Mental health policy and practice across Europe: an overview

288 Mental health policy and practice
success. However, it has developed widely as a model both to prevent homelessness
and to reintegrate those who have been excluded from community life.
Responses to homelessness
However ‘homelessness’ is defined (European Commission 2003d), mental
health problems are prevalent among an important proportion of those without
accommodation; and homelessness causes a set of other difficulties with, for
example, access to health services, education or employment. It is a multidimensional
problem. Measures to combat social exclusion emphasize the challenge
to develop appropriate integrated responses both to prevent and address
homelessness. However, housing supply is only part of the problem; discrimination
and the letting practices of both public and private sector landlords can
lead to exclusion (Edgar et al. 2002).
The risk of homelessness has been associated with deinstitutionalization and
discharge from long-stay psychiatric hospitals, but it is also raised by hospital
admission for acute episodes of mental illness. Altogether, homelessness is
more likely among people with mental health problems for a variety of reasons
including affordability, conflicts and unsafe living environments (Mental Health
Commission 1999) – even among those in contact with mental health services.
Of course, for many homeless persons the first challenge is to enable access
to appropriate services. The SMES-Europa (2002) report offers a number of
examples of initiatives to provide health and social care, often involving
volunteers.
In Athens, a non-governmental humanitarian organization (Doctors without
Borders) offers medical and social help to homeless people with psychosocial
problems, drug addicts, alcohol addicts, refugees, immigrants and ex-prisoners.
Paid employees comprise just a quarter of the staff, the remaining 75 per cent
being professionals who volunteer their assistance (doctors, psychologists and
social workers). Component services include psychological support and social
care, a mobile unit and needle exchange programme. Users are recruited through
self-demand as well as referral from social and health services and the police.
The project collaborates with other similar projects to meet the multiple needs
of these users (SMES-Europa 2002).
The need for interdisciplinary teams or more integrated services to meet complex
and multiple needs has led to the introduction of a range of one-stop-shop
type provision – for example, the services of housing officers, benefit staff, social
workers, specialist mental health workers and voluntary organizations (Mental
Health Commission 1999; Pillinger 2001). The engagement of homeless mentally
ill people with services often takes time and perseverance, and demands
that services go to where the homeless persons are – thus, the development of
street-outreach services or mobile outreach teams.
Homeless people with mental illness are contacted in a range of accommodation
settings from emergency and temporary hostels to long-term sheltered
accommodation and supported housing. Emergency accommodation in hostels
is available across Europe in urban areas and provides an essential safety net. In
general, such hostels have beds immediately available, and impose no referral or