The aim of this work was to identify factors associated with homelessness status in patients admitted to the psychiatric emergency ward of a French public teaching hospital over the 6-year study period (2001-2006).

The study was based on a retrospective review of the psychiatric emergency ward's administrative and medical computer databases. Each emergency care episode had accompanying data including demographic, financial, clinical, and management information.

During this 6-year study, the psychiatric service recorded 16,754 care episodes concerning 8,860 different patients, of which 591 were homeless (6.7%) and 8,269 were non-homeless (93.3%). The mean ± SD number of visits to the psychiatric emergency service was higher for homeless (4.9±12.3) than for non-homeless patients (1.7±2.4) (p< .001). A total of 331 homeless patients (56%) had more than one care episode, versus 2,180 (26%) for non-homeless patients. Factors associated with homelessness included male sex, single status, and the reception of social financial assistance. Schizophrenia (43.7%) and substance use disorders (31.0%) were the most frequent disorders in homeless patients. Aggressive behaviour and violence were reported equally in homeless and non-homeless patients. Homeless patients were hospitalized less often after having received care in the emergency ward.

Although there is near-universal access to free mental health care in France, our findings suggest that the quality and adequacy of subsequent care were not always guaranteed. Multidisciplinary and collaborative solutions are needed to improve the management of homeless patients.