scholarly journals Improving the treatment and remission of major depression in homeless people with severe mental illness: The multicentric French Housing First (FHF) program

Author(s):  
G. Fond ◽  
A. Tinland ◽  
M. Boucekine ◽  
V. Girard ◽  
S. Loubière ◽  
...  
2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Lemoine ◽  
S Loubiere ◽  
A Tinland ◽  
M Boucekine ◽  
V Girard ◽  
...  

Abstract Objectives Recent studies have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness at a short-term horizon. The paper assesses the long-term effects of an independent housing with a recovery-oriented approach in homeless people with severe mental illness on social recovery, mental symptoms and quality of life among homeless adults with high support needs for mental and physical health services. Design and methods “Un Chez Soi d’Abord” was a randomized controlled trial conducted in 4 French cities: Lille, Marseille, Paris and Toulouse. From August 2011 to April 2014, homeless participants with a DSM-IV-TR diagnosis of bipolar disorder or schizophrenia (N = 703) were randomly assigned to Housing First (n = 353) or Treatment as Usual (n = 350). Mental symptoms (MCSI), social recovery (RAS), global physical and mental status (SF-36), subjective quality of life (S-QoL) and addictions (MINI) were collected every 6 months over 48 months. Mixed models using a longitudinal and cluster design were performed, and adjusted to age on the street, gender and mental disorder diagnosis and testing for time*group and site*time interactions. Results HF patients exhibited higher recovery (β = 3.6, 95%CI: 0.4 to 6.9), higher S-QoL (4.7, 1.1 to 8.3) such as the self-esteem (10.9, 5.8 to 15.6) and physical well-being (8.4, 3.1 to 13.8) sub-dimensions, and improved mental health symptoms (-3.1, -5.4 to -0.9) over the 4-year follow-up. No significant differences were observed for SF36 scores. HF and TAU participants experienced similar alcohol or substance dependence evolution between baseline and 48 months. Conclusions HF is a highly effective intervention associated with improved relational environment, enhancing recovery and quality of life in homeless people with schizophrenia or bipolar disorders. Addiction issues have been identified and should be targeted so as to further improve the Housing First approach. Key messages Housing First model is a highly effective intervention. Housing First model enhances recovery and quality of life in homeless people.


BJPsych Open ◽  
2019 ◽  
Vol 5 (4) ◽  
Author(s):  
Caroline Smartt ◽  
Martin Prince ◽  
Souci Frissa ◽  
Julian Eaton ◽  
Abebaw Fekadu ◽  
...  

Background Despite being a global problem, little is known about the relationship between severe mental illness (SMI) and homelessness in low- and middle-income countries (LMICs). Homeless people with SMI are an especially vulnerable population and face myriad health and social problems. In LMICs, low rates of treatment for mental illness, as well as differing family support systems and cultural responses to mental illness, may affect the causes and consequences of homelessness in people with SMI. Aims To conduct a systematic, scoping review addressing the question: what is known about the co-occurrence of homelessness and SMI among adults living in LMICs? Method We conducted an electronic search, a manual search and we consulted with experts. Two reviewers screened titles and abstracts, assessed publications for eligibility and appraised study quality. Results Of the 49 included publications, quality was generally low: they were characterised by poor or unclear methodology and reporting of results. A total of 7 publications presented the prevalence of SMI among homeless people; 12 presented the prevalence of homelessness among those with SMI. Only five publications described interventions for this population; only one included an evaluation component. Conclusions Evidence shows an association between homelessness and SMI in LMICs, however there is little information on the complex relationship and direction of causality between the phenomena. Existing programmes should undergo rigorous evaluation to identify key aspects required for individuals to achieve sustainable recovery. Respect for human rights should be paramount when conducting research with this population. Declaration of interest None.


2015 ◽  
Vol 169 (1-3) ◽  
pp. 292-297 ◽  
Author(s):  
Vincent Girard ◽  
Aurelie Tinland ◽  
El had Mohamed ◽  
Laurent Boyer ◽  
Pascal Auquier

2021 ◽  
pp. 1-8
Author(s):  
Kelly Fleetwood ◽  
Sarah H. Wild ◽  
Daniel J. Smith ◽  
Stewart W. Mercer ◽  
Kirsty Licence ◽  
...  

Background Severe mental illness (SMI) is associated with increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care. Aims To determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit). Method We conducted a cohort study using routinely collected linked data-sets, including adults with a first hospital admission for stroke in Scotland during 1991–2014, with process-of-care quality indicator data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, 1-year and 5-year mortality and receipt of process-of-care quality indicators by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction). Results Among 228 699 patients who had had a stroke, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared with adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) = 1.33, 95% CI 1.16–1.52), bipolar disorder (aOR = 1.37, 95% CI 1.18–1.60) and major depression (aOR = 1.11, 95% CI 1.05–1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of process-of-care quality indicators. Conclusions Pre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.


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