Premature deaths among homeless people

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The Health Research Board (HRB) has published a report of premature deaths among people experiencing homelessness.

The report was commissioned by the Department of Health in order to improve understanding of premature mortality among people who are homeless and to inform healthcare policy and services for this cohort.

A study of 2020 data is currently underway and will be repeated for subsequent years in order to assess the impact of an extensive suite of measures which have been implemented to address the issue.

The findings were presented to the National Homeless Action Committee, the cross-governmental and inter-agency oversight group for delivering policies and actions relating to homelessness.

The study used 2019 mortality data among people known to be homeless from closed files in the Coroners’ Service, with a total of 84 premature deaths recorded.

The majority of those who died had a history of drug and alcohol use, and the deaths were primarily the result of the social determinants of health, including inadequate accommodation, poverty, lack of employment, child and adult trauma, and imprisonment. 

Since this data was recorded, there have been extensive advancements in healthcare services for people who are homeless. A funding boost of €26 million was provided in addition to the recurring fund of €40 million in supports for people addicted to drugs between 2021 and 2023.  This has allowed the Department of Health and the HSE to put in place a number of public health measures since COVID-19 to improve health outcomes for people who experience homelessness.

Significant developments include:

  • Appointment of a homeless deaths coordinator and establishment of an oversight committee led by Dr Austin O’Carroll. 
  • Granting of planning permission to establish a supervised injecting facility for people who inject drugs on the street.
  • A single integrated case management model was established in Dublin in 2022, which has provided health and wellbeing assessments to over 1,400 clients in private emergency accommodation.
  • Increased availability of Naloxone, the antidote for opioid overdose.
  • Defibrillators installed in all 74 private emergency accommodation facilities.
  • An additional 144 people who are homeless received opioid substitution treatment.
  • Over €25 million in capital funding to construct a 100-bed medical treatment and recovery facility for people who are homeless.
  • Development of a hospital discharge protocol for people who are homeless.
  • Approved model of care for the dual diagnosis programme for people who present with a concurrent mental health disorder and a substance use disorder.

Commenting on the report, HRB Chief Executive Dr Mairead O’Driscoll said, “Both in Ireland and internationally, there is a lack of robust research in relation to deaths among people who are homeless. By collating and analysing this data on a national basis, the Health Research Board can help improve understanding of how and why these deaths occurred. This evidence can be used to inform policy and develop harm reduction strategies to support and protect those currently living with homelessness.”

Dr Ena Lynn, Senior Researcher at the HRB and lead author of the report, said, “Two important insights from this data are the role of substance use and the high levels of mental health and medical issues among those who died, showing that this is a vulnerable population with complex needs. There is no one single solution to these challenges, but our findings can help shape holistic responses across healthcare services: for example, strengthening mental health supports, enhancing harm reduction strategies related to the provision of first aid, which would include provision and administering of naloxone and addressing barriers to access and retention in treatment services.”

Noting the report, Minister Hildegarde Naughton said, “This report makes for very difficult reading. It is a desperately sad state of affairs that vulnerable people have died in such circumstances, and my thoughts are with their families and friends. Government is working hard to assist people in vulnerable situations and this important work is a priority. I am very conscious that behind every statistic is a human story. I am however hopeful that as these figures reflect the situation pre COVID-19, the follow-up study will reflect the impact of the enhanced public health measures that have been implemented since the onset of the pandemic.”