Alcohol, drug and mental health issues in marginalised people using Salvation Army homeless services in the UK and Ireland

First published: 10 May 2019 | Last updated: 20 May 2019

Adrian Bonner1, Claire Luscombe2, Lucy Grayton1,Pamela Taylor3, Marianne van den Bree3

1 Corresponding author: Centre for Health Services Study, University of Kent, UK, CT2 7NY

2 The Salvation Army Social Services Department, UK and Ireland

3 Department of Psychological Medicine, Cardiff University, Wales, UK


To identify the key factors contributing to marginalisation in people using homeless services.


In-depth semi-structured psychiatric interviews and validated questionnaires involving homeless people2 conducted January 2006 and April 2009.


28 homeless residential and day centres in 8 regions of the UK.


967 people volunteered, after informed consent, to participate take part in the study which was approved by The Salvation Army and Cardiff University Ethics committee.


The study was undertaken by 7 researchers, psychology graduates, who had been trained in interview techniques and supervised by a Forensic Psychiatrist. Data collection involved an initial screen to collect basic information about social relations, education/employment history. Psychiatric, personality, alcohol and drug misuse, and cognitive function were later ascertained. Instruments used included the Addiction Severity Index, the AUDIT, Dast -20, GHQ-12, Psychosis Screening Questionnaire, Impact of Events Scale-revised (for PTSD), Personality Diagnostic Questionnaire-4, and Mini Mental State Examination (for DSM-IV diagnoses).

Findings and Conclusion

The people interviewed had high rates of unsatisfactory life experiences, absence of meaningful relationships, substance misuse, employment and financial difficulty, serious mental health problems and lack of access to appropriate care. Regional differences in these problems were also noted.

The findings stress the need for relevant individual assessments, support plans and specific interventions to address relationship problems by supporting agencies.


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Dr Adrian Bonner