Collaborative, caring, Canadian

Homeless people have a high prevalence of physical illness, mental illness and substance abuse and a higher level of health care needs than people with housing. Between a quarter and a third of the homeless have a serious mental illness such as schizophrenia, major depressive disorder or bipolar disorder. To address their complex health needs a number of mental health programmes for the homeless have been developed. One such approach is collaborative mental health care in which teams are made up of a number of different disciplines such as psychiatrists, psychologists, mental-health nurses etc. However, there has been little research into the effectiveness of collaborative mental health care in treating homeless people or into the effectiveness of shelter-based programmes. A review of 73 clients treated by one such programme in Canada found that the prevalence of severe and persistent mental illness and substance use disorders at the start of the programme was 76.5% and 48.5% respectively. After six months 35.3% of the clients had improved clinically and 48.5% were housed. Improvements in mental health were associated with the number of visits with a psychiatrist and adherence to treatment as was being housed. The presence of a substance use disorder was associated with lower odds of housing after six months.

Stergiopoulos, Vicky ... [et al] - Collaborative mental health care for the homeless: the role of psychiatry in positive housing and mental health outcomes Canadian Journal of Psychiatry January 2008, 53(1), 61-67