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August 28, 2020

Systematic review: Do discharge programmes reduce the likelihood of homelessness?

Guillermo Rodríguez-Guzmán

As we work towards an evidence-based end to homelessness, it is essential that we look at all routes into homelessness, and tackle the causes in order to minimise, and eventually eradicate, the effects. We’ve known for some time that people being discharged from institutions such as hospitals, mental health facilities, prison, social care or armed forces face high risks of homelessness for a number of reasons; it may be because they were homeless before entering an institutional setting or because previous accommodation arrangements have broken down or are now unsuitable.

So what can we do to prevent this?

To delve deeper into this issue, we undertook a systematic review, created in partnership with the Campbell Collaboration and Queen’s University Belfast. Discharge programmes for individuals experiencing, or at risk of experiencing homelessness, summarises the best existing international evidence on whether the discharge interventions that seek to prevent people leaving various institutions becoming homeless are effective.

The most important thing we learned was that discharge interventions can work. The studies included in the review suggest they can be effective in improving housing stability and reducing hospitalisations, and are promising for reducing likelihood of re-incarceration.

Read the systematic review

There is a need for a deeper look into outcomes in future studies, i.e. not just whether or not a person is housed after discharge, but also looking at their health, wellbeing and other factors such as employment.

The review also highlights the importance of individualised care and discharge plans, which is a common theme for any interventions related to homelessness - a person centred approach is always best. Key features to consider to ensure the success of a discharge programme include: creating a clear written plan in consultation with the person, planning before discharge where possible, and joint working between agencies with clear lines of accountability to ensure that no one falls through the cracks.

We also learned that more research is needed to understand how discharge from different institutions - such as hospitals, mental health facilities, prison, social care or armed forces - is affected by different interventions, especially in the UK context.

We opted for a systematic review because it is vital that policy-making and practice is informed by rigorous synthesis. By ensuring methodological quality, systematic reviews reduce the risk of bias as well as improve the reliability and accuracy of conclusions. At the Centre we also follow internationally recognised methods for systematic reviews, guaranteeing they meet the highest quality standards.

While systematic reviews have been used extensively in other fields, such as health and international development, there is no tradition of systematic reviews in homelessness in the UK. Therefore, even though the findings of this review are based on a small number of studies (23 after screening), it is currently the best available evidence of the effectiveness of such approaches for improving outcomes for people experiencing homelessness.

The results are encouraging as they show that discharge programmes can be effective in reducing homelessness and hospitalisations and may be effective in reducing re-incarceration post-discharge. However, the evidence is of mixed methodological quality, exclusively from the USA and limited to only a few outcome domains. Thus, more, high quality research is needed to improve the evidence base for the effectiveness of discharge programmes.

You can read Discharge programmes for individuals experiencing, or at risk of experiencing homelessness: a systematic review here. If you have any questions or would like to discuss the findings of the review, just get in touch.

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