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Journal article

Homelessness and mental illness

Author:
SCOTT Jan
Journal article citation:
British Journal of Psychiatry, 162, March 1993, pp.314-324.
Publisher:
Royal College of Psychiatrists

Outlines the research, highlights current views on the definition and classification of homeless populations, and offers some guidelines on avenues which need to be explored.

Journal article

Medical and psychiatric needs of the homeless: a preliminary response

Authors:
SURBER W. Robert, et al
Journal article citation:
Social Work: A journal of the National Association of Social Workers (NASW), 33(2), March 1988, pp.116-119.
Publisher:
Oxford University Press

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Journal article

Mental health and homelessness : issues and findings

Authors:
BEAN G.J., STEFL M.E., HOWE S.R.
Journal article citation:
Social Work: A journal of the National Association of Social Workers (NASW), 32(5), 1987, pp.411-416.
Publisher:
Oxford University Press

Reports on a study of homeless people in Ohio in which almost one third of respondents were in need of mental health services.

Journal article

Psychopathology among young homeless people: longitudinal mental health outcomes for different subgroups

Authors:
HODGSON Kate J., SHELTON Katherine H., VAN DEN BREE Marianne B.
Journal article citation:
British Journal of Clinical Psychology, 54(3), 2015, pp.307-325.
Publisher:
Wiley-Blackwell

Objectives: This study aimed to examine prevalence and subtypes of psychopathology among a British sample of young homeless people and to investigate potential associations between identified typologies and a priori specified current and past experiences. In addition, the study intended to explore physical health, mental health, and housing outcomes for the different mental health subgroups. Methods: Structured interviews including a mental health assessment were conducted with 90 young homeless people aged 16–23 years. Follow-up interviews were conducted approximately 10 and 20 months later. Cluster analysis at baseline was used to identify groups based on lifetime mental health problems. Results: The current and lifetime incidence of mental health problems was high (88% and 93%, respectively). Three subgroups of homeless young people were identified: (1) minimal mental health issues; (2) mood, substance, and conduct disorder; and (3) post-traumatic stress disorder, mood, and anxiety issues. These groups differed with respect to follow-up indicators of change and stability of mental health status, service use, and suicide risk, but not housing outcome. Other characteristics (gender ratio, past experiences) also distinguished the subgroups. Conclusions: Typologies of young homeless people based on psychopathology reveal differences in lifetime and future experiences including mental health at follow-up. Identified groups could be used to tailor interventions towards differing needs. (Edited publisher abstract)

Journal article

Adapting the individual placement and support model with homeless young adults

Authors:
FERGUSON Kristin M., XIE Bin, GLYNN Shirley
Journal article citation:
Child and Youth Care Forum, 41(3), June 2012, pp.277-294.
Publisher:
Springer

This study adapts the evidence-based intervention the Individual Placement and Support (IPS) for use with homeless young adults with mental illness. Convenience sampling was used to recruit 20 homeless young adults (ages 18–24) with mental illness from the host agency. Participants received the IPS intervention over 10 months. A comparison sample was used at a separate agency of 16 homeless young adults with mental illness, who received standard agency services. Using a pre-post, self-comparison quasi-experimental design, the impact of the IPS was assessed on five employment outcomes: (1) ever-worked rate, (2) working-at-follow-up rate, (3) monthly work rate, (4) weekly work hours and (5) weekly income. Results found that the IPS group was significantly more likely to have worked at some point over the 10-month study as well as to have worked a greater number of months overall. The study demonstrates that the IPS model is adaptable to work with homeless young adults with mental illness and is associated with successful retention and employment outcomes.

Journal article

Can home come first?

Author:
-
Journal article citation:
Connect, 44, 2011, pp.18-19.
Publisher:
Homeless Link

Housing First is a model developed in the US in 1992. Designed specifically for people with a diagnosed mental health problem, the model prioritises housing people housed in their own accommodation before focusing on other areas of their lives, such as substance misuse or unemployment. This article looks at how the approach works and whether it would work in the UK.

