideal of) full integration into mainstream health care.

What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography

“…However, many people with experience of homelessness report that their needs are not well met when accessing mainstream health or substance use services. Stigmatising and negative attitudes also, unfortunately, remain commonplace [21,[42][43][44]. For those who have successfully engaged with treatment, there can be distinct challenges associated with continued engagement with treatment and recovery as a result of being homeless.…”

The Health of Homeless Women

“…As might be expected, access to general health services appears to be most universal in the Nordic states. For example, in Norway, any specialist health care services tend to be provided on the basis of health care need (such as for substance use) rather than because of any homelessness status (Anderson and Ytrehus, 2012). Similarly, in Slovenia research indicated that the majority of homeless persons found health care services accessible (Razpotnik & Dekleva 2009a, b).…”

“…In an international review, Pleace and Quilgars (2004) identified adaptations to exiting services, specialist primary care services, and specialist complementary services (for example, alcohol and drug support, dentistry, podiatry, and opticians): but found limited evaluative evidence of their effectiveness. There has been considerable debate around the necessity of specialist services compared to the need to better ensure homeless people's inclusion in mainstream services (Anderson et al, 2006;FEANTSA 2006FEANTSA , 2011Joly et al, 2011;Jones and Pleace, 2010;O'Carroll and O'Reilly, 2008), with Anderson and Ytrehus (2012) concluding that specialist health care provision for homeless people should be transitional and ultimately designed to aid reintegration into mainstream services.…”

“…The need for more effective interagency work across housing, homelessness and health services is increasingly recognized as a requirement for improving homeless people's access to health care services (Anderson and Ytrehus, 2012;Cornes et al, 2011;Joly et al, 2011). Although there is a lack of evidence on the specific experiences of women, research from Ireland illustrated how health interventions such as discharge from (and repeated admission to) psychiatric hospitals can contribute to women's homelessness (Mayock et al, 2015).…”

The 'Arc of Prosperity' Revisited: Homelessness Policy Change in North Western Europe

“…While housing may be largely distributed through the market, homelessness interventions are rarely, if ever, delivered by market mechanisms (though they may reflect market failure). Comparative homelessness research has often used welfare state regimes as a background typology (Anderson & Ytrehus, 2012;Baptista & O'Sullivan, 2008;Benjaminsen et al, 2009) and there is some consensus that homelessness to some extent reflects welfare state regimes, the degree of decommodification of welfare and the generosity of welfare spending. Nordic welfare states would be characterised as least commodified/most generous, with the Southern European countries at the opposite end of the spectrum.…”