How can health services effectively meet the health needs of homeless people?
Presentation by Nat Wright, Leeds University, UK, at a FEANTSA conference on "The Right to Health is a Human Right: Ensuring Access to Health for People who are Homeless", 2006
Published on: Mar 3, 2016
Transcripts - How can health services effectively meet the health needs of homeless people?
Health Promotion For People Who Are Homeless FEANTSA conference Wroclaw, 2006Dr Nat Wright MBChB DRCOG FRCGP
Being Housed Is:“having an adequate dwelling (or space) over which a person and his/her family can exercise exclusive possession, being able to maintain privacy and enjoy social relations, and having a legal title to occupy”Edgar B, Doherty J, Meert H. Review of Statistics on Homelessness in Europe. www.feantsa.org/obs/stats_review_2003_announcement.htm . Accessed 10-2-2 .
WHAT IS HEALTH PROMOTION?World Health Organisation 1986 Ottawa Charter “the process of enabling people to increase control over and improve their health….to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is seen therefore as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capabilities.”World Health Organisation. Ottawa Charter. 1986. Geneva, WHO.
What are the major health needs of homeless people? Dual Diagnosis, high morbidity and mortality particularly related to:- Substance Use- Alcohol Use- Mental Health- Physical infestations and infections- Common clinical problems more difficult to manage in homeless populations e.g - diabetes - Elderly
Barriers to healthcare involvement- Workload- Lack of skills- Value base - “deserving” / “undeserving” - migrant - violent - antisocial - Double exclusion (ethnicity, sexuality, gender)
Addressing Health Need – generic issues• Combine pharmacology (medicines interventions) with psychology (e.g. cognitive behavioural therapy, motivational enhancement therapy)• Addressing housing, benefits, employment issues – floating support• Importance of primary care – mainstream, specialised, hospital based
Addressing Health Needs Due to Drug Misuse• Opiate maintenance therapy – methadone or buprenorphine (possible role for injectable heroin)• Overdose prevention training to reduce risk of heroin related death; naloxone distribution through peer training model• Supervised Injecting Centres
Addressing Mental Ill-Health• Talking Therapies• Caution prescribing antidepressants that are toxic in overdose• Assertive outreach models• Dual diagnosis with alcohol – access mainstream services but not alcohol specific
Addressing Tuberculosis Infection• Tuberculin test screening (chest x-rays and sputum testing are not necessarily feasible)• Contact tracing (through homeless shelters rather than named person contacts)• Treatment completion rates higher if directly observed through housing programmes rather than acute hospitals
Addressing Physical Ill- Health• Anti-retroviral therapy for those with hepatitis C• Podiatry (nail cutting, adapted shoes)• Insecticides in hostels to address infestations
Prevention• Immunisations – hepatitis A and B, tetanus, influenza, pneumococcus and diphtheria;• Informal interactive methods (video, role play) to promote sexual health• Contraception• Personal and community hygiene to promote physical health (facilities to wash clothes and shower);• Podiatry interventions to provide adapted shoes or cut toe nails
Integrating Housing and Social Support• Floating support• Housing quality standards and competitive tendering• Shifting housing provision from large scale institutions to individualised support• Healthy Housing Policy – abolishing “priority need” for “intentional” homeless
And finally……….Better links and integrated programmes with• Prisons• Housing – stat and non-stat sector• Life skills options• Benefits and future employment opportunities• Political highlighting of naloxone and drug consumptions rooms to reduce drug related deaths
The Endemail@example.comFull WHO report:How can health care systems effectively deal with the major health care needs of homeless people?http://www.euro.who.int/eprise/main/WHO/Progs/H