Search results for ‘Subject term:"mental health problems"’ Sort:
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Integrating permanent supportive housing and co-occurring disorders treatment for individuals who are homeless
- Authors:
- SMELSON David A., et al
- Journal article citation:
- Journal of Dual Diagnosis, 12(2), 2016, pp.193-201.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objectives: This pilot study examined the feasibility and preliminary outcomes of systematically integrating permanent supportive housing and an evidence-based co-occurring disorders intervention called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION). Methods: This single-group open pilot enrolled 107 people with co-occurring disorders experiencing chronic homelessness from two Massachusetts inner-city and rural areas. Enrolled subjects were interested in receiving permanent supportive housing along with 1 year of MISSION services. Data were collected through baseline and 6- and 12-month follow-up assessments. Results: Participants were mostly male (76.6%), Caucasian (52.3%), and unemployed (86.0%), with an average of 8.34 years of homelessness. Self-reported lifetime problems with anxiety (75.7%) and depression (76.6%) were common, as was use of alcohol (30.8%), cannabis (31.8%), and cocaine (15.9%). Almost all participants (95.3%) were placed into permanent housing, which took on average 42.6 days from enrollment. Among those placed, nearly 80% of the clients were able to retain housing through the end of the study. Overall retention was high, with 86.0% remaining in MISSION treatment until the end of the study. While there were no significant changes in rehospitalisation, service utilisation, or substance use, there were modest significant mental health symptom improvements from baseline to program completion. Conclusions: This pilot study suggests that co-occurring disorder interventions like MISSION are feasible to integrate with permanent supportive housing despite the somewhat differing philosophies, and preliminary data suggested substantial improvements in housing and modest improvements in mental health symptoms. While caution is warranted given the lack of a comparison group, these findings are consistent with other rigorous studies using MISSION among homeless individuals who did not receive permanent supportive housing. (Edited publisher abstract)
The interplay of rural issues, mental illness, substance use and housing problems
- Authors:
- JONES Rebecca, et al
- Journal article citation:
- Journal of Mental Health, 23(6), 2014, pp.317-322.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
People with mental health and substance use problems form a significant subgroup of the homeless population. Using a qualitative framework, this study examines the experiences of people with mental illness and/or substance use issues, experiencing significant housing problems in rural areas. Individual interviews were conducted with 40 respondents in Australia. Themes generated a discussion around three main areas; (1) current housing problems, (2) pathways into unsuitable housing, and (3) factors contributing to appropriate accommodation. The study highlights the need for agency staff to identify and assist with the housing issues of their clients. (Edited publisher abstract)
Disappearing acts: The social networks of formerly homeless individuals with co-occurring disorders
- Authors:
- HAWKINS Robert Leibson, ABRAMS Courtney
- Journal article citation:
- Social Science and Medicine, 65(10), November 2007, pp.2031-2042.
- Publisher:
- Elsevier
Studies of the social lives of men and women living with co-occurring disorders (substance abuse and serious mental illness) suggest that social networks critically influence recovery. In this paper, the authors examine some of the reasons that the social networks of individuals with co-occurring disorders are small, and the impact of small networks for this population. Using a social capital framework with cross-case analysis, 72 in-depth qualitative interviews with 39 formerly homeless mentally ill men and women who were substance abusers were analysed. All were participants in the New York Services Study (NYSS), a federally funded study of mentally ill adults in New York City. The patterns suggest that networks shrunk because (1) social network members died prematurely, (2) study participants withdrew or pushed others away, and (3) friends and family members faced so many obstacles of their own that they could not provide resources for the study participants. The authors suggest that as networks diminished, some participants responded by attempting to rebuild their networks, even if the networks provided negative social capital, and others isolated themselves socially to escape the pressures and disappointments of interaction.
Beyond help: improving service provision for street homeless people with mental health and alcohol or drug dependency problems
- Author:
- O'LEARY Jenny
- Publisher:
- National Homeless Alliance
- Publication year:
- 1997
- Pagination:
- 71p.,bibliog.
- Place of publication:
- London
Report aiming to contribute to the improvement of services for street homeless people who have both a mental health and an alcohol or drug problem or 'dual diagnosis' of their problems.
Barriers for homeless with dual diagnosis: lessons learned from intensive mobile psychosocial assertive community treatment program
- Authors:
- ZOLNIKOV Tara Rava, et al
- Journal article citation:
- Advances in Dual Diagnosis, 14(4), 2021, pp.169-182.
