Skip to main content


Log in

Timing, prevalence, determinants and outcomes of homelessness among patients admitted to acute psychiatric wards

  • Original Article
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

An Erratum to this article was published on 18 August 2011



To document the prevalence, timing, associations and short-term housing outcomes of homelessness among acute psychiatric inpatients.


Cross-sectional study of 4,386 acute psychiatric admissions discharged from a single NHS Trust in 2008–2009.


Homelessness occurred in 16%. Most homelessness (70%) was either recorded as present at admission or started within 1 week. It was associated with younger age; male gender; ethnicity other than White British or Black African/Caribbean; being single, divorced, separated or widowed; diagnosis of drug and alcohol disorder; detention under a forensic section of the Mental Health Act; having no previous admission or alternatively having a longer previous admission; having a low score on the depressed mood or hallucinations and delusions items of the Health of the Nation Outcome Scales (HoNOS); and having a high score on the HoNOS relationship difficulties and occupation and activities items. Of those who were followed-up for 28 days after discharge, 53% had a new address recorded; of those who were not, only 22% did.


Homelessness affects a substantial minority of psychiatric admissions in the UK. Housing outcomes are uncertain, and it is possible that more than half continue to be homeless or living in very transient situations. Demographic and diagnostic associations with homelessness were consistent with US studies; associations with HoNOS item scores and having had no admission in the preceding 2 years suggest that, in many cases, social adversity predominates over active psychopathology at the time of admission.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Bhugra D (1996) Homelessness and mental health. Cambridge University Press

  2. Koffman J, Fulop N (1999) Homelessness and the use of acute psychiatric beds: findings from a one-day survey of adult acute and low-level secure psychiatric patients in North and South Thames regions. Health Soc Care Commun 7:140–147. doi:10.1046/j.1365-2524.1999.00156.x

    Article  Google Scholar 

  3. Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL (1998) Hospitalization costs associated with homelessness in New York City. N Engl J Med 338:1734–1740

    Article  PubMed  CAS  Google Scholar 

  4. Rosenheck R, Seibyl C (1998) Homelessness: health service use and related costs. Med Care 36:1256–1264

    Article  PubMed  CAS  Google Scholar 

  5. Herman DB, Susser ES, Jandorf L, Lavelle J, Bromet EJ (1998) Homelessness among individuals with psychotic disorders hospitalized for the first time: findings from the Suffolk County Mental Health Project. Am J Psychiatry 155:109–113 Retrieved May 27, 2010

    PubMed  CAS  Google Scholar 

  6. Mowbray CT, Johnson VS, Solarz A (1987) Homelessness in a state hospital population. Hosp Commun Psychiatry 38:880–882 Retrieved June 6, 2010

    CAS  Google Scholar 

  7. Appleby L, Desai PN (1985) Documenting the relationship between homelessness and psychiatric hospitalization. Hosp Commun Psychiatry 36:732–737 Retrieved May 27, 2010

    CAS  Google Scholar 

  8. Susser ES, Lin SP, Conover SA (1991) Risk factors for homelessness among patients admitted to a state mental hospital. Am J Psychiatry 148:1659–1664 Retrieved June 6, 2010

    PubMed  CAS  Google Scholar 

  9. Ash D, Haynes J, Braben P, Galletly C (2003) Violence, self-harm, victimisation and homelessness in patients admitted to an acute inpatient unit in South Australia. Int J Soc Psychiatry 49:112–118. doi:10.1177/0020764003049002004

    Article  PubMed  Google Scholar 

  10. Whiteley JS (1955) Down and out in London; mental illness in the lower social groups. Lancet 269:609–610 Retrieved June 14, 2010

    PubMed  CAS  Google Scholar 

  11. Herzberg JL (1987) No fixed abode. A comparison of men and women admitted to an East London psychiatric hospital. Br J Psychiatry 150:621–627 Retrieved June 13, 2010

    Article  PubMed  CAS  Google Scholar 

  12. Fisher N, Turner S, Pugh R (1990) Homeless and mentally ill. Lancet 335:916–917. doi:10.1016/0140-6736(90)90516-8

    Article  PubMed  CAS  Google Scholar 

  13. Greenberg GA, Hoblyn J, Seibyl C, Rosenheck R (2006) Housing outcomes for hospitalized homeless veterans. J Health Care Poor Underserved 17:425–440 Retrieved June 6, 2010

    Article  PubMed  Google Scholar 

  14. Caton CL, Shrout PE, Eagle PF, Opler LA, Felix A, Dominguez B (1994) Risk factors for homelessness among schizophrenic men: a case-control study. Am J Public Health 84:265–270. doi:10.2105/AJPH.84.2.265

    Article  PubMed  CAS  Google Scholar 

  15. Stewart R, Soremekun M, Perera G, Broadbent M, Callard F, Denis M et al (2009) The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry 9:51. doi:10.1186/1471-244X-9-51

    Article  PubMed  Google Scholar 

  16. Wing JK, Beevor A, Curtis R, Park S, Hadden S, Burns A (1998) Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry 172:11–18. doi:10.1192/bjp.172.1.11

    Article  PubMed  CAS  Google Scholar 

  17. Royston P (2005) Multiple imputation of missing values: update of ice. Stata J 5:188–201

    Google Scholar 

  18. Tulloch AD, Fearon P, David AS (2011) Residential mobility among patients admitted to acute psychiatric wards. Health Place 17:859–866

