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Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study

BMJ 2009; 339 doi: (Published 27 October 2009) Cite this as: BMJ 2009;339:b4036

More needs to be done

The article has been a very timely publication, given the
current context of economic recession, confirming some of
previous research on excess mortality in those lacking a
domicile, and attempting to highlight the mortality baggage
the homeless in a bigger nationwide study, separating
homelessness from low income.

Working in the field of Psychiatry for quite a few years,
non inclusion of the ‘real homeless’, those living
the street, was a disappointment but understandable due to
design of the study. As suggested by the authors, the
figures are
likely to be much worse compared to those in “shelters,
rooming houses and hotels”.

It is well known that most major psychiatric illnesses
associated with a higher mortality 1 and in
Schizophrenia, the life span may be 20% shorter
While suicide and injury may account for over 20% of
the increasing incidence of metabolic syndrome is gradually
identified as a preventable cause. Mentally ill are more
to have sedentary lifestyle and are at increasing risk of
cardiovascular diseases due to obesity, dyslipidemia and
diabetes, some of which may be attributable to atypical
antipsychotics. Furthermore, they are more likely to smoke
compounding their risks. Among the mentally ill homeless,
who become homeless after becoming ill have higher
prevalence of
dependence on alcohol4.

Whilst being homeless is in itself a major stressful
the lack of nutrition and hygiene, polysubstance misuse,
hesitancy or inability to seek medical help puts them into a
downward cycle. Lack of employment can predispose to
sex work, causing its own health damage.

We agree that the excess mortality in homeless may not be
accounted by economic situation alone and that there are
difficult and compounding factors to decipher. It will
more efficient and effective social services and health
initiatives to improve the health of this underprivileged
disadvantaged section of society.


1. Osby et al, Archives of General Psychiatry.

2. Harris et al, British Journal of Psychiatry. 1998; 173:11

3. Newman SC et al, Canadian Journal of Psychiatry.

4. Sullivan G et al, Social Psychiatry and Psychiatric
Epidemiology. 2000;35:444-450

Competing interests:
None declared

Competing interests: No competing interests

30 October 2009
Nadeem Z Mazi-Kotwal
ST6 in Psychiatry
Madhavan Seshadri, ST3 in Psychiatry, Calnwood Court, Calnwood Road, Luton, LU40LX
Bedfordshire and Luton NHS Partnership Trust, Calnwood Court, Calnwood Road, Luton, LU40LX