Homelessness among people with severe mental illness in Switzerland.

QUESTIONS UNDER STUDY This study addresses socio-demographic and clinical characteristics among homeless people in Switzerland admitted to inpatient care, the use of and pathways to inpatient care by this group and, the extent to which psychiatric disorders contribute to the risk of homelessness. METHODS Based on data of a psychiatric case register we analysed 16247 people consecutively referred to psychiatric hospitals of a catchment area in Switzerland between 1998 and 2001. RESULTS 1.6% of all admitted patients (N = 257) were homeless (mean age: 34.4 years; women: 30.0%). The homeless as compared to other psychiatric inpatients had higher rates of substance use disorders, equal rates of psychotic and personality disorders, but lower rates of organic and affective disorders. Homeless people were more often compulsorily or as an emergency admitted. General practitioners (GPs) were less involved in the admission. The homeless had a shorter inpatient stay and their health status did not equally improve like in other patients. Risk factors of being homeless at psychiatric admission were: young age, male gender, single, low education level, urban residence, abuse of illicit drugs, especially multiple substance use, and having a dual diagnosis. CONCLUSIONS Social factors and psychopathology are independently contributing to the risk of homelessness. Health care inequalities were found with regard to pathways to inpatient care (high rate of compulsory and emergency admissions, low involvement of GPs) and hospital stay (shorter stay, less improvement). Compared to other countries, disproportionate use of inpatient resources by homeless people could not be confirmed.