Abstract
Chronic homelessness is a red flag symptom, marking a significantly increased risk of ill-health and premature death in homeless people. By definition homeless people tend to have chaotic and transient lives, as their priorities are very different from housed people. When a homeless person has tuberculosis (TB), and must complete a minimum of six months treatment in order to be cured, adherence to the full course can be an insurmountable problem. For people who are in the United Kingdom (UK) illegally, or with no recourse to public services, the situation is even bleaker. A fear of authority can deter them from seeking health care until the disease is extremely advanced. However, once stabilised on medication and medically fit for discharge from hospital, there is a real danger that they will be lost to follow-up because of their homelessness, thus putting themselves and others at risk. A model for housing homeless TB patients has been developed in Hackney, east London. Those housed have predominantly been in the UK illegally. Having the capacity to house them has made a significant difference to the health of the patient, the work of the TB team, and the cost to local health services. What is known about this topic? The problem of non-adherence to medical treatment remains a challenge for health professionals. Adherence to tuberculosis treatment is poor in high risk groups such as the homeless Incentives have been used to help patients remain on long term treatment (Giuffrida & Torgerson, 1997; Priebe et al, 2013) What this paper adds: A ‘social’ problem such as homelessness should be considered as a co-morbidity and addressed at the same time as health problems Incentives can create conditions for the patient to make other changes to improve overall quality of life Keywords : Tuberculosis, homelessness, accommodation, health care, service level agreement
Highlights
Chronic homelessness is a red flag symptom, marking a significantly increased risk of ill-health and premature death in homeless people
Some came to the United Kingdom (UK) without registering with the Workers Registration Scheme (WRS), and many have fallen on hard times, becoming homeless and unwell as the recession hit the construction industries
All the patients we have housed have been ineligible according to at least one of the five criteria set by London Borough of Hackney (LBH)
Summary
“They come singly or in huddled clusters, subdued, their eyes downcast, their shoulders stooped They tell us tales of loss, of devastation, of living in the shadows, always fearful of exposing themselves to bureaucratic scrutiny. Over the last fifteen years the number of cases in the city has risen by nearly 50 percent (Public Health England, London i, 2014). Most illegal migrants live ‘beneath the radar’, working for food, hand-outs or a place to stay They exist as invisible social outcasts, exploited and fearful. A Health Protection Agency (HPA) reported that of 6,343 TB cases with known social factors, 2.6 percent ‘were currently homeless or had a history of homelessness’ (Tuberculosis in London, 2010).
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