Journal article

Supportive housing for addicted, incarcerated homeless adults

Authors:
HICKERT Audrey O., TAYLOR Mary Jane
Journal article citation:
Journal of Social Service Research, 37(2), March 2011, pp.136-151.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Homeless populations often suffer from mental illness, substance abuse, and criminality. Housing interventions have been effective in serving homeless persons with criminal experience, substance abuse issues, and mental illness. However, previous studies have noted the difficulty of working with this population and that success can be limited. This study examined outcomes for clients of a new supportive housing intervention. The Homeless Assistance Rental Program (HARP) provided supporting housing for homeless persons who were struggling with mental illness, in jail, in criminal justice programmes, in substance abuse programmes, or aging out of foster care. The sample for the study consisted of 102 individuals who participated in HARP at some point during its first 22 months of operation. Data was collected from 4 major sources: the Housing Authority; the Substance Abuse division; jail records; and the self-sufficiency matrix completed with HARP participants by their case managers. Use of formal treatment, jail contact, and community stability were compared pre- and post-housing. Jail bookings and residential substance abuse treatment significantly declined post-housing, while clients improved in income level, access to food, and housing stability. Results from official justice and treatment system data suggest that supportive housing can lead to significant changes.

Journal article

Roofless in a steel city: learning from the homeless mentally ill

Author:
SPENCE Sean A.
Journal article citation:
Psychiatric Bulletin, 33(2), February 2009, pp.64-69.
Publisher:
Royal College of Psychiatrists

A small, city-wide clinical outreach service for the homeless mentally ill in Sheffield, UK, attained its present configuration 6 years ago. This paper discusses the lessons learnt in the course of the service’s existence. The homeless mentally ill identified by the service have disengaged from the ‘mainstream’ services and society. Most are from disturbed homes, nearly all have had prior contact with psychiatric services and as many as half have served prison terms. As service users, they must be actively sought out and engaged, which places specific demands upon a mental health team: flexibility of approach, patience and a willingness not to judge others’ values. Though largely anecdotal, the inferences drawn in Sheffield may have parallels elsewhere, not least since individual lives can turn upon pivotal (‘anecdotal’) encounters and those evinced by the homeless tell us much about society, psychiatry and the values of contemporary healthcare providers. Also, most of the time, the proposed model has been successful.

Journal article

Client-level measures of services integration among chronically homeless adults

Authors:
MARES Alvin S., GREENBERG Greg A., ROSENHECK Robert A.
Journal article citation:
Community Mental Health Journal, 44(5), October 2008, pp.367-376.
Publisher:
Springer

This American study presents three client-level measures of services integration, two objective measures, representing the proportion of needed services received and the number of outpatient services received by each client, and one subjective measure, a five-item scale measuring perceived coordination of care among clients’ service providers. Data from the evaluation of the collaborative initiative to help end chronic homelessness (CICH) are used to examine bivariate and multivariate relationships of these three client-level measures to two system-level measures of services integration, one addressing interagency services coordination/planning and the other interagency trust/respect as well as to baseline client characteristics among 734 chronically homeless adults in 11 American cities. Client-level measures of service integration were not strongly associated to each other or to the system-level measures, except for weak associations between one objective client measure and the system-level measure of service coordination and planning, and another between client-level use of outpatient mental health services and system-level trust and respect. Multivariate analysis showed that clients who received a greater array of needed services received more service overall and were more likely to have a diagnosis of PTSD and more medical problems, but less serious alcohol problems. Clients who reported more outpatient mental health and substance abuse visits were significantly more likely to be married, to be veterans, to have more serious drug problems, and to be dually diagnosed. Clients with more serious drug problems reported poorer coordination among their service providers on the subjective measure of client-level service integration. Three client-level measures of services integration were, at best, weakly associated with measures of system-level integration. Positive associations between client-level measures of integration and health status, outpatient service use and negative relationships with indicators of substance abuse suggest they may usefully represent the experiences of chronically homeless clients, even though they are not strongly related to system-level measures.

Journal article

An investigation of mental health care delivery from consumers’ perspectives

Author:
LEIPERSBERGER Tatjana
Journal article citation:
Journal of Human Behavior in the Social Environment, 15(1), 2007, pp.1-21.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

People who are both homeless and suffering from severe mental problems face many difficulties, which are explored in semi-structured interviews with 25 individuals recruited from a mental health centre in a large Midwestern city. The Constant Comparative Method of analysis revealed a range of barriers to engagement with mental health services, including: personal distrust and fear; poverty; the inexperience and high turnover of mental health staff; and societal stigma against homelessness and mental illness. The findings give support to the importance of a single helping individual, and the availability of private space. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street,  Binghamton, NY 13904-1580).

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