- Publisher:
- Emerald
Purpose: Dual diagnosis is a term that describes the co-occurrence of mental health disorders or illness and substance use or abuse disorders. Because this co-occurrence results in multiple diseases, layers of treatment are often needed to successfully create positive change in the individual. The purpose of this study is to explore factors of treatment that could facilitate improvements in functionality and quality of life for those with a dual diagnosis. Design/methodology/approach: A secondary data analysis, using both quantitative and qualitative data, was completed. Secondary analysis is an empirical exercise that applies the same basic research principles as studies using primary data and has steps to be followed, including the evaluative and procedural steps commonly associated with secondary data analysis. Documentation data from the intensive mobile psychosocial assertive community treatment program was gathered for this analysis; this program was used because of the intensive and community-based services provided to patients with a dual diagnosis. Findings: The major findings from this secondary analysis suggested that significant barriers included “denial” (e.g. evasion, suspension or avoidance of internal awareness) of diagnoses, complicated treatment and other barriers related to housing. Ultimately, these findings provided greater insight into potential effective treatment interventions for people living with a dual diagnosis. Originality/value: This study adds to the growing body of literature showing that patient-centred care allows for more effective treatment and ultimately, improved health outcomes. (Edited publisher abstract)
Rough sleeping follow up: mental health and substance misuse services
- Author:
- NATIONAL ASSEMBLY FOR WALES. Equality, Local Government and Communities Committe
- Publisher:
- National Assembly for Wales
- Publication year:
- 2019
- Pagination:
- 14
- Place of publication:
- Cardiff
A report from National Assembly for Wales Equality, Local Government and Communities Committee to investigate the difficulty for rough sleepers of accessing integrated substance misuse and mental health services. The Committee consulted with people with expertise across housing, substance misuse, and health to better understand the gaps in services and potential solutions. It found that cultural issues within organisations, attitudes between different professional groups and lack of leadership were significant barriers to delivering effective services for people with housing, mental health issues and substance misuse. The report makes recommendations covering the areas: the identification and dissemination of good practice; organisational culture and leadership; joint commissioning and funding; and the design and delivery of integrated services. The recommendations include better access to good quality training for staff working with rough sleepers. (Edited publisher abstract)
Living with dual diagnosis and homelessness: marginalized within a marginalized group
- Authors:
- SCHUTZ Christian G., et al
- Journal article citation:
- Journal of Dual Diagnosis, 15(2), 2019, pp.88-94.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: Concurrent mental and substance use disorders or dual diagnosis are highly prevalent among individuals experiencing homelessness. Studies have indicated that dual diagnosis leads to poorer health outcomes and higher health service utilization among those affected. This study aims to estimate the prevalence of dual diagnoses among homeless populations in British Columbia (BC), Canada, and understand their characteristics and specific factors associated with dual diagnoses. Methods: The BC Health of the Homeless Survey is a cross-sectional study involving the homeless population of three cities in BC. The survey assessed addiction and concurrent disorders with standardized interviews—the Mini-International Neuropsychiatric Interview Plus, the Maudsley Addiction Profile, and the Brief Symptom Inventory—in a sample of 500 individuals who are homeless living in shelters or on the street. Individuals were characterized into four groups: those without any current mental disorder, those with substance use disorders only, those with mental disorders only, and those with concurrent substance use and mental disorders. Focusing on the concurrent disorder group, multivariate analysis comparing individuals with dual diagnosis to those without concurrent disorders was completed. Results: Consistent with previous studies, individuals with dual diagnoses report more severe physical and psychological symptoms. Among the homeless, they were more likely to be Aboriginal and younger and more likely to not make it into a shelter. They also reported substantially more difficulties in getting the health care service that they need. Conclusions: Within this marginalized group, individuals with dual diagnosis were more likely to be from groups considered to be more vulnerable with more complex needs. They were having more problems accessing even basic support, such as shelters and health care. Without a systematic approach in providing appropriate care to individuals with dual diagnosis, the most vulnerable clients are not only the ones likely to suffer the most but also the ones having the most problems meeting their basic needs. (Edited publisher abstract)
Harm reduction in a Norwegian housing first project: a qualitative study of the treatment providers’ practice
- Authors:
- ANDVIG Ellen Sofie, SAELOR Knut Tore, OGUNDIPE Esther
- Journal article citation:
- Advances in Dual Diagnosis, 11(1), 2018, pp.4-15.
