A Cross-Sectional Study of Unstable Housing and Housing-Related Symptom Content in People With Psychosis Admitted for Inpatient Treatment: A Clinical Record Interactive Search Study

Abstract

Background and Aims

Rates of psychosis in the homeless population are markedly higher compared to the general population. Understanding potential psychological mechanisms underpinning links between psychosis and homelessness is important for the development of effective care pathways for this highly marginalised group. This study aimed to examine the housing status of a sample of people with psychosis admitted to psychiatric inpatient hospital in one UK mental health trust. We further aimed to examine the presence and relevance of symptoms which were directly related to housing (e.g., persecutory beliefs about neighbours).

Methods

A cross-sectional study was conducted using an electronic healthcare database, containing anonymised patient records (Clinical Record Interactive Search). Information on housing status, symptoms, and content of symptoms relating to housing were extracted and independently double-coded from clinical notes at the person's admission.

Results

351 service users were in the sample, which covered discharges over a 12-month period (1st April 2021 to 31st March 2022). There was a higher proportion of individuals living without a fixed address in the sample (10%) compared to population estimates (1%–2%). Housing-related thematic content of symptoms was evident in 34% of the sample (e.g., attributing voices to neighbours, feeling under surveillance at home). The only variable significantly associated with housing status was gender, with men at higher odds of unstable housing compared to women. Individuals with concerns directly related to their housing or housing instability were no more likely to have a longer length of admission than those without housing-related concerns.

Conclusion

A significant proportion of individuals with psychosis admitted for psychiatric inpatient treatment, experienced housing instability. For some of the sample, symptom content directly related to housing. This raises important considerations for how social needs are assessed on admission to psychiatric hospital. Further research in this area is encouraged.