Osman, Abdi D ORCID: https://orcid.org/0000-0002-8104-8019, Bhowmik, J, Rachele, Jerome ORCID: https://orcid.org/0000-0002-5101-4010, Gilmartin-Thomas, J, Gill, Peter ORCID: https://orcid.org/0000-0001-7772-4849, Gunarathne, L and Braitberg, G (2026) Understanding Healthcare-Seeking Patterns of People Experiencing Homelessness: A Quantitative Multi-Centre Analysis of Emergency Department Utilisation. Psychiatric Quarterly. ISSN 0033-2720

Abstract

People experiencing homelessness (PEH) face significant barriers to healthcare access. This study explores the socio-demographic and clinical characteristics, as well as health-seeking behaviour, of PEH presenting to two major Australian metropolitan Emergency Departments (EDs). A quantitative observational study was conducted using administrative and clinical data from ED records for all PEH presentations during 2023. Data were analysed using SPSS (v30) and R (4.5.1). Of the 541 cases initially screened, 310 met inclusion criteria, with mean age of 42.4 years (SD = 14.0), and mean ED length of stay (LOS) of 8.48 h (SD = 8.34 h). Disposition status was significantly associated with triage acuity, self-harm history, substance use, chronic disease, suicidal intent, and emergency psychiatry review. Patients with self-harm or substance use histories were more likely to have follow-up arranged (p < 0.001 and p = 0.006 respectively). Younger patients were more often referred to mental health facilities (p = 0.002). This cohort demonstrated a wide range of psychosocial and clinical needs, including documented self-harm, mental health conditions, substance use, and chronic disease, with suicidal intent recorded in one in five presentations. Disposition outcomes varied substantially, and patients triaged as ‘not urgent’ showed the highest rate of leaving against medical advice (45.2%), suggesting perceived acuity may influence care engagement. Differences across age, sex, and ED length of stay further highlight the diversity of presentations. Collectively, these findings reinforce the need for flexible and responsive care pathways that account for the heterogeneity and complexity of this population.

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