title: Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities.
abstract: BACKGROUND
  Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities.
  
  
  METHODS
  Two methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them.
  
  
  RESULTS
  Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision.
  
  
  CONCLUSIONS
  While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic services.
authors: Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland. reamonn.canavan@nuigalway.ie
authors: Réamonn
authors: R
authors: Canavan
authors: Margaret M
authors: MM
authors: Barry
authors: Aleksandra
authors: A
authors: Matanov
authors: Henrique
authors: H
authors: Barros
authors: Edina
authors: E
authors: Gabor
authors: Tim
authors: T
authors: Greacen
authors: Petra
authors: P
authors: Holcnerová
authors: Ulrike
authors: U
authors: Kluge
authors: Pablo
authors: P
authors: Nicaise
authors: Jacek
authors: J
authors: Moskalewicz
authors: José Manuel
authors: JM
authors: Díaz-Olalla
authors: Christa
authors: C
authors: Strassmayr
authors: Aart H
authors: AH
authors: Schene
authors: Joaquim J F
authors: JJ
authors: Soares
authors: Andrea
authors: A
authors: Gaddini
authors: Stefan
authors: S
authors: Priebe
mesh_terms: D002947:Cities; D005060:Europe; D006297:Health Services Accessibility; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000600:supply & distribution; D036301:Qualitative Research; D011787:Quality of Health Care