Attitudes towards homeless people, beliefs and burnout among NHS staff in physical and mental health work settings

Abstract

Previous research has highlighted a strong association between mental illness and repeat homelessness. Despite this, there is a dearth of literature exploring the processes and mechanisms that underpin this relationship. The first chapter of this research aimed to address this gap by exploring how mental health problems are implicated in the maintenance of repeat homelessness, using realist synthesis. This realist review systematically appraised theoretical and empirical literature across a number of contexts, and iterative searches highlighted 37 relevant and rigorous articles eligible for inclusion. Themes across the literature were abstracted to develop a heuristic model of how mental health problems maintain repeat homelessness via two interacting pathways; social isolation and maladaptive coping (substance-use, gambling, antisocial behaviour). Implications for the findings are discussed and limitations are explored.

Given that staff attitudes are a significant factor impacting accessibility and engagement of marginalised client-groups including homeless clients, the second chapter of this research aimed to explore factors that contribute to stigmatising attitudes in staff working across mental health and physical health settings. Sixty-six health professionals were recruited from a range of NHS settings and were required to complete an online survey exploring demographic factors, psychological factors (attitudes, burnout, evaluative beliefs, effective working with complex clients, stress, support) and professional factors (training and experience). T-tests revealed significant differences between staff with mental health experience compared to physical health staff, such that physical health staff showed more stigmatising attitudes towards homeless clients, lower effective working with complex clients, higher levels of depersonalisation and poorer perceived levels of support. Univariate and multivariate analyses demonstrated significant associations between psychological and professional factors with attitudes, burnout and effective working with complex clients. Clinical implications are discussed and directions for future research are considered.

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Identifiers

ORCID for Nicholas Maguire: orcid.org/0000-0003-4295-8068

ORCID for Sarah Kirby: orcid.org/0000-0003-1759-1356

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