© 2013 Hogrefe Publishing Crisis 2013 DOI: 10.1027/0227-5910/a000202 Short Report Self-Harm and Homeless Adults Graham Pluck 1 , Kwang-Hyuk Lee 1 , and Randolph W. Parks 1,2 1 Academic Clinical Psychiatry, University of Sheffield, UK, 2 Alton Mental Health Center, Illinois Department of Human Services, Alton, IL, USA Abstract. Background: Homelessness is associated with an increased incidence of mental illness and risk of self-harm, including suicide. Aims: To assess the prevalence of self-harm (including nonsuicidal self-injury and attempted suicide) among a UK sample of homeless adults and to compare demographic, clinical, and homeless-related variables to determine which are linked to self-harm in this population. Method: A sample of 80 homeless adults were interviewed regarding history of self-harm, mental health history, demographic, and homeless-related information. Results: Sixty-eight percent of the sample reported past acts of self-harm. Those with histories of self-harm started using significantly more substances since becoming homeless and were younger when they first became homeless. They were also significantly more likely to have a past psychiatric admission and thoughts of self-harm in the past year. Conclusion: Self-harm is common among homeless adults and linked to long- term and enduring social and mental health concerns. Keywords: homelessness, self-harm, suicide, substance misuse, mental illness Homelessness is recognized as a major social problem in most developed countries (Toro, 2007). It has been estima- ted that in the United Kingdom there are around 85,000 people sleeping in public spaces or temporary shelters (Kenway & Palmer, 2003), with figures of around 350,000 in the United States and 35,000 in Canada (Murphy, 2000). Homelessness in western countries is linked to mental ill- nesses including drug and alcohol misuse, psychosis, and depression (Fazel, Khosla, Doll, & Geddes, 2008). One estimate of mortality in Danish hostel residents suggested that they were six times more likely to die by suicide than the general population (Nordentoft & Wan- dall-Holm, 2003). Other studies have demonstrated links between completed suicide by homeless people and psy- chiatric comorbidity (Barak, Cohen, & Aizenberg, 2004), drug or alcohol abuse and recent suicidal ideation (Bickley et al., 2006), and short or repeated hostel stays (Nordentoft & Wandall-Holm, 2003). A UK study reported that home- less adults who committed suicide, when compared with a non-homeless suicide sample, were less likely to have been in contact with services in the past week, had missed their previous psychiatric contact, and were less likely to be compliant with medication (Bickley, et al., 2006). All of these studies deal with actual death by suicide. Intent to die is considered a key part of the definition of suicide (Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007). However, in many cases, particularly if nonfatal, suicidal intent is not clear. Suicidal patients vary in the ex- tent to which they are ambivalent, wish to live, or wish to die; not surprisingly, it is the latter group that is at higher risk of suicide (O’Connor et al., 2012). Owing to these am- biguities, “self-harm” has been defined by the UK’s Nati- onal Institute for Health and Clinical Excellence (NICE) as “intentional self-poisoning or injury, irrespective of the apparent purpose of the act” (National Institute for Health and Clinical Excellence, 2004, p. 7). It therefore includes nonsuicidal self-injurious acts as well as suicide attempts. Using such criteria, it has been found that homeless adults who self-harm, compared with domiciled self-harm cases, are more likely to be male, single, unemployed, and have a criminal history (Haw, Hawton, & Casey, 2006). We investigated the demographic, clinical, and home- lessness-related variables in a sample of homeless adults with or without history of self-harm (including nonsuicidal self-injury and suicide attempts). Method Participants We recruited 80 homeless adults from homeless shelters, charitable meals services, and medical services for the ho- meless in Sheffield, England. The mean age was 35.2 years (standard deviation [SD] = 9.2) and 67 (84%) were male. Definition of Homelessness and Participation We defined homelessness as: (1) lacking a secure tenan- cy, (2) accessing services for homeless adults, and (3) self-describing as homeless. This research formed part of a neuropsychological study of this sample, where further details and inclusion criteria are reported (Pluck, Lee, Da- vid, Spence, & Parks, 2012). The participation rate was not formally recorded; however, a payment of £30 (US $45) was made to each individual, and a few opted not to participate.