How health care providers can help address the health consequences of homelessness

Hwang, SW, Burns T. Health interventions for people who are homeless. The Lancet. 2014; 384: 1541-47.

Issue: Social policies and structural factors are generating housing instability and homelessness in Canada, which has serious implications for health. As a result, health care providers treat many people dealing with homelessness.

Study focus: We conducted one literature review exploring any type of intervention related homelessness, and another literature review looking specifically at mental health services for people experiencing homelessness. We focused on studies from high income countries, and contextualized our findings based on our experiences as physicians working with people experiencing homelessness in Canada and the UK.

Findings: Health care providers and organizations require particular practices and commitments to help respond to the health consequences of homelessness.* These include but are not limited to:

Positive patient-provider relationships based on respect, upholding dignity, building mutual trust, and showing warmth and care.

Well-rounded health care teams. Including people who have experiences of homelessness as members of health care teams can improve care. In addition, provision of health care should include – through internal staff and/or collaboration with external organizations – barrier-free access to primary care, mental health care, addiction treatment and housing services.

Close collaboration with community services and programs. This includes communicating with community-based providers to facilitate transitions of care, and the ability to make referrals to the full range of appropriate programs and resources available in a given community. There might be no particular ‘right time’ to connect people to services – and mental health services in particular – so providers are recommended to take any opportunity to do so.

Finding ways to follow-up. In particular, health care providers working from emergency departments should develop systems to ensure appropriate follow-up in the community.

Addressing the root causes of homelessness. As interrelated social policies and structural factors lead to homelessness and resulting health impacts, health care providers have an important role to play in advocating for broader change to address the root causes of homelessness.

* Our study also included an exploration of a range of interventions. Please see paper for details here.

Read a related story from the St. Michael’s Hospital newsroom.

Contact: Dr. Stephen Hwang (