{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:35:25Z","timestamp":1787924125601,"version":"build-2784847793"},"reference-count":35,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec id=\"S2056472426120717_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People experiencing homelessness (PEH) attend emergency departments, often presenting with complex needs. The relationship between housing status and access to mental healthcare is not well established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120717_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare characteristics, clinical severity and admission rates by housing status, and to examine whether homelessness is associated with admission after adjusting for severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120717_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study of patients referred to psychiatry at an inner-city emergency department between 1 January and 31 December 2020. Housing status was recorded at presentation. Severity was rated using the Threshold Assessment Grid (TAG, range 0\u201324). The primary outcome was hospital admission. Group differences were examined using\n                      <jats:italic>t<\/jats:italic>\n                      -tests and\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      tests. Multivariable logistic regression models assessed variables associated with admission, adjusting for TAG total, age and gender, and then for individual TAG domains.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120717_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 771 referrals, 282 (36.6%) were PEH. PEH had higher severity (mean TAG 12.3\n                      <jats:italic>v<\/jats:italic>\n                      . 8.1,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) but lower admission rates (10.6\n                      <jats:italic>v<\/jats:italic>\n                      . 18.0%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.006). All TAG domains were elevated among PEH, with the largest differences in survival, risk from others and social functioning. Each one-point TAG increase was associated with higher odds of admission (adjusted odds ratio (aOR) 1.34,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), as was older age (aOR 1.04 per year,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). PEH had lower odds of admission (aOR 0.16,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), which persisted following domain-level adjustment (aOR 0.45,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.039).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120717_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite greater severity, admission rates among PEH were lower following emergency psychiatric assessment. These findings highlight the need for better understanding of how emergency mental health services respond to the complex needs of this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12071","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:13:56Z","timestamp":1787922836000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Housing status and emergency mental health outcomes in an inner-city emergency department: retrospective cohort study"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0828-703X","authenticated-orcid":false,"given":"Ailbhe","family":"Brennan","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05m7pjf47","id-type":"ROR","asserted-by":"publisher"}],"name":"University College Dublin School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajinkya","family":"Mehta","sequence":"additional","affiliation":[{"name":"Health Service Executive (HSE) Dublin North East"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maia","family":"Springael","sequence":"additional","affiliation":[{"name":"University College Dublin School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Kilbride","sequence":"additional","affiliation":[{"name":"Health Service Executive (HSE) Dublin North East"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6995-5361","authenticated-orcid":false,"given":"Anne M.","family":"Doherty","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05m7pjf47","id-type":"ROR","asserted-by":"publisher"}],"name":"University College Dublin School of Medicine"},{"name":"Mater Misericordiae University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"S2056472426120717_ref4","unstructured":"4 Irish Statute Book (ISB). Housing Act, 1988. ISB, 1988 (https:\/\/www.irishstatutebook.ie\/eli\/1988\/act\/28\/enacted\/en\/html)."},{"key":"S2056472426120717_ref3","unstructured":"3 F\u00e9d\u00e9ration Europ\u00e9enne d\u2019Associations Nationales Travaillant avec les Sans-Abri [European Federation of National Organisations Working With the Homeless] (FEANTSA). ETHOS \u2013 European Typology on Homelessness and Housing Exclusion. FEANTSA, 2017 (https:\/\/www.feantsa.org\/download\/ethos2484215748748239888.pdf)."},{"key":"S2056472426120717_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31869-X"},{"key":"S2056472426120717_ref14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016420"},{"key":"S2056472426120717_ref31","unstructured":"31 Goering, P , Veldhuizen, S , Watson, A , Adair, C , Kopp, B , Latimer, E , et\u00a0al. National Final Report. Cross-Site At Home\/Chez Soi Project. Mental Health Commission of Canada, 2014 (https:\/\/www.mentalhealthcommission.ca\/wp-content\/uploads\/drupal\/mhcc_at_home_report_national_cross-site_eng_2_0.pdf)."},{"key":"S2056472426120717_ref15","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-019-1002-6"},{"key":"S2056472426120717_ref6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003750"},{"key":"S2056472426120717_ref30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0290599"},{"key":"S2056472426120717_ref1","unstructured":"1 United Nations Human Settlements Programme (UN-Habitat). Housing Rights. UN-Habitat, n.d. (https:\/\/unhabitat.org\/programme\/housing-rights)."},{"key":"S2056472426120717_ref33","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.561"},{"key":"S2056472426120717_ref24","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2020-209992"},{"key":"S2056472426120717_ref11","unstructured":"11 Department of Housing, Local Government and Heritage. Monthly Homelessness Report: Report on the Number of Individuals, Families and Children Accessing State-Funded Local Authority Homeless Emergency Accommodation. Department of Housing, Local Government and Heritage, 2026 (https:\/\/assets.gov.ie\/static\/documents\/0ec6084a\/Monthly_Homelessness_Report_Februrary_2026.pdf)."},{"key":"S2056472426120717_ref12","volume-title":"Dublin Simon Community Annual Review 2013","year":"2013"},{"key":"S2056472426120717_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckac191"},{"key":"S2056472426120717_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckaf144"},{"key":"S2056472426120717_ref22","unstructured":"22 National Institute for Health and Care Excellence (NICE). Integrated Health and Social Care for People Experiencing Homelessness. NICE, 2022 (https:\/\/www.nice.org.uk\/guidance\/ng214)."},{"key":"S2056472426120717_ref21","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796019000052"},{"key":"S2056472426120717_ref13","doi-asserted-by":"publisher","DOI":"10.1017\/S0790966700017560"},{"key":"S2056472426120717_ref5","unstructured":"5 Institute for Health Metrics and Evaluation. GBD Results Tool. IHME, 2025 (https:\/\/ghdx.healthdata.org\/gbd-results-tool)."},{"key":"S2056472426120717_ref16","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-023-04945-z"},{"key":"S2056472426120717_ref27","doi-asserted-by":"publisher","DOI":"10.1017\/ipm.2021.41"},{"key":"S2056472426120717_ref32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.1163"},{"key":"S2056472426120717_ref18","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0447.2002.02356.x"},{"key":"S2056472426120717_ref19","first-page":"45","article-title":"Threshold 4: an evaluation of the Threshold Assessment Grid as an aid to mental health referrals","volume":"1","author":"Slade","year":"2003","journal-title":"Prim Care Ment Health"},{"key":"S2056472426120717_ref29","unstructured":"29 Health Service Executive National Social Inclusion Office. National Strategic Plan to Improve the Health of People Experiencing Homelessness in Ireland (2024\u20132027). Health Service Executive National Social Inclusion Office, 2024 (https:\/\/about.hse.ie\/publications\/national-strategic-plan-improve-health-people-experiencing-homelessness-ireland\/)."},{"key":"S2056472426120717_ref28","doi-asserted-by":"publisher","DOI":"10.1017\/ipm.2020.104"},{"key":"S2056472426120717_ref2","unstructured":"2 United Nations General Assembly. Inclusive Policies and Programmes to Address Homelessness, Including in the Aftermath of the Coronavirus Disease (COVID-19): Resolution A\/RES\/78\/172. United Nations, 2023 (https:\/\/undocs.org\/A\/RES\/78\/172)."},{"key":"S2056472426120717_ref17","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1007\/s001270050011","article-title":"Threshold Assessment Grid (TAG): the development of a valid and brief scale to assess the severity of mental illness","volume":"35","author":"Slade","year":"2000","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"S2056472426120717_ref26","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2021.970"},{"key":"S2056472426120717_ref23","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6923e1"},{"key":"S2056472426120717_ref25","doi-asserted-by":"publisher","DOI":"10.1017\/ipm.2022.6"},{"key":"S2056472426120717_ref34","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230896"},{"key":"S2056472426120717_ref35","unstructured":"35 Health Service Executive National Social Inclusion Office. Protocol for the Transfer of Care for People Experiencing Homelessness in Dublin: From Hospitals to Community. Health Service Executive National Social Inclusion Office, 2025 (https:\/\/about.hse.ie\/api\/v2\/download-file\/file_based_publications\/Protocol_for_the_Transfer_of_Care_for_People_Experiencing_Homele_FuYDMdn.pdf)."},{"key":"S2056472426120717_ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s001270170017"},{"key":"S2056472426120717_ref9","doi-asserted-by":"publisher","DOI":"10.1186\/s12245-022-00435-3"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472426120717","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:14:00Z","timestamp":1787922840000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472426120717\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":35,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["S2056472426120717"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2026.12071","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e218"}}