Homeless people with mental illness need better access to primary care
Homeless people with mental illness lack access to primary care and seldom visit a GP at all, according to research published in the Medical Journal of Australia.
Dr Qun Mai and her co-authors from The University of Western Australia conducted a retrospective cohort study of 204,727 users and 294,076 matched non-users of mental health services in WA from 1 January 1990 to 30 June 2006.
They found that users of mental health services visited GPs significantly more often than non-users, with an overall adjusted rate ratio (ARR) of visits to GPs in this group of 1.622.
Dr Mai said the overall ARR of visits to GPs was higher in patients from all categories of mental illness, and these results were not changed by location (metropolitan, rural or remote addresses).
However, a notable exception to the general pattern of results was observed in the four per cent of users of mental health services with no fixed address, with an ARR of visits to GPs in this group of just 0.058.
“This subgroup seldom visited a GP at all,” Dr Mai said.
“Further work is required to assess the need for outreach programs to deliver primary care to homeless people with mental illness.”
Dr Mai said relying solely on GPs to provide preventive services might be insufficient, given the complex care needs in this group.
“A system-wide, multidisciplinary and coordinated approach, together with building a strong community-based mental health services system, which includes appropriate health promotion strategies for people with mental illness, may be part of the eventual solution to health inequities in this vulnerable and sizeable population,” Dr Mai said.
She said that although it was encouraging that most users of mental health services were able to access GP services, the poorer physical health outcomes in this group identified in the study could mean that they had not benefited from their higher level of use of GP services.
“Promoting higher levels of GP attendance may be futile. Therefore, policies focusing on how to improve the quality and preventive value of existing contacts between patients with mental illness and their GPs may be a more fruitful approach,” Dr Mai said.
The Medical Journal of Australia is a publication of the Australian Medical Association.
The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.
CONTACT: Dr Qun Mai 0447 893 660
