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Access to public mental health services among older adults with severe mental illness
- Authors:
- GILMER Todd P., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.313-318.
- Publisher:
- Wiley
Data from San Diego County, 2002-2006, were used to examine how older adults initially accessed the public mental health system, and their utilization over the subsequent 90 days. Multivariate regression models were used to control for demographic and clinical characteristics. Older adults (age 60 +) were more likely to access the public mental health system through the Psychiatric Emergency Response Team (PERT), a combined law-enforcement and psychiatric service that responds to psychiatric related 911 calls. Older adults were also less likely to receive follow-up care. This lower rate of follow-up was due to both the initial site of service - and an associated lower rate of follow-up among PERT clients - as well as a lower rate of follow-up among older adult clients initiating services in other sectors. This paper suggests two areas for intervention that would improve access to care for older adults: improving linkages and referrals between PERT and outpatient providers; and additional efforts to retain older adults at outpatient programs.
Implementation and outcomes of forensic Housing First programs
- Authors:
- KRIEGEL Liat S., HENWOOD Benjamin F., GILMER Todd P.
- Journal article citation:
- Community Mental Health Journal, 52(1), 2016, pp.46-55.
- Publisher:
- Springer
This mixed-method study used administrative data from 68 supportive housing programmes and evaluative and qualitative site visit data from a subset of four forensic programmes to (a) compare fidelity to the Housing First model and residential client outcomes between forensic and nonforensic programmes and (b) investigate whether and how providers working in forensic programmes can navigate competing Housing First principles and criminal justice mandates. Quantitative findings suggested that forensic programmes were less likely to follow a harm reduction approach to substance use and clients in those programmes were more likely to live in congregate settings. Qualitative findings suggested that an interplay of court involvement, limited resources, and risk environments influenced staff decisions regarding housing and treatment. Existing mental health and criminal justice collaborations necessitate adaptation to the Housing First model to accommodate client needs. (Edited publisher abstract)
Aging in place within permanent supportive housing
- Authors:
- HENWOOD Benjamin F., KATZ Marian L., GILMER Todd P.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(1), 2015, pp.80-87.
- Publisher:
- Wiley
Objectives: This study examined whether and how permanent supportive housing (PSH) programs are able to support ageing in place among tenants with serious mental illness. Design: Investigators used a mixed-method approach known as a convergent parallel design in which quantitative and qualitative data are analysed separately and findings are merged during interpretation. Quantitative analysis compared 1-year pre-residential and post-residential outcomes for PSH program enrollees, comparing adults aged 35-49 years (n = 3990) with those aged 50 years or older (n = 3086). Case study analysis using qualitative interviews with staff of a PSH program that exclusively served older adults identified challenges to providing support services. Results: Substantial declines in days spent homeless and in justice system settings were found, along with increases in days living independently in apartments and in congregate settings. Homelessness and justice system involvement declined less for older adults than younger adults. Qualitative themes related to working with older adults included increased attention to medical vulnerability, residual effects of institutional care, and perceived preference for congregate living. Conclusions: PSH is an effective way to end homelessness, yet little is known about how programmes can support housing stability among aging populations. Additional support and training for PSH staff will better promote successful ageing in place. (Edited publisher abstract)