title: Mental disorders among homeless people admitted to a French psychiatric emergency service.
abstract: OBJECTIVE
  The aim of this study was to identify factors associated with homelessness status among patients admitted to the psychiatric emergency ward of a French public teaching hospital over a six-year study period (2001-2006).
  
  
  METHODS
  The study was based on a retrospective review of the psychiatric emergency ward's administrative and medical computer databases. Each emergency care episode had accompanying data that included demographic, financial, clinical, and management information.
  
  
  RESULTS
  During this six-year study, the psychiatric service recorded 16,754 care episodes for 8,860 different patients, of which 591 were homeless (6.7%) and 8,269 were nonhomeless (93.3%). The mean+/-SD number of visits to the psychiatric emergency service was higher for homeless patients (4.9+/-12.3) than for nonhomeless patients (1.7+/-2.4) (p<.001). A total of 331 homeless patients (56.0%) had more than one care episode, whereas 2,180 (26.4%) of nonhomeless patients had more than one care episode. Factors associated with homelessness included being male, being single, and receiving financial assistance through government social programs. Schizophrenia (43.7%) and substance use disorders (31.0%) were the most common disorders among homeless patients. Aggressive behavior and violence were reported equally among homeless patients (3.5%) and nonhomeless patients (3.2%). Homeless patients were less likely than nonhomeless patients to be hospitalized after receiving care in the emergency ward (47.8% versus 51.1%) (p=.002).
  
  
  CONCLUSIONS
  Although there is near-universal access to free mental health care in France, study findings suggest that the quality and adequacy of subsequent care are not guaranteed. Multidisciplinary and collaborative solutions are needed to improve the management of mental health care for homeless patients.
authors.affiliation: Department of Psychiatry, La Conception Hospital, Marseille, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Henry
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
authors.forename: Raoul
authors.initials: R
authors.lastname: Belzeaux
authors.forename: Karine
authors.initials: K
authors.lastname: Baumstarck-Barrau
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Samuelian
mesh_terms: D000328:Adult; D019992:Databases as Topic; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000453:epidemiology*; D008875:Middle Aged; D012189:Retrospective Studies