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
Study at a glance
- Design
- Cross-sectional — Baseline analysis from Toronto At Home/Chez Soi Housing First trial sample
- N
- N=550 · Final analytic sample with baseline interviews
- Population
- Homeless adults with mental illness at the Toronto At Home/Chez Soi site
- Outcome
- Past-year perceived discrimination in healthcare and associations with ED use
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Discrimination in care for homeless adults
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
40% reported unmet healthcare needs despite high access markers.
Although the majority of respondents had a regular medical doctor (66%), a usual source of outpatient care (90%), and a provincial health card (93%), 40% reported unmet healthcare needs.
Which discrimination types were most prevalent?
After grouping variables in the three categories of interest, the most prevalent forms of perceived discrimination were due to mental illness/substance use (33%) and homelessness/poverty (30%).
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.
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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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