Marcel Slockers

20 Chapter 1 and healthcare programmes can reduce risk behaviour among homeless people 52 There is also some evidence that housing as an intervention is important for people with psychiatric problems. As a result of the ‘housing first’ intervention for psychiatric patients at risk of becoming homeless, the number of hospitalisations in a psychiatric ward decreased. Programmes aimed at high risk groups, such as people released from prison or psychiatric as well as the introduction of national plans aimed at homeless people, tend to improve the mental health of these groups. 4 In the Netherlands, the Action Plan for Social Support 2006-2010 as a social policy inter- vention was evaluated for the four major cities. 28 It was reported how many people reached the stable mix. Improvements in many areas were observed: the safety index in Rotterdam had improved; fewer violent incidents were reported as well as reduced drug use on the streets. In addition, the sense of security among the Rotterdam population had improved. 53 In the evaluation, however, the impacts on health problems and mortality among homeless people were ignored. For this reason, we have expanded the evaluation, and in this thesis, we analyse health problems and mortality among homeless people in Rotterdam before and after the implementation of the Action Plan for Social Support. In this study, we have also explored the effect on the accessibility of care for homeless people of the unique Dutch policy from 2015, which excludes people without an address from health insurance. This policy has not been evaluated before. 6. How can research and research data contribute to better care for homeless people? The fact that homeless people have no stable contacts or accommodation makes it difficult to do research with a high level of evidence. 5 For inclusion and follow-op of homeless people in scientific research, it is unpredictable how and where to find the homeless people again. Validity of studies among homeless people is often limited. However, the interna- tional consensus among street doctors is that in order to provide good healthcare, research and data on health problems and mortality in this group is urgently needed. 4,54 In order to improve healthcare for homeless people, as well as the related funding, well-founded research data are essential. Research on mortality, life expectancy and cause of mortality among homeless people in Rotterdam has not been conducted before. The current distribu- tion of health problems used at the consultancy hours was not known either, as it had not been investigated after 2005. Likewise, the effects of the Action Plan for Social Support on homeless people’s health had not been evaluated. There was also no assessment of the implications of policy changes in health insurance for the accessibility of healthcare among homeless people.