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I have been following recent discussions about paying for migrant healthcare as it has been an issue I have personally faced through my work as a psychiatrist in central London and particularly when I worked in the Joint Homelessness Team, one of 5 specialist teams in London that work with people who are homeless and who have a severe and enduring mental illness. Currently as an in-patient locum consultant I struggle with trying to plan a discharge for someone who is not entitled to benefits and yet is clearly vulnerable in their mental health and social needs.
In the Joint Homelessness team there was certainly a perceived increase in those individuals who had been referred to the team but who had no recourse to public funds. Myself, Dr Elizabeth Venables and Dr Punita Sharma wanted to quantify this and so looked at all referrals over a 2 year period and their outcomes and compared this with a similar sample in the team published by Merson in 1981. Although the absolute numbers of those who are not eligible for benefits are small and difficult to quantify precisely, of the 437 cases referred, 20% were EU nationals, a variable amount having eligibility for some benefits. 5% were illegal immigrants, not entitled to any benefits and in 5% the immigration status was unknown. Following a period of in-patient treatment 15 patients were repatriated.
I believe this service evaluation highlights a number of ethical and social issues and places the migrant health tourist under the microscope. With homelessness increasing, housing benefits and mental health services struggling with cuts, this group are increasingly vulnerable. For those who migrate due to a psychotic illness or who through the process of migration develop a psychotic illness and become homeless, accessing health care is particularly difficult and pertinent. There is certainly little choice involved and the risks for the individual are great. In fact often the nature of a paranoid illness is that the individual resists all attempts made for them to receive treatment.
In our findings the overall figures of those patients who have no recourse to public funds were far less than the perceived numbers but this perhaps reflects the difficulties services have trying to support rough sleepers with predominately psychotic illnesses who do not have access to benefits and or housing. The complexity of access to healthcare for migrants is vast and extends way beyond financial costs and requires a much more detailed and focused examination.
References:
Merson, S. A psychiatric service for the homeless mentally ill: the first two years. Psychiatric Bulletin 1996, 20:662-665.
Re: Paying for migrant healthcare
I have been following recent discussions about paying for migrant healthcare as it has been an issue I have personally faced through my work as a psychiatrist in central London and particularly when I worked in the Joint Homelessness Team, one of 5 specialist teams in London that work with people who are homeless and who have a severe and enduring mental illness. Currently as an in-patient locum consultant I struggle with trying to plan a discharge for someone who is not entitled to benefits and yet is clearly vulnerable in their mental health and social needs.
In the Joint Homelessness team there was certainly a perceived increase in those individuals who had been referred to the team but who had no recourse to public funds. Myself, Dr Elizabeth Venables and Dr Punita Sharma wanted to quantify this and so looked at all referrals over a 2 year period and their outcomes and compared this with a similar sample in the team published by Merson in 1981. Although the absolute numbers of those who are not eligible for benefits are small and difficult to quantify precisely, of the 437 cases referred, 20% were EU nationals, a variable amount having eligibility for some benefits. 5% were illegal immigrants, not entitled to any benefits and in 5% the immigration status was unknown. Following a period of in-patient treatment 15 patients were repatriated.
I believe this service evaluation highlights a number of ethical and social issues and places the migrant health tourist under the microscope. With homelessness increasing, housing benefits and mental health services struggling with cuts, this group are increasingly vulnerable. For those who migrate due to a psychotic illness or who through the process of migration develop a psychotic illness and become homeless, accessing health care is particularly difficult and pertinent. There is certainly little choice involved and the risks for the individual are great. In fact often the nature of a paranoid illness is that the individual resists all attempts made for them to receive treatment.
In our findings the overall figures of those patients who have no recourse to public funds were far less than the perceived numbers but this perhaps reflects the difficulties services have trying to support rough sleepers with predominately psychotic illnesses who do not have access to benefits and or housing. The complexity of access to healthcare for migrants is vast and extends way beyond financial costs and requires a much more detailed and focused examination.
References:
Merson, S. A psychiatric service for the homeless mentally ill: the first two years. Psychiatric Bulletin 1996, 20:662-665.
Competing interests: No competing interests