Self-harm in people experiencing homelessness: investigation of incidence, characteristics and outcomes using data from the Multicentre Study of Self-Harm in England

Background People who experience homelessness are thought to be at high risk of suicide, but little is known about self-harm in this population. Aims To examine characteristics and outcomes in people experiencing homelessness who presented to hospital following self-harm. Method Data were collected via specialist assessments and/or hospital patient records from emergency departments in Manchester, Oxford and Derby, UK. Data were collected from 1 January 2000 to 31 December 2016, with mortality follow-up via data linkage with NHS Digital to 31 December 2019. Trend tests estimated change in self-harm over time; descriptive statistics described characteristics associated with self-harm. Twelve-month repetition and long-term mortality were analysed using Cox proportional hazards models and controlled for age and gender. Results There were 4841 self-harm presentations by 3270 people identified as homeless during the study period. Presentations increased after 2010 (IRR = 1.09, 95% CI 1.04–1.14, P < 0.001). People who experienced homelessness were more often men, White, aged under 54 years, with a history of previous self-harm and contact with psychiatric services. Risk of repetition was higher than in domiciled people (HR = 2.05, 95% CI 1.94–2.17, P < 0.001), as were all-cause mortality (HR = 1.45, 95% CI 1.32–1.59. P < 0.001) and mortality due to accidental causes (HR = 2.93, 95% CI 2.41–3.57, P < 0.001). Conclusions People who self-harm and experience homelessness have more complex needs and worse outcomes than those who are domiciled. Emergency department contact presents an opportunity to engage people experiencing homelessness with mental health, drug and alcohol, medical and housing services, as well as other sources of support.

[1]  L. Appleby,et al.  Suicide by homeless patients in England and Wales: national clinical survey , 2021, BJPsych Open.

[2]  M. Nordentoft,et al.  Risk of homelessness after discharge from psychiatric wards in Denmark: a nationwide register‐based cohort study , 2019, Acta psychiatrica Scandinavica.

[3]  P. Bourque,et al.  A randomized controlled trial of the effectiveness of Housing First in a small Canadian City , 2019, BMC Public Health.

[4]  V. Paudyal,et al.  Multimorbidity and emergency department visits by a homeless population: a database study in specialist general practice. , 2019, The British journal of general practice : the journal of the Royal College of General Practitioners.

[5]  L. Appleby,et al.  Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England , 2019, British Journal of Psychiatry.

[6]  Jennifer Dixon,et al.  The NHS long term plan , 2019, British Medical Journal.

[7]  S. Gentile,et al.  Improving Health Care Management in Primary Care for Homeless People: A Literature Review , 2018, International journal of environmental research and public health.

[8]  P. Corcoran,et al.  Self-harm among the homeless population in Ireland: A national registry-based study of incidence and associated factors. , 2017, Journal of affective disorders.

[9]  S. Barker,et al.  Experts by Experience: Peer Support and its Use with the Homeless , 2017, Community Mental Health Journal.

[10]  J. J. Cutuli,et al.  Adversity and children experiencing family homelessness: implications for health , 2017, Journal of children & poverty.

[11]  J. Watson,et al.  Social exclusion, health and hidden homelessness. , 2016, Public health.

[12]  R. Holland,et al.  Factors associated with access to care and healthcare utilization in the homeless population of England , 2016, Journal of public health.

[13]  K. Hawton,et al.  Impact of the recent recession on self-harm: Longitudinal ecological and patient-level investigation from the Multicentre Study of Self-harm in England. , 2016, Journal of affective disorders.

[14]  J. Daeppen,et al.  Harm-reduction goals and safer-drinking strategies among individuals attending a new drop-in center , 2015, Addiction Science & Clinical Practice.

[15]  J. Geddes,et al.  The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations , 2014, The Lancet.

[16]  P. Krustrup,et al.  Street football is a feasible health‐enhancing activity for homeless men: Biochemical bone marker profile and balance improved , 2014, Scandinavian journal of medicine & science in sports.

[17]  M. Nordentoft,et al.  Suicide and unintentional injury mortality among homeless people: a Danish nationwide register-based cohort study. , 2014, European journal of public health.

[18]  D. Gunnell,et al.  Time trends in coroners' use of different verdicts for possible suicides and their impact on officially reported incidence of suicide in England: 1990–2005 , 2012, Psychological Medicine.

[19]  Gregory K Brown,et al.  Safety planning intervention: a brief intervention to mitigate suicide risk , 2012 .

[20]  M. Nordentoft,et al.  Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study , 2011, The Lancet.

[21]  W. Manning,et al.  Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. , 2010, Archives of general psychiatry.

[22]  K. Fitzpatrick,et al.  Social assets and mental distress among the homeless: exploring the roles of social support and other forms of social capital on depression. , 2008, Social science & medicine.

[23]  A. House,et al.  Self-harm in England: a tale of three cities , 2007, Social Psychiatry and Psychiatric Epidemiology.

[24]  K. Hawton,et al.  Deliberate self-harm patients of no fixed abode , 2006, Social Psychiatry and Psychiatric Epidemiology.

[25]  Keith Hawton,et al.  Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. , 2003, The British journal of psychiatry : the journal of mental science.

[26]  Kwang-Hyuk Lee,et al.  Self-harm and homeless adults. , 2013, Crisis.