Grant: CIHR Fellowship

Over 235,000 Canadians are homeless annually, and more than 5,000 are homeless on any given night in Toronto. Homelessness is associated with high rates of mental illness, such as psychotic illness, drug dependence, major depression, and personality disorders. The pan-Canadian research project At Home/Chez Soi showed that homeless mentally ill people tend to be high users of acute mental health services, such as hospitals and emergency departments. These public services, plus shelters, ambulances, police, and jails, are estimated to cost nearly $53,000 per homeless person per year. Meanwhile, the same people are also less likely than their housed counterparts to seek care in the community in the form of appointments with a family doctor or a psychiatrist. There are multiple explanations for the preferential use of acute care settings in comparison with outpatient settings, such as competing priorities, stigma, and barriers to care. Our study will be the first to analyze the social and clinical situation of homeless people suffering from mental illness on the scale of a whole state or country. No study has yet investigated the kind of care the homeless receive directly after their discharge from a psychiatric hospital. I will use health administrative data to examine all patients discharged from an Ontario psychiatric hospital during a three-year period. My main hypothesis is that upon their discharge from a psychiatric hospital, people who are homeless will be less likely to receive a physician follow-up and more likely to be rehospitalized or to revisit the emergency department. They will also have a higher mortality rate. Evidence found in this study will help with planning and designing programs that will improve access to care for homeless people.