A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19

Emma Adams; Jeff Parker; Tony Jablonski; Joanne Kennedy; Fiona Tasker; Desmond Hunter; Katy Denham; Claire Smiles; Cassey Muir; Amy O'Donnell; Emily C Widnall; Kate Dotsikas; Eileen Kaner; Sheena Ramsay

doi:10.3390/ijerph19063459

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19

Emma Adams^*, Jeff Parker, Tony Jablonski, Joanne Kennedy, Fiona Tasker, Desmond Hunter, Katy Denham, Claire Smiles, Cassey Muir, Amy O'Donnell, Emily C Widnall, Kate Dotsikas, Eileen Kaner, Sheena Ramsay

^*Corresponding author for this work

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.

Original language	English
Article number	3459
Number of pages	14
Journal	International Journal of Environmental Research and Public Health
Volume	19
Issue number	6
DOIs	https://doi.org/10.3390/ijerph19063459
Publication status	Published - 15 Mar 2022

Bibliographical note

Funding Information:
Funding: This research was funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) development fund for early career researchers (ECRs). E.A.A and Kate D. are supported by the NIHR SPHR Pre-doctoral Fellowship Funding Scheme, Grant Reference Number PD-SPH-2015 and C.M. is being supported by the NIHR SPHR PhD studentship (SPHR-PHD-FUS-002). A.O. is an NIHR Advanced Fellow. E.K. is supported by an NIHR Senior Investigator award and is Director of the NIHR Applied Research Collaboration North East and North Cumbria. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

mental health
health inequalities
homelessness
health care access
multiple complex needs
COVID-19
substance use

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Adams, E., Parker, J., Jablonski, T., Kennedy, J., Tasker, F., Hunter, D., Denham, K., Smiles, C., Muir, C., O'Donnell, A., Widnall, E. C., Dotsikas, K., Kaner, E., & Ramsay, S. (2022). A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19. International Journal of Environmental Research and Public Health, 19(6), [3459]. https://doi.org/10.3390/ijerph19063459

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abstract = "People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.",

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note = "Funding Information: Funding: This research was funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) development fund for early career researchers (ECRs). E.A.A and Kate D. are supported by the NIHR SPHR Pre-doctoral Fellowship Funding Scheme, Grant Reference Number PD-SPH-2015 and C.M. is being supported by the NIHR SPHR PhD studentship (SPHR-PHD-FUS-002). A.O. is an NIHR Advanced Fellow. E.K. is supported by an NIHR Senior Investigator award and is Director of the NIHR Applied Research Collaboration North East and North Cumbria. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2022 by the authors. Licensee MDPI, Basel, Switzerland.",

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Adams, E, Parker, J, Jablonski, T, Kennedy, J, Tasker, F, Hunter, D, Denham, K, Smiles, C, Muir, C, O'Donnell, A, Widnall, EC, Dotsikas, K, Kaner, E & Ramsay, S 2022, 'A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19', International Journal of Environmental Research and Public Health, vol. 19, no. 6, 3459. https://doi.org/10.3390/ijerph19063459

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19. / Adams, Emma; Parker, Jeff; Jablonski, Tony et al.
In: International Journal of Environmental Research and Public Health, Vol. 19, No. 6, 3459, 15.03.2022.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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AU - Parker, Jeff

AU - Jablonski, Tony

AU - Kennedy, Joanne

AU - Tasker, Fiona

AU - Hunter, Desmond

AU - Denham, Katy

AU - Smiles, Claire

AU - Muir, Cassey

AU - O'Donnell, Amy

AU - Widnall, Emily C

AU - Dotsikas, Kate

AU - Kaner, Eileen

AU - Ramsay, Sheena

N1 - Funding Information: Funding: This research was funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) development fund for early career researchers (ECRs). E.A.A and Kate D. are supported by the NIHR SPHR Pre-doctoral Fellowship Funding Scheme, Grant Reference Number PD-SPH-2015 and C.M. is being supported by the NIHR SPHR PhD studentship (SPHR-PHD-FUS-002). A.O. is an NIHR Advanced Fellow. E.K. is supported by an NIHR Senior Investigator award and is Director of the NIHR Applied Research Collaboration North East and North Cumbria. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

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N2 - People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.

AB - People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.

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KW - health inequalities

KW - homelessness

KW - health care access

KW - multiple complex needs

KW - COVID-19

KW - substance use

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DO - 10.3390/ijerph19063459

M3 - Article (Academic Journal)

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M1 - 3459

ER -

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19

Abstract

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