Community psychiatric care for homeless people in inner London

Data about 'homeless' and 'home-based' clients referred to and recorded by community psychiatric nurses (CPNs) in Bloomsbury, an inner London health district, in 1985 and 1986 were reviewed. Of the 974 people seen, 642 were home-based and 322, homeless at time of referral. The homeless were more commonly under 65-years-of-age, living alone and unemployed. Two thirds of both groups had a psychiatric history, with half also having been admitted to a mental hospital. CPNs identified mental health problems in both groups with equal frequency, but homeless people were more likely to express their main problem as related to housing, finance or unemployment. Four out of five home-based clients were referred by statutory services compared with only two out of five homeless clients. The latter were less likely to receive supportive care from the CPN service and were more often referred to other agencies; these differences remained after controlling for the presenting problems. One in three people referred to this service were homeless. The social aspects of their problems, and their lack of contact with statutory services, suggest that homeless people need a multi-disciplinary approach for mental health care.