Evaluation of the Housing First program in patients with severe mental disorders in France: study protocol for a randomized controlled trial

Abstract

BackgroundRecent studies in North American contexts have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness. In the context of the highly generous French national health and social care system, which is easily accessible and does not require out-of-pocket payment, the French Health Ministry insists on rigorous techniques, including randomized protocols, to evaluate the impact of Housing First approaches in France.Method and designA prospective randomized trial was designed to assess the impact of a Housing First intervention on health outcomes and costs over a period of 24 months on homeless people with severe mental illness, compared to Treatment-As-Usual. The study is being conducted in four cities in France: Lille, Marseille, Paris and Toulouse. The inclusion criteria are as follows: over 18 years of age, absolutely homeless or in precarious housing, and possessing a ‘high’ level of need: diagnosis of schizophrenia or bipolar disorder and moderate to severe disability according to the Multnomah Community Ability Scale (score ≤ 62) and at least one of the following three criteria: 1) having been hospitalized for mental illness two or more times in any one year during the preceding five years; 2) co-morbid alcohol or substance use; and 3) having been recently arrested or incarcerated. Participants will be randomized to receiving the Housing First intervention or Treatment-As-Usual. The Housing First intervention provides immediate access to independent housing and community care. The primary outcome criterion is the use of high-cost health services (that is,, number of hospital admissions and number of emergency department visits) during the 24-month follow-up period. Secondary outcome measures include health outcomes, social functioning, housing stability and contact with police services. An evaluation of the cost-effectiveness and cost-utility of Housing First will also be conducted. A total of 300 individuals per group will be included.DiscussionThis is the first study to examine the impact of a Housing First intervention compared to Treatment-As-Usual in France. It should provide key information to policymakers concerning the cost-effectiveness and health outcomes of the Housing First model in the French context.Trial registrationThe current clinical trial number is NCT01570712

Victimization and posttraumatic stress disorder in homeless women with mental illness are associated with depression, suicide, and quality of life

“…The French Housing First program is a multicenter randomized controlled trial conducted in the following French cities: Lille, Marseille, Paris, and Toulouse 25 and is designed to assess the impact of a Housing First intervention on health outcomes and costs over a period of 24 months on homeless people with severe mental illness compared to Treatment- As-Usual (five evaluations: baseline, 6, 12, 18 and 24 months). Baseline (t0) was the only data used in the present analysis, before any intervention.…”

Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care

“…A growing literature supports the effectiveness of Housing First (HF) for individuals who are both homeless and mentally ill. HF promotes client choice, and has demonstrated impacts on community integration , residential stability , client satisfaction and service costs . Several nations have mounted large‐scale initiatives to address chronic homelessness using HF, including the United States , Canada , France and Australia . However, empirical evidence concerning the effectiveness of HF for people with prominent substance use problems has been described as ‘mixed and unsettled’ .…”

Effectiveness of interventions to reduce homelessness: a systematic review and meta‐analysis

“…We identified 43 randomized controlled studies (RCTs) reported in 78 publications (24,26,27,39,40, that met our inclusion criteria, and two studies in progress (31,82). See Appendix 9 for a description of the studies in progress.…”

“…Appendix 9: Description of studies in progress (82) This is a randomized trial aiming to assess the effect of Housing First on health outcomes and costs for adults who are homeless are at risk of becoming homless and have either schizophrenia, bipolar disorder or a severe disability. Housing stability is a secondary outcome.…”