Access Barriers to Health for Homeless People

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Presentation given by Bill Edgar at a FEANTSA conference on "The Right to Health is a Human Right: Ensuring access to health for homeless people", Wroclaw, Poland, 2006

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Access Barriers to Health for Homeless People

  1. 1. Joint Centre for Scottish Housing Research Access Barriers to Health Services for Homeless People Conference Wroclaw, Poland Bill EdgarEuropean Observatory on Homelessness
  2. 2. Overview of Presentation Health Service Needs and Use Barriers to Access Policy Responses Differences across Europe Factors or Drivers of change
  3. 3. Health Needs are Different Homeless Families with Children Rough Sleepers Mental Health Problems Substance Abuse Problems People with Multiple Needs
  4. 4. Health Services Accessed Emergency and Outreach Services Mainstream (GP, Hospital) After-care services Specialist Services Long-term Care
  5. 5. Factors leading to Homelessness CAUSES FACTORS TRIGGERS HEALTH ISSUES STRUCTURAL Poverty Debts GP Registration Unemployment Financial Crisis Housing Eviction (arrears) Eviction (behaviour) INSTITUTIONAL Institutional Living Leaving care Discharge Procedures Foster / State Care Leaving Care Prison Experience Leaving prison Armed Forces Forces discharge RELATIONSHIP Abusive relationship Leaving family After Care (childhood) home (women and children) Abusive relationship (with a partner) Fleeing violent Family Breakdown relationship (death or Coping with living separation) alone PERSONAL Mental Illness Deterioration / Undiagnosed condition illness episode Learning Difficulty Support breakdown Housing and Support Drug Dependency Substance Misuse Specialist care Alcohol Dependency Substance Misuse
  6. 6. Homelessness factors creatingbarriers Living Situation – No abode – Family and friends – Overnight hostel, temporary accommodation – Supported accommodation Lifestyle – Social / family support – Self-esteem and self-neglect – Behaviour
  7. 7. Health factors creating barriers Structural – Funding of health services – Health Structures – Targeted Policies Institutional – Family Doctor Registration – Organisational rules of referral to mainstream – Organisational rules of referral to specialist Agency – Individual capacity (esteem, lifestyle) – Professional attitudes and capacity (training)
  8. 8. What are the policy responses ? Enhance Mainstream Services – Within GP practices, Hospitals – Within Hostels – Within Specialist units Provide Alternative Services – Hostel based provision – Walk-in centres – Outreach and mobile services Improve Access to Specialist Services – Co-ordination / Partnership / Joint Working – Discharge and aftercare – Referral and Tracking
  9. 9. Mechanisms for ImprovingAccess Structural – Improved planning and guidance (state) – Address finance issues – Availability of services (provision, rural areas) Institutional – Facilitate registration with doctor – Adapt or enhance mainstream services – Provide specialist staff or units in mainstream – Provide specialist services Agency – Support the individual (care plan, aftercare, referral) – Changing attitudes and performance (training) – Tailored services
  10. 10. NHS Portugal Denmark UKHEAL AustriaTH Estonia IntegratedFI None SHINANCE Greece Netherlands PHI HOMELESS STRATEGIES
  11. 11. National Health Services Portugal – No Homeless Strategy, Health not an issue – NGO limited health services role – Emergency treatment most accessible – Family doctors in local health clinics Denmark, UK – Central Planning and Guidance – Mainstream services dominate – Continuity of treatment, aftercare issues – Hostels (medical staff, sick wards) – Supported housing services, residential care
  12. 12. Social Health Insurance Estonia – No homeless strategy – Ambulance Service (3% calls to homeless) – homeless centres and shelters main locus – Tallinn City funds nurses in shelters Austria – Regional / Municipal strategies – Rural provision problems – E-card administration, immigrants – NGOs key to co-ordination
  13. 13. Results of a Survey of Services Improved planning, research and tracking Improved coordination Resources for servicing the uninsured persons Medical workers specialised in homeless needs More finances
  14. 14. Private Health Insurance Netherlands – Homeless strategies in main cities – Medical Expenses Act funds homeless services – Enhanced care, sick bays, nursing homes (since 1993) – Health Care Insurance Legislation (2006) – Non-insured, debt recovery, what is necessary care Greece – No homeless strategies – Psychargos discharge (EU funded) – NGO services (psychiatric in origin – Klimaka)
  15. 15. What are the Factors Drivingchange? Developments in Policy – Positive : health and homeless action plans – Negative : insurance debt and recovery Improvements in Service Provision – NGOs : in hostels services – Support Finance: long term care Improvements in Delivery of Services – Targets : family doctors – Local Projects: innovation, coordination – Improved Training and attitudes
  16. 16. ARE HOMELESS SERVICESA SERVICE OF LAST RESORT FOR PEOPLE WHO ARE FAILED BY THE HEALTH SERVICES ?

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