- Publisher:
- Emerald
Purpose: Little is known about how harm reduction is practiced in Norwegian housing first (HF) projects. The purpose of this paper is to explore, describe, and interpret how providers apply a harm reduction approach within a housing project focused on individuals who are homeless with co-morbid substance use and mental health problems. Design/methodology/approach: This qualitative study was part of a larger evaluation study of a three-year HF project in a Norwegian municipality. Data were collected using four multi-stage focus groups with five providers working in the HF project. Focus group interviews were transcribed verbatim and analysed using thematic analysis. Findings: Analysis resulted in three main themes: “Letting the service user sit in the driver’s seat,” “We don’t follow service provision contracts, we do everything,” and “Collaborating with the local community.” Research limitations/implications: There is a need to develop increased knowledge about service users’ experiences within the harm reduction approach. Practical implications: To practice effective harm reduction, treatment providers must have open authorisations and the opportunity to exercise professional judgement. Harm reduction practice must also focus on social, political, and economic factors influencing users’ everyday lives. Originality/value: The paper contributes to the knowledge base on harm reduction within HF practice that differs from a traditional model wherein clients are expected to abstain from substance use. It highlights important preconditions for challenges practitioners might encounter at both individual and service system levels. (Publisher abstract)
Case management models in permanent supported housing programs for people with complex behavioral issues who are homeless
- Authors:
- CLARK Colleen, GUENTHER Christina C., MITCHELL Jessica N.
- Journal article citation:
- Journal of Dual Diagnosis, 12(2), 2016, pp.185-192.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: This article examines two evidence-based models of case management for people with co-occurring disorders and histories of chronic homelessness and to better understand their roles in permanent supported housing. The two models are examined to see how they assist in ending homelessness, as well as the role they play in an individual's recovery from co-occurring disorders. Methods: Participants in two supported housing programs were interviewed at baseline and 6 months. One program used Critical Time Intervention (n = 144) and the other used Assertive Community Treatment (n = 90). Staff in both programs were interviewed about their experiences and fidelity assessments were conducted for each program. Results: Both programs operated at high levels of fidelity. Despite similar criteria for participation, there were significant differences between groups. Critical Time Intervention participants were older, were more likely to be male, were more likely to be homeless, and reported greater psychiatric symptoms and higher levels of substance use. Separate outcome analyses suggested that each program was successful in supporting people to transition from homelessness to stable housing; 88.6% of Assertive Community Treatment participants were homeless at baseline, while at 6 months 30% were homeless, and 91.3% of those in the Critical Time Intervention were homeless at baseline, while 44.3% were homeless at 6 months. Participants in the Critical Time Intervention program also showed significant decreases in alcohol use, drug use, and psychiatric symptoms. The preliminary results suggest that each case management model is helpful in assisting people with complex behavioural health needs and chronic homelessness to move to stable housing. Conclusions: Permanent supported housing seems to be an effective way to end homelessness among people with co-occurring disorders. Further research is needed to determine which case management models work most effectively with supported housing to help policy makers and program directors make informed decisions in developing these programs. (Edited publisher abstract)
Health care integration for formerly homeless people with serious mental illness
- Authors:
- WENSTEIN Lara Carson, et al
- Journal article citation:
- Journal of Dual Diagnosis, 9(1), 2013, pp.72-77.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: The primary objective of this study was to evaluate medical health and health care in a programme of integrated primary and behavioral health care for people with experiences of homelessness and mental illness. Methods: Using a retrospective chart review, we examined health status and rates of health care quality indicators in a group of 123 Housing First participants with histories of chronic homelessness and diagnoses of serious mental illness, including a subgroup of 43 participants who received integrated medical and behavioural health care. Results: In addition to having serious mental illness, participants had high rates of comorbid chronic disease and risk behaviour: 76% had at least one chronic disease, 59% had two or more chronic diseases, 6.5% had HIV, and 83% used tobacco. The integrated care programme subgroup had relatively high rates of documentation of some health care quality indicators: 62% with body mass index, 73% with blood pressure, 77% with tobacco use history, 87% with substance use history. Conclusions: Our study confirms that people with experiences of homelessness and serious mental illness also have serious medical comorbidities and documents the feasibility of providing on-site integrated primary care and health screenings in supportive housing programmes. (Publisher abstract)