Healthcare Professionals' Experiences of Mental Health Crises Among People Experiencing Homelessness
Abstract
Background: People experiencing homelessness face significant barriers to accessing mental health care, often resulting in untreated psychological distress and crisis presentations. In Ireland, the absence of dedicated mental health services for this population means that frontline clinicians frequently manage acute mental health deterioration within generalist settings not designed or resourced for such care.
Aim: To explore the experiences of healthcare professionals responding to mental health crises among individuals experiencing homelessness and to identify systemic, relational, and organisational factors influencing care delivery.
Methods: A descriptive qualitative study informed by critical realism was conducted using semi-structured interviews with 14 healthcare professionals, including general practitioners, specialist nurses, a psychotherapist, and service leaders. Reflexive Thematic Analysis was employed to identify patterns and develop key themes grounded in participant experiences.
Results: Five key themes emerged—
- Barriers to Access: Rigid eligibility criteria, catchment-based exclusions, and dual diagnosis policies limit access to mental health services.
- Trust and Therapeutic Relationships: Trust-building is essential but challenged by system-level discontinuity and stigma.
- Trauma-Informed and Holistic Approaches: Participants prioritised care models responsive to trauma, substance use, and instability.
- Stability as a Foundation: Housing, healthcare continuity, and harm-reduction were viewed as prerequisites for engagement.
- Systemic and Policy Failures: Fragmented care, reliance on emergency departments, and proposed legislative reforms were cited as exacerbating crisis-driven responses.
Conclusion: Healthcare professionals are routinely required to manage mental health crises within under-resourced generalist settings, relying on person-centred, relational, and harm-reduction strategies to bridge systemic gaps. Findings underscore the urgent need for integrated, trauma-informed models of care that address housing, substance use, and interagency coordination.
Learning Objectives:
- Describe key structural and systemic barriers to mental health care for individuals experiencing homelessness.
- Analyse the impact of therapeutic relationships and trauma-informed care in responding to mental health crises.
- Evaluate system-level strategies for improving mental health service access and equity for marginalised populations.
Notes
References: Gilmore J., Karmakar S., Chukwu A., (2025) Review of Crisis Mental Health Support within Inclusion Health. University College Dublin.
Onapa, H., Sharpley, C. F., Bitsika, V., McMillan, M. E., MacLure, K., Smith, L., & Agnew, L. L. (2022). The physical and mental health effects of housing homeless people: A systematic review. Health & social care in the community, 30(2), 448-468.
Gutwinski, S., Schreiter, S., Deutscher, K., & Fazel, S. (2021). The prevalence of mental disorders among homeless people in high-income countries: an updated systematic review and meta-regression analysis. PLoS medicine, 18(8), e1003750.
Sigma Membership
Omega Epsilon at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Descriptive/Correlational
Research Approach
Qualitative Research
Keywords:
Public and Community Health, Health Equity or Social Determinants of Health, Crisis Intervention (Mental Health Services), Homeless Persons, Homelessness, Attitudes of Medical Personnel, Health Services Accessibility
Recommended Citation
Gilmore, John P., "Healthcare Professionals' Experiences of Mental Health Crises Among People Experiencing Homelessness" (2026). International Nursing Research Congress (INRC). 145.
https://www.sigmarepository.org/inrc/2026/presentations_2026/145
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-06
Healthcare Professionals' Experiences of Mental Health Crises Among People Experiencing Homelessness
Toronto, Ontario, Canada
Background: People experiencing homelessness face significant barriers to accessing mental health care, often resulting in untreated psychological distress and crisis presentations. In Ireland, the absence of dedicated mental health services for this population means that frontline clinicians frequently manage acute mental health deterioration within generalist settings not designed or resourced for such care.
Aim: To explore the experiences of healthcare professionals responding to mental health crises among individuals experiencing homelessness and to identify systemic, relational, and organisational factors influencing care delivery.
Methods: A descriptive qualitative study informed by critical realism was conducted using semi-structured interviews with 14 healthcare professionals, including general practitioners, specialist nurses, a psychotherapist, and service leaders. Reflexive Thematic Analysis was employed to identify patterns and develop key themes grounded in participant experiences.
Results: Five key themes emerged—
- Barriers to Access: Rigid eligibility criteria, catchment-based exclusions, and dual diagnosis policies limit access to mental health services.
- Trust and Therapeutic Relationships: Trust-building is essential but challenged by system-level discontinuity and stigma.
- Trauma-Informed and Holistic Approaches: Participants prioritised care models responsive to trauma, substance use, and instability.
- Stability as a Foundation: Housing, healthcare continuity, and harm-reduction were viewed as prerequisites for engagement.
- Systemic and Policy Failures: Fragmented care, reliance on emergency departments, and proposed legislative reforms were cited as exacerbating crisis-driven responses.
Conclusion: Healthcare professionals are routinely required to manage mental health crises within under-resourced generalist settings, relying on person-centred, relational, and harm-reduction strategies to bridge systemic gaps. Findings underscore the urgent need for integrated, trauma-informed models of care that address housing, substance use, and interagency coordination.
Learning Objectives:
- Describe key structural and systemic barriers to mental health care for individuals experiencing homelessness.
- Analyse the impact of therapeutic relationships and trauma-informed care in responding to mental health crises.
- Evaluate system-level strategies for improving mental health service access and equity for marginalised populations.
Description
This study explores how healthcare professionals respond to mental health crises among people experiencing homelessness in the absence of dedicated services. Findings highlight systemic barriers, the importance of trauma-informed, relationship-based care, and the urgent need for integrated, equitable mental health support.