Caring for patients experiencing homelessness
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj-2024-080768 (Published 31 March 2025) Cite this as: BMJ 2025;388:e080768
- Gemma Ashwell, GP in inclusion health and clinical lecturer1,
- Andrea E Williamson, GP and professor of general practice and inclusion health2,
- Mandy Pattinson, lived experience programme manager3,
- Stephen W Hwang, staff physician and research scientist4
- 1Faculty of Medicine and Health, University of Leeds & Bevan Healthcare, Bradford, UK
- 2General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, UK
- 3Pathway, London, UK
- 4MAP Centre for Urban Health Solutions, Unity Health Toronto & Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada
- Correspondence to: G Ashwell g.k.ashwell{at}leeds.ac.uk
What you need to know
People experiencing homelessness face multiple barriers to accessing health care and have high mortality and morbidity from preventable or treatable conditions
Clinicians should consider preventive care, harm reduction, and the increased rates of multimorbidity and early onset frailty when caring for people experiencing homelessness
Trauma informed practice provides a framework to enable respectful, safe, collaborative, and empowering relationships
There has been a worldwide rise in homelessness over the past 10 years.1 On a single night in 2024 roughly 771 480 people in the United States were experiencing homelessness, the highest figure since reporting began in 2007.2 Equivalent figures in England showed that, on a given night in 2024, an estimated 354 016 people were homeless which is 1 in 160 people.3
Health and homelessness are closely interconnected, and there is much that can be done by healthcare professionals to improve the lives of people experiencing homelessness. Here, we explore the health impacts of homelessness and barriers to accessing healthcare, with a focus on adults in high income countries. We also offer practical considerations for clinicians providing care to people experiencing homelessness.
How does homelessness affect health?
Patterns of homelessness are complex and diverse and include rough sleeping; staying in temporary accommodation such as night shelters, hostels, and women’s refuges; and hidden forms of homelessness such as staying with friends, sofa surfing, and living in squats or “beds in sheds.”4 The support needs of people experiencing homelessness are also diverse. A person who has become homeless due to a job loss but without other risk factors may require little support and be able to return to housing quickly. For many, however, homelessness can be a longer term problem, resulting from an accumulation of risks and traumatic experiences at different points along their life course.5
The landmark Marmot Review in 2010 drew widespread attention …
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