Discrimination in care for homeless adults
Among homeless adults with mental illness, perceived healthcare discrimination—especially for mental illness/poverty—linked to worse symptoms and more ED use.
Source
Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings
What they did
Using Toronto At Home/Chez Soi baseline data, researchers measured past-year perceived discrimination in healthcare and associations with mental health, substance use, and emergency department use.
What they found
42% reported any discrimination; mental illness/substance use (33%) and homelessness/poverty (30%) were most common; discrimination associated with greater lifetime substance/mental severity and more frequent ED use.
The limits
What it doesn't show
Causal direction (discrimination vs illness severity) and whether anti-discrimination interventions reduce ED use.
Key terms
- Perceived discrimination
- Self-reported unfair treatment attributed to social identity in care settings.
- Housing First
- Program offering housing without sobriety prerequisites; parent trial context.
- Unmet healthcare need
- Perceived need for care that was not obtained.
- ED use
- Emergency department utilization frequency.
- CSI
- Colorado Symptom Index for mental health symptom severity.
- Health equity
- Fair opportunity for health unaffected by unjust social disadvantage.
Flashcards
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Quiz yourself
Any perceived discrimination prevalence:
Common questions
How common was any discrimination?
42% reported at least one form in the past 12 months.
Which attributions were most common?
Mental illness/substance use (33%) and homelessness/poverty (30%).
Did people lack a doctor?
Most had a doctor (66%) and usual care source (90%), yet 40% reported unmet needs.
What outcomes linked to discrimination?
Greater substance/mental severity and more frequent ED use.
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