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Being homeless can make you sick. Being sick can make you homeless. Poor mental and physical health is common among people who are homeless. People who are homeless have mortality rates 3½ to 4 times greater than the housed population. They have higher morbidity from physical conditions that are common as well as conditions that are rarely found in the general population. The need for a specialist team to deal with the often challenging physical and mental health needs of people who are homeless has long been acknowledged and a government funded health team now operates within the homeless services in Cork ensuring people who are homeless have access to the most appropriate health care.
Research has identified a number of barriers which impede access for people who are homeless to GP services such as:
- Distance from their GP
- The requirement for appointments; and
- Attitudinal barriers from reception or medical staff
Research studies in the US and the UK have found that people who are homeless underutilise medical insurance or free primary health care.
Due to the combination of poor health and lack of access to appropriate primary health care, people who are homeless use secondary care services to a greater extent than the housed population. Rates of admission to acute hospitals vary from 2.7 to 7 times greater than the housed population. Accident & Emergency usage rates have been shown to be 2.6 to 5 times greater than the general population. There is evidence that specialist services are more accessible for homeless people than mainstream services.
The high rates of mortality and morbidity among people who are homeless, the poor levels of access to primary care services and the high usage of secondary care services all point to the need for specialised health care services targeting the homeless population in settings that they use on a regular basis such as shelters and community based support services.
A government funded health team provides such services in Cork. The Adult Homeless Multi Disciplinary Team consists of doctors and nurses specialising in physical and mental health among people who are homeless. The team works within the homeless services in Cork, including Cork Simon Community at Anderson’s Quay. The team includes Primary health care, Psychiatrist, Counselling, Community Welfare and a Methadone treatment programme.
Throughout 2011 people using Cork Simon projects and services accounted for over 3,000 consultations with the health team. At least 15% of those consultations were to do with mental health.
In 2010 Cork Simon Community conducted a health study among all people using Cork Simon projects and services during the last week of July. Homelessness Makes You Sick found that among people using Cork Simon projects and services 39% were referred to the health team.
Access to the health team is via Cork Simon’s Day Service on Anderson’s Quay.
In January 2011 the health team’s GP, Dr. Coffey was awarded the 2011 Fiona Bradley medal in recognition of his “commitment to the integrity of vulnerable individuals”. The Fiona Bradley medal is awarded each year to people who have contributed to better medical practice, particularly in the most disadvantaged areas of our society.
In January 2012, Dr. Coffey was was appointed Fellow of the Royal College of General Practitioners. Fellowship is the highest honour awarded by the College recognises significant contributions to patient care and the esteem in which a doctor is held by peers.
Both the Fiona Bradley medal and the appointment as Fellow of the RCGP recognise the difference the GP and his colleagues in the health team make in people’s lives everyday.