    Google Scholar 

  19. Bodner TE (2008) What improves with increased missing data imputations? Struct Equ Model: Multidiscip J 15:651. doi:10.1080/10705510802339072

    Article  Google Scholar 

  20. Royston P, Ambler G, Sauerbrei W (1999) The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 28:964–974 Retrieved March 26, 2010

    Article  PubMed  CAS  Google Scholar 

  21. Royston P, Sauerbrei W, Becher H (2010) Modelling continuous exposures with a “spike” at zero: a new procedure based on fractional polynomials. Stat Med Adv online publ. doi:10.1002/sim.3864

  22. Hosmer DW, Lemeshow S, May S (2008) Applied survival analysis: regression modeling of time-to-event data. Wiley

  23. Royston P, Sauerbrei W (2008) Multivariable model-building: a pragmatic approach to regression analysis based on fractional polynomials for modelling continuous variables. Wiley

  24. Royston P, Sauerbrei W (2003) Stability of multivariable fractional polynomial models with selection of variables and transformations: a bootstrap investigation. Stat Med 22:639–659. doi:10.1002/sim.1310

    Article  PubMed  CAS  Google Scholar 

  25. Harrell FE (2001) Regression modeling strategies: with applications to linear models, logistic regression and survival analysis. Springer, New York

    Google Scholar 

  26. Rubin DB (1987) Multiple imputation for nonresponse in surveys. John Wiley & Sons, Inc, New York

    Book  Google Scholar 

  27. Adams J, Rosenheck R, Gee L, Seibyl CL, Kushel M (2007) Hospitalized younger: a comparison of a national sample of homeless and housed inpatient veterans. J Health Care Poor Underserved 18:173–184. doi:10.1353/hpu.2007.0000

    Article  PubMed  Google Scholar 

  28. Nordentoft M, Knudsen HC, Jessen-Petersen B, Krasnik A, Saelan H, Brodersen AM et al (1997) Copenhagen Community Psychiatric Project (CCPP): characteristics and treatment of homeless patients in the psychiatric services after introduction of community mental health centres. Soc Psychiatry Psychiatr Epidemiol 32:369–378. doi:10.1007/BF00788176

    PubMed  CAS  Google Scholar 

  29. Folsom DP, Hawthorne W, Lindamer L, Gilmer T, Bailey A, Golshan S et al (2005) Prevalence and risk factors for homelessness and utilization of mental health services among 10, 340 patients with serious mental illness in a large public mental health system. Am J Psychiatry 162:370–376. doi:10.1176/appi.ajp.162.2.370

    Article  PubMed  Google Scholar 

  30. Greenberg GA, Rosenheck RA (2010) Mental health correlates of past homelessness in the National Comorbidity Study Replication. J Health Care Poor Underserved 21:1234–1249. doi:10.1353/hpu.2010.0926

    PubMed  Google Scholar 

  31. Greenberg GA, Rosenheck RA (2010) Correlates of past homelessness in the National Epidemiological Survey on Alcohol and Related Conditions. Adm Policy Ment Health 37:357–366. doi:10.1007/s10488-009-0243-x

    Article  PubMed  Google Scholar 

  32. Caton CL (1995) Mental health service use among homeless and never-homeless men with schizophrenia. Psychiatr Serv 46:1139–1143 Retrieved June 6, 2010

    PubMed  CAS  Google Scholar 

  33. Martijn C, Sharpe L (2006) Pathways to youth homelessness. Soc Sci Med 62:1–12

    Article  PubMed  Google Scholar 

  34. Mojtabai R (2005) Perceived reasons for loss of housing and continued homelessness among homeless persons with mental illness. Psychiatr Serv 56:172–178. doi:10.1176/

    Article  PubMed  Google Scholar 

  35. Kisely S, Campbell L, Crossman D, Gleich S, Campbell J (2007) Are the Health of the Nation Outcome Scales a valid and practical instrument to measure outcomes in North America? A three-site evaluation across Nova Scotia. Commun Ment Health J 43:91–107. doi:10.1007/s10597-006-9067-2

    Article  Google Scholar 

  36. Trauer T, Callaly T, Hantz P, Little J, Shields R, Smith J (1999) Health of the Nation Outcome Scales. Results of the Victorian field trial. Br J Psychiatry 174:380–388. doi:10.1192/bjp.174.5.380

    Article  PubMed  CAS  Google Scholar 

  37. Bech P, Bille J, Schütze T, Søndergaard S, Wiese M, Waarst S (2003) Health of the Nation Outcome Scales (HoNOS): implementability, subscale structure and responsiveness in the daily psychiatric hospital routine over the first 18 months. Nord J Psychiatry 57:285–290. doi:10.1080/08039480310002156

    Article  PubMed  Google Scholar 

  38. Social Exclusion Unit (2004) Mental health and housing: factsheet 6. Office of the Deputy Prime Minister, London

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Alex D. Tulloch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tulloch, A.D., Fearon, P. & David, A.S. Timing, prevalence, determinants and outcomes of homelessness among patients admitted to acute psychiatric wards. Soc Psychiatry Psychiatr Epidemiol 47, 1181–1191 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: