Open Access Highly Accessed Open Badges Research article

Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities

Réamonn Canavan1*, Margaret M Barry1, Aleksandra Matanov2, Henrique Barros3, Edina Gabor4, Tim Greacen5, Petra Holcnerová6, Ulrike Kluge7, Pablo Nicaise8, Jacek Moskalewicz9, José Manuel Díaz-Olalla10, Christa Straßmayr11, Aart H Schene12, Joaquim J F Soares13, Andrea Gaddini14 and Stefan Priebe2

Author Affiliations

1 Health Promotion Research Centre, National University of Ireland Galway, University Road, Galway, Ireland

2 Unit for Social and Community Psychiatry, Queen Mary University of London, Mile End Road, London, UK

3 Department of Hygiene and Epidemiology, University of Porto Medical School, Al Prof Hernani Monteiro, 4200-319, Porto, Portugal

4 National Institute for Health Development, 1096 Budapest Nagyvárad tér 2, Budapest, Hungary

5 L Laboratoire de recherche, Etablissement public de santé Maison Blanche, 3-5 rue Lespagnol, 75020, Paris, France

6 Department of Psychiatry, 1st Faculty of Medicine, Charles University, Ke Karlovu 11/120 00, Prague, Czech Republic

7 Clinic for Psychiatry and Psychotherapy, Charité, University Medicine Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany

8 Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30.05 B-1200, Bruxelles, Belgium

9 Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957, Warsaw, Poland

10 Ma Madrid Salud, Calle Juan Esplandiú n 13, 28007, Madrid, Spain

11 Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, 1090, Vienna, Austria

12 Academic Medical Center, University of Amsterdam, Meibergdreef 5, Room PA1-156, 1105 AZ, Amsterdam, The Netherlands

13 Department of Public Health Sciences, Karolinska Institute, Norrbacka, SE-171 76, Stockholm, Sweden

14 Laziosanità ASP - Public Health Agency, Lazio Region, Via di S. Costanza 53, 00198, Rome, Italy

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BMC Health Services Research 2012, 12:222  doi:10.1186/1472-6963-12-222

Published: 27 July 2012



Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities.


Two methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them.


Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision.


While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic services.