Homeless youngsters' drug problems

Compared to other young people homeless youngsters are more likely to start taking drugs at a younger age and to take them more often. However, little research has been done into the specific factors that lead homeless youngsters into drug taking. A team of researchers from the University of California, Los Angeles looked into this issue in a sample of 156 homeless youngsters, aged between 15 and 25. They found that the youngsters who perceived their health as being worse and who had poorer coping strategies were more likely to have bigger drug problems.

Nyamathi, Adeline ... [et al] - Correlates of Substance Use Severity Among Homeless Youth Journal of Child and Adolescent Psychiatric Nursing, 23(4), 214–222

Mental-health and homelessness

A new report by the U.K. homeless charity Crisis has underlined the links between mental-health problems and homelessness. If found that 85% of residents in one homeless shelter had a range of personality, anxiety or post-traumatic stress disorders that had not been formally diagnosed. The number of rough sleepers has fallen dramatically over the last ten years but 3,000 people spent some time sleeping on the streets in London last year. In November 2008 the housing minister, Margaret Beckett, announced a £200m programme to strengthen assertive outreach services and introduce individual budgets for homeless people.

You can download the Crisis report from

http://www.crisis.org.uk/publications/MentalHealthReview.pdf

Homelessness and drug use

Homelessness and drug and/or alcohol abuse often go hand-in-hand. Homeless people who abuse drugs and alcohol are more likely to demonstrate ineffective coping skills, low levels of self-efficacy and to end up in prison. They are also vulnerable to hepatitis and HIV, victimization, sexually-transmitted diseases, unwanted pregnancy, depression and suicidality. A focus-group study of 54 homeless and drug-using people between the ages of 18 and 24 looked into their attitudes to drugs and what they saw as the facilitators of and barriers to good-quality health care. Participants saw substance abuse as a health risk and a barrier to care but also as an adaptive response to psychological pain and survival on the streets. Facilitators to care and suggestions for improved health delivery and quality of care included using health mentors to assist in navigating the medical system, culturally-competent care, improved amenities in waiting rooms and expanded pharmaceutical services.

Christiani, Ashley ... [et al] - Attitudes of homeless and drug-using youth regarding barriers and facilitators in delivery of quality and culturally sensitive health care Journal of Child and Adolescent Psychiatric Nursing August 2008, 21(3), 154-163

Keeping the mentally ill off the streets

A recent study in London, Ontario (Canada) found that 194 people had been discharged from psychiatric facilities onto the street in 2002. This is usually disastrous for the people concerned leading to re-hospitalization and prolonged homelessness. An intervention was developed in which people were given immediate assistance in accessing housing and help in paying their first and last month's rent. Participants in the study were divided into two groups, one receiving the intervention and the other receiving treatment as usual. After 3 and 6 months all the individuals in the intervention group had retained their housing. All but one of the people in the control group remained homeless and that person only got accomodation by becoming involved in prostitution. The results of the study were so dramatic that the control group was immediately discontinued with all the participants receiving the intervention.

Forchuk, C. ... [et al] - Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and 'no fixed address' Journal of Psychiatric and Mental Health Nursing September 2008, 15(7), 569-575

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