Background: The burden of illness faced by people experiencing both homelessness and mental illness is staggering. When the needs of this population go unmet, it is often the healthcare system that is criticized. The aim of this thesis was to examine patterns of medical service use among people experiencing homelessness and mental illness, and to identify factors associated with high-levels of use, health outcomes and opportunities for intervention. It was hypothesized that people with the highest objective needs would access more medical services and that those who access care in a timely and continuous fashion would have better outcomes, including lower risk of hospitalization. Methods: Data were drawn from both the baseline interviews of Vancouver At Home (VAH) study participants and the Inter-Ministry Research Initiative database. All analyses were retrospective using both self-report and administrative data to examine factors associated with low vs. high health service use, continuity of care following hospitalization, and timeliness of community-based medical service use following detention in provincial custody. Results: Among VAH participants, we found that those with lower assessed need were accessing more health services that those with higher needs (i.e., schizophrenia). When continuity of care was examined, we found that our sample was accessing community-based outpatient services in both a timely and ongoing manner, however, it was not conferring a protective benefit against rehospitalization. Finally, when studying the impact of timely community medical service use following release from provincial custody, we found that those who accessed services in both a timely and continuous manner were more likely to be hospitalized than those not using services in this manner. Discussion: These findings highlighted the overwhelming burden of illness among people experiencing homelessness and mental illness. Contrary to our hypotheses, those with the greatest needs were not accessing the most health services, and for those who did access services frequently, these contacts did not offer protection against further negative health outcomes including hospitalization. Collectively these findings suggest looking beyond the healthcare system and underscore the importance of structural and systemic failings within our social, justice and healthcare systems as perpetuating the morbidity within this population.
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Thesis advisor: Somers, Julian
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