Bringing together health care, shelter and interdisciplinary education.
The Shelter Health Network is a collaboration of health professionals and social service organizations established in 2005 in order to reach a high risk population of people who do not have stable housing and who have complex health problems. The major proponents of this initiative include: Good Shepherd Centres, Salvation Army, Wesley Urban Ministries, Mission Services, Wayside House and CMHA.
People who are homeless experience poorer health as being homeless creates barriers to accessing health service. Helping people with both their housing and their health at the same time has a better chance of being effective than trying to help with one issue at a time.
The Shelter Health Network is also committed to teaching nursing students, medical students, post graduate residents and other health professionals. Interdisciplinary (or interprofessional) education happens when two or more professions learn from and about each other to improve the quality of care. The complex health needs of people who are homeless require different types of skills from different types of service providers. Our close link with McMaster University, its teachers and its researchers means that our network can help others to understand the problems of health and homelessness.
In the past two decades, both provincial and federal governments as well as municipalities have issued key mental health and primary health care policy documents concerned with reform. From these reports emphasis has been placed on developing comprehensive care in the community that is accessible, integrated and multi-disciplinary; offering a level of continuity, quality and satisfaction to both clients and providers; and focusing on health promotion, independence and choice (Health Canada, 2003; Kirby, 2002; Provincial Forum of Mental Health Implementation Task Forces, 2002; Romanow, 2002; Metropolitan District Health Council, 1996; Ontario’s Premier’s Council, 1989).
The research evidence tells us that within the context of these reforms those who are impoverished, including the homeless pose special challenges to the provision of health care in terms of: 1) the complexity of health care needs and 2) in the provision of accessible and appropriate levels of health care. People living in poverty or who are homeless have lower levels of general health. They experience multiple and often chronic physical, mental health and addiction problems resulting in higher levels of health care use including emergency room visits and lengthy hospital stays (Policy Forum on Improving Access to Health Care and Social Services for People Experiencing Homelessness, 2005).
In a comprehensive survey of more than 350 people living in relative or absolute homelessness in the City of Hamilton (2004), nearly 1/3 of participants reported being admitted to hospital in the previous year; this in a city with one of the highest poverty rates in the Province of Ontario (approximately 95,000 or 1 in every 5 people). Given the high poverty rate as well as the rate of acute care service use reported by those surveyed, hospitals in Hamilton can expect an alarming rate of at least 1 in every 5 admissions and perhaps as high as 1 in every 3 admissions to be that of someone living in poverty presenting with a complex health care need.
Barriers to accessing and utilizing more appropriate levels of health care services by those who are impoverished is in part attributed to significant gaps existing within the delivery of services. These include lack of coordination and continuity of health care services across sectors particularly from acute care into community settings; lack of integration between health and social services; lack of harm reduction housing; lack of understanding by health care professionals of issues related to poverty and homelessness and finally, a lack of co-ordination across all three levels of government (Policy Forum on Improving Access to Health Care and Social Services for People Experiencing Homelessness, 2005).
The Shelter Health Network is consistent with recommendations from a collaborative study completed in 2002 (Primary Health Care in East Downtown Hamilton), and with the direction of the new Local Integrated Health Network in the Province. The LIHN legislation “places significant decision-making power at the community level and focuses the local health system on the community’s needs, improving health results for patients in every part of the province”. The intent of LHIN is to “break down the barriers that patients face, and ensure that decisions are made in the interests of patient care”.(http://www.health.gov.on.ca/)