Learning difficulties common in the homeless
Homeless patients are significantly more likely to have intellectual disability compared with the general population, a general practice based study has found.
The researchers determined the prevalence of intellectual disability in a cohort of homeless patients attending a general practice in Hull.
The PCT-managed practice focusses on the needs of the socially excluded. Homelessness was defined as ‘staying in temporary accommodation for the homeless' and all participants considered themselves to be homeless.
Prospective participants from a randomly generated list were asked to participate in the study by their hostel workers until the target number of 50 was achieved. Intellectual ability was assessed using a range of validated tools, and testing was complemented by a detailed review of the primary care medical file and interview data to determine references to intellectual difficulties in childhood.
The model for identifying intellectual disability was consistent with the definition and classification of intellectual disability published by the American Association for Mental Retardation.
In the study group, men outnumbered women by a factor of more than four to one. The average age of participants was 33, range 17-64 years and 33 were men. Full and verbal IQ scores attained by the homeless group were significantly lower than would be expected. There was no significant difference in performance IQ between the scores attained by the homeless group studied and the published means for the test. Clinical assessment of intellectual disability found that six of the 50 participants (12%) would satisfy the criteria for intellectual disability services.
Adults with learning difficulties face a range of socio-economic inequalities. Current government policy does not acknowledge homelessness as a specific issue in intellectual disability, and there has been little research in this area.
The study suggests that, in addition to mental ill-health, substance misuse and homelessness itself, underlying intellectual disability is also an important cause of cognitive impairment and difficulty in functioning for the homeless population.
GPs should be aware that there is increased risk of becoming homeless for those with learning disabilities, and that a significant proportion of the homeless patients they see will have intellectual disability. Health information and advice for the homeless should be provided in an accessible way, potentially supported by appropriate written and visual information.
Peter M, Oakes PM and Davies RC. Intellectual disability in homeless adults. A prevalence study. J Intellect Disabil 2008;12(4):325-34Reviewer
Dr Jez Thompson
Former GP, clinical director, Leeds Community Drug Services