Prevalence and risk factors for non-secure housing in inpatients of mental health hospitals: findings from a survey in North rhine - Westphalia, Germany.

backgroundLittle is known about uptake of mental healthcare services by homeless people and even less is known about those living in precarious housing. The "WohnLos" study determined the prevalence of non-secure housing (defined as homelessness or precarious housing) among inpatients of two groups of public mental health hospitals in the state of North Rhine-Westphalia (NRW), Germany.

methodsWe conducted a questionnaire survey in the two hospital groups, which provide in- and out-patient mental healthcare for a population of about ten million people. Clinical staff filled in a questionnaire for every inpatient on two record dates in 2020 and 2021. The questionnaire included sociodemographic variables, clinical variables, information on psychiatric care, and information on the individual housing situation.

resultsFifteen of the twenty hospitals participated in the study and provided information on 4252 inpatients (return rate per hospital on average 59%). The prevalence of non-secure housing was on average 16.5% of all cases (7.9% homeless (houseless or roofless) and 8.6% precarious housing (insecure or inadequate)). The prevalence of non-secure housing was highly variable between the hospitals. The highest rates were found in hospitals located in large cities in the Rhineland and the lowest rates in the Ruhr industrial area. Among the patients with non-secure housing, the sociodemographic and clinical characteristics were similar in the subgroups of patients living in homelessness and patients living in precarious housing. Diagnoses of schizophrenia and substance use disorders, younger age, male gender, unemployment and migration background were important factors associated with non-secure housing. Social support was an important protective factor.

conclusionsWe identified implementable features of services for mental health inpatients with housing needs, like discharge management initiating psychosocial support from families and professional social services, the implementation of services bridging the gap between inpatient and outpatient settings, and the networking with housing-oriented post-discharge services like housing first and residential care facilities. Our study draws special attention to mentally ill patients living in precarious housing conditions, who constitute half of all mental healthcare inpatients with housing needs in our study, and who have similar psychosocial burden and housing needs as homeless patients.