Objective: To use standardized instruments to investigate the relationship between mental disorder and other health problems among a community sample of persons living in severe domestic squalor.
Design: Cross-sectional study of clients of the the London borough of Lewisham Social Services, Special Duty Team. The Special Duty Team cleans homes of people of all ages who live in severely squalid conditions in Lewisham.
Materials and Methods: All clients consenting to participate were assessed with the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to determine ICD-10 diagnoses, if present.
Results: 81/91 eligible clients referred to the SDT were interviewed over 11 months giving a response rate of 89%. Most (51%) were younger than 65 years of age. Over two-thirds (70%) had an active mental disorder. The most common ICD-10 diagnoses were psychoactive substance dependence and abuse (32%). Substance abuse frequently occurred co-morbidly with the next most common diagnoses; organic mental disorders (12% with alcohol; 10% without) and schizophrenia (9%; 12%). 10% had a developmental disorder. 21 participants (26%) had a physical health problem significantly contributing to their living conditons. Those with contributory physical health problems were living in a less severe domestic squalor. People aged 65 or more were less likely to have a mental disorder than younger subjects. Only 30 (57%) of 57 subjects with an active mental disorder had contact with mental health services in the preceding year.
Conclusion: There were high rates of mental disorder among people living in squalid conditions and receiving special cleaning services. Significant physical health problems were also present in some cases. A disproportionate number were elderly. There were possible deficits in the health care received.
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