Health service providers urged to remove barriers to better support homeless people

Front-line healthcare services need adapting to better support the often chaotic lives of people living rough on the street, according to a new study.

The report, which involved researchers spending time on the streets with the homeless, concludes that better “adaptive services” would make a positive impact on people’s lives and could begin to help turn their fortunes around.

The research finds health service providers currently have limited resources, flexibility and understanding on how best to support their needs.

Researchers at the University of Bath conducted interviews with more than 100 people living rough in Dublin, and they suggest health services need to review access to ensure they do not place unnecessary barriers on homeless people.

They suggest this might include increased access to walk-in slots including in hostels, new training for healthcare staff to manage challenging behaviour, education for health professionals to address the stigmas associated with homelessness, and increased efforts to promote and make accessible health services as friendly and responsive to homeless people’s needs.

The charity Shelter said the number of homeless people in England had risen by 23,000 to 280,000 since 2016.

Dublin GP Dr Austin O’Carroll, a former doctorate student at the University of Bath, said: “Doing this research has made me acutely aware of the range and depth of barriers to homeless people in traditional medical services.

“The most pervasive of these barriers was stigma, as not only was it a barrier in itself, but it protected service providers from the shame of providing inaccessible services.

“The most inaccessible services were the ones where homeless people did not even attempt to access – as ‘everyone knows’ there is no point attending that service.

“This is an internalised barrier and something that needs to be addressed urgently.”

Co-author Dr David Wainwright, from the University of Bath, added: “Homeless people, sleeping rough, are a very needy group but also one which is incredibly difficult to reach.

“This creates significant challenges when it comes to devising and targeting policy interventions that can make their lives better.

“Of course, there are multiple pressing factors that create this situation – highlighted in particular at this time of year.

“However, this study focuses on some clear and important interventions which can make a positive difference when it comes to their access to high-quality healthcare services, most significantly where there are large disenfranchised homeless populations.”

Although the specific research was conducted in Dublin, the researchers suggest its findings are applicable internationally.

In relation to the UK, they suggest many of the same barriers identified in Ireland are applicable to homeless people in cities across England, Wales, Scotland and Northern Ireland.

The study, Making sense of street chaos: an ethnographic exploration of homeless people’s health service utilisation, is published in the International Journal for Equity in Health.

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