Homelessness: care for the most vulnerable - a narrative review of risk factors, health needs, stigma, and intervention strategies.

PURPOSE OF REVIEW: To summarize the most recent literature on risk factors of homelessness, mental, and somatic health needs, healthcare use, stigma as well as intervention strategies for people experiencing homelessness.

RECENT FINDINGS: Studies identified adverse life events as well as mental health problems like drug use or suicidality as significant predictors of becoming homeless. Prevalence rates of mental disorders, especially substance use disorders, psychotic disorders, and depression are high. Barriers of healthcare use are financial resources and insurance status as well as experiences of discrimination. Aspects of trust and safety as well as age and gender were identified of high importance in the design of interventions. Strategies of permanent supportive housing like Housing First have shown a stable positive effect on housing stability, but not mental health outcomes. Peer support, forms of intensive case management, and harm reduction strategies are the most promising approaches to address these further needs.

SUMMARY: Exploration into the relationship of homelessness and mental health as well as adequate intervention strategies is far from being conclusive. Especially, the development of effective interventions addressing issues of trauma, stigma and discrimination, community integration, and mental health needs is still in its infancy.