Collaborative Mental Health Care for the Homeless: The Role of Psychiatry in Positive Housing and Mental Health Outcomes

Stergiopoulos, Vicky; Dewa, Carolyn S.; Rouleau, Katherine; Yoder, Shawn; Chau, Nancy

doi:10.1177/070674370805300109

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…With regards to housing, significant reductions in the mean number of days spent in shelters and streets were observed in both groups over the follow-up period. This finding is consistent with an earlier study by Stergiopoulos et al[ 40 ] that found that a substantial proportion of shelter residents at the IMCC site obtained housing within 6 months after referral to the program. Few studies have examined the effects of collaborative mental health interventions on housing outcomes outside of the case management and assertive community treatment literature.…”

Section: Discussionsupporting

confidence: 93%

“…Housing First and case management programs such as ICM and ACT have been shown to improve housing stability, mental health, and substance use outcomes in this population [ 20 , 21 , 23 ], however, the availability of these programs is limited in many jurisdictions [ 15 , 80 , 81 ]. Shelter-based collaborative care models avoid long waiting lists for primary and specialty services [ 40 ], and allow for timely access to coordinated, less intensive supports. These models may have an important role in the continuum of services available to people experiencing homelessness and mental illness.…”

Section: Discussionmentioning

confidence: 99%

“…A study of a Shared Care Clinical Outreach Service to provide multidisciplinary care to individuals experiencing homelessness demonstrated that it is possible to adapt a collaborative mental health care model for this population [ 39 ]. A pilot study of a shelter-based collaborative mental health care team by our group showed positive housing outcomes among 49 % of participants and clinical improvement among 35 %, 6 months after program enrollment [ 40 ]. It must be noted however, that the pilot study`s sample was recruited from a single site, thus limiting the generalizability of study findings.…”

Section: Introductionmentioning

confidence: 99%

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The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study

Stergiopoulos

Schuler

Nisenbaum

et al. 2015

BMC Health Serv Res

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BackgroundAlthough a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model.MethodsIn total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains.ResultsWe observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures.ConclusionsOur findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study

Stergiopoulos

Schuler

Nisenbaum

et al. 2015

BMC Health Serv Res

Self Cite

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“…One step to reduce that risk is to increase access to immediate, safe, affordable, permanent housing. Indeed, when combined with quality mental health services, secure, supportive housing has been shown to lead to significant improvements in mental health outcomes among formerly homeless citizens (Stergiopoulos et al 2008). Thus, we believe that emphasis must also be placed—within both research and public policy—on developing housing-based mental health programs for homeless women.…”

Section: Discussionmentioning

confidence: 99%

“I Need Help and I Know I Need Help. Why Won’t Nobody Listen to Me?”

Huey

Fthenos

Hryniewicz

2012

Society and Mental Health

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In the present study, we draw on interviews conducted with 79 homeless women in Detroit and Chicago to reveal the extent to which women in our sample have experienced multiple forms of trauma and other significant stressors over their life course, events that we show have had serious negative effects on their mental and emotional well-being. We then look at their ability to access counseling services and consider barriers to service use. For those women who have utilized counseling services, we examine their reported satisfaction with the services accessed and identify certain deficiencies. Based on our findings, we conclude that it could reasonably be argued that the ‘pathological homeless woman’ is a construct tied to women’s experiences with a health care system that frequently fails them.

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“…Medication non-adherence is an important problem among people with psychiatric disorders experiencing homelessness. Adherence to prescribed psychotropic drugs is associated not only with improved clinical outcomes but also improved housing outcomes ( 1 ). However, a minority (as low as 12%) of homeless individuals reach therapeutic efficacy with their prescribed psychotropics ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

A systematic review of approaches to improve medication adherence in homeless adults with psychiatric disorders

Hird,

Radhakrishnan,

Tsai

2024

Front. Psychiatry

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IntroductionMedication non-adherence is a significant problem among homeless individuals with psychiatric disorders in the United States. We conducted a systematic review to identify strategies to improve psychiatric medication adherence among homeless individuals with psychiatric disorders, including substance use disorders.MethodsWe searched seven databases (MEDLINE, Embase, PsychInfo, Scopus, Web of Science, CDSR, and CENTRAL) and screened 664 studies by title and abstract followed by full-text review. Our inclusion criteria were studies that: involved an intervention for homeless adults with psychiatric disorders, reported a quantitative outcome of medication adherence, and were published in English in a peer-reviewed journal. We rated the relative effectiveness of strategies described in each study using a self-designed scale.ResultsEleven peer-reviewed studies met criteria for inclusion in this review. Within these studies, there were seven different approaches to improve medication adherence in this population. Three studies were randomized controlled trials (RCTs) and the remaining were observational studies. Outpatient interventions included Assertive Community Treatment, Cell Phone-Assisted Monitoring, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Homeless-Designated Pharmacy Clinics. Residential, shelter-based, and inpatient interventions included use of the Housing First model, Modified Therapeutic Communities, and Homeless-Designated Inpatient Care. The approaches described in four of the eleven studies were rated as scoring a 3 or higher on a 5-point scale of effectiveness in improving medication adherence; none received 5 points.DiscussionThe interventions with the strongest evidence for improving medication adherence in this population were Assertive Community Treatment, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Housing First. Overall, studies on this topic required more rigor and focus on medication adherence as an outcome in this population. This review highlights several promising strategies and the need for larger RCTs to determine effective and diverse ways to improve medication adherence among homeless adults with psychiatric disorders.

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Collaborative Mental Health Care for the Homeless: The Role of Psychiatry in Positive Housing and Mental Health Outcomes

Cited by 9 publications

References 31 publications

The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study

The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study

“I Need Help and I Know I Need Help. Why Won’t Nobody Listen to Me?”

A systematic review of approaches to improve medication adherence in homeless adults with psychiatric disorders

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