SOCIAL EM & POPULATION HEALTH
SAEM PULSE | SEPTEMBER-OCTOBER 2024
Addressing Barriers to Psychiatric Services for the Unhoused: A Case for the Expanded Use of Long-Acting Injectables
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By Alana Moore; Orly Morgan; Juhi Varshney, MD; and Mark Supino, MD, on behalf of the SAEM Social Emergency Medicine and Population Health Interest Group
Introduction
People experiencing homelessness (PEH) represent a highly vulnerable segment of the population frequently confronted with numerous mental health challenges. Extensive research indicates a significant overlap between PEH and those with severe psychiatric conditions, including schizophrenia, schizoaffective disorder, bipolar disorder, depression, post-traumatic stress disorder, substance use disorder, and acute psychotic episodes. The link between
housing insecurity and mental illness arises from various complex sociological and physiological factors, with the chronic stress of housing insecurity exacerbating pre-existing psychiatric conditions prevalent among PEH. Both housing instability and mental illness profoundly impact long-term health outcomes, with studies suggesting a 17.5-year reduction in life for PEH compared to the national average. Individuals with schizophrenia face a threefold decrease in life expectancy regardless of their housing status.
Engagement with Psychiatric Care
When PEH engage with psychiatric care, it is predominantly in acute care and inpatient settings. National surveys estimate that 34% of PEH Emergency Department (ED) admisssions are due to acute psychiatric issues, compared to 4% of ED visits in the general population. Despite the critical need for access to mental health services, outpatient psychiatric care utilization and psychiatric medication