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PubMed2006

[Threatened homelessness and mental disorders. Prevalence and influencing factors in populations at risk].

BACKGROUND: This study aims to assess the psychiatric morbidity of persons at risk of homelessness and to analyze correlations and risk factors between homelessness and mental disorders. METHODS: The sample included 101 citizens of Mannheim, Germany, who were immediately threatened by eviction. Mental disorders were diagnosed using a standardized test, and other factors were also assessed. Data from August 2000 to June 2002 were collected. RESULTS: Acute mental disorders requiring treatment were determined in 79.3% of the study sample. Addiction disorders (alcoholism) played a major role. Personality, anxiety, and affective disorders were even more frequent than in a control group of homeless people in the same region, whereas schizophrenia and other mental disorders were similarly prevalent. Regression analyses confirmed unemployment, alcoholism, and male gender as the most important risk factors for homelessness among people threatened by eviction. CONCLUSIONS: The results suggest that prevention strategies should be multidimensional and interdisciplinary.

Adult↗
PubMed1996

[Evaluation of "Wallstrasse 16", day facility for the homeless and needy in Basel].

"16, Wallstrasse, Common House for homeless and indigent People" in Basel is a new kind of facility in the range of already existing low threshold institutions of common kitchen, low threshold centre and night's lodging. This daycenter has the objective to offer homeless and indigent persons a place of tranquility rest where they can make new acquaintances and feel at home. In addition, its various facilities meet the sanitary needs of its clientele. The evaluation of the "Wallstrasse" was conducted by the Institute for Social and Preventive Medicine of the Basel University on behalf of the Federal Office of Health. Combining qualitative and quantitative research methods it inquired 1.) to what extent the institution realized its own objectives and 2.) if and how it met the needs of its target group. The evaluation revealed that its clientele mainly consisted of marginalized consumers of illegal drugs exclusively coming from that very area and often living in unstable housing conditions. Thus, the intended target group was reached. Within a year's time the attendance increased from 10 to 80 visitors a day to a high frequency of use. All of the various facilities of the house were used and appreciated. The evaluation stressed the significance as a place of tranquility and rest offering shelter not found in the street. The daycenter fills a gap in the range of low threshold services and contributes to the drug scene remove from the street. It establishes the base for extended social work which however cannot be properly realized due to the shortage of personnel. The evaluation found a good acceptance among the residents as well as a conflict free relationship with the police and a good cooperation with other institutions.

Day Care, Medical↗
PubMed2005

Evaluation of flood and landslide risk to the population of Italy.

We have compiled a database of floods and landslides that occurred in Italy between AD 1279 and 2002 and caused deaths, missing persons, injuries, and homelessness. Analysis of the database indicates that more than 50,593 people died, went missing, or were injured in 2580 flood and landslide events. Harmful events were inventoried in 26.3% of the 8103 Italian municipalities. Fatal events were most frequent in the Alpine regions of northern Italy and were caused by both floods and landslides. In southern Italy, landslides were the principal agents of fatalities and were most numerous in the Campania region. Casualties were most frequent in the autumn. Fast-moving landslides, including rock falls, rockslides, rock avalanches, and debris flows, caused the largest number of deaths. In order to assess the overall risk posed by these processes, we merged the historical catalogs and identified 2682 "hydrogeomorphological" events that triggered single or multiple landslides and floods. We estimated individual risk through the calculation of mortality rates for both floods and landslides and compared these rates to the death rates for other natural, medical, and human-induced hazards in Italy. We used the frequency distribution of events with fatalities to ascertain the magnitude and frequency of the societal risks posed by floods and landslides. We quantified these risks in a Bayesian model that describes the probabilities of fatal flood and landslide events in Italy.

Bayes Theorem↗
PubMed1997

Patterns of psychiatric service use by homeless mentally ill clients.

The objective of this study was to describe the patterns of service use of homeless mentally ill clients prior to and for two years following an admission to Skid Row Mental Health (SRMH) services in Los Angeles during a recent year (N = 268). Twenty clients were still at SRMH two years later. These clients were older and more likely to be female; most of their prior service use was at SRMH. For the majority of the 124 clients in the second group, those who had been discharged and not readmitted, the index admission was their only admission. The 124 clients in the third group, these with admissions after the index admission, had long histories in the system. Cluster analysis showed distinct patterns in service use during the follow-up period. Knowledge of patterns of service use by homeless mentally ill persons will enhance understanding of interventions which have the greatest chance of success.

Adult↗
PubMed2006

Long-term adherence to first-line highly active antiretroviral therapy in a hospital-based cohort: predictors and impact on virologic response and relapse.

A high level of adherence to highly active antiretroviral therapy (HAART) is essential to minimize the risk of treatment failure and HIV disease progression. This cohort study evaluated the prevalence and predictors of long-term adherence with first-line HAART in a hospital-based unselected sample of HIV patients from central Italy, and examined the association between adherence and virological response or relapse. Between July 1996 and June 2004, 171 patients (67.3% males; mean age, 41.2 years) were followed for at least 24 weeks and up to 8 years. Adherence was measured by patient self-reports and confirmed using pharmacy records. The prevalence of high-level adherence (>or=90%) at 6 months was 88.3%; slightly less than 80% at 12 months. The incidence of adherence failure in the sample remained fairly stable until 24 months of follow-up, then it declined about 5% every 6 months. Cox analysis showed that compared to single/separated patients, homeless and married persons were, respectively, 1.95 times more likely and two times less likely to experience adherence failure (p < 0.05). The adjusted risk of adherence failure among patients who did not suffer drug-related toxicity was 0.57 (p < 0.05). Medication adherence was significantly associated with shorter time to virological response and longer time to relapse. Adherents were 1.69 times more likely to achieve viral suppression and nine times less likely to experience relapse than nonadherents (p < 0.01). Efforts at improving adherence should be prolonged for at least 24 months. A protective role of marriage for adherence failure is promising but requires confirmation in further research, that should also clarify the exact mechanisms determining the association.

Adult↗
PubMed2000

Childhood risk factors for criminal justice involvement in a sample of homeless people with serious mental illness.

It has been suggested that criminal justice involvement among the homeless, particularly those with mental illness, is largely situational. The objective of this study was to assess, in a sample of homeless seriously mentally ill people, the prevalence of childhood conduct disorder behaviors as a risk factor for adult criminal activity as well as the extent and types of adult criminal justice contact. Data were taken from the national ACCESS program, which conducted extensive baseline interviews with 7,222 homeless seriously mentally ill adults. The interview assessed demographics, childhood risk factors for criminal activity such as conduct disorder behaviors, foster care, and parental abuse, as well as current illness severity and recent criminal justice contact. The 2-month arrest rate in this sample was much higher than national rates (11% compared with 1% annually in the general population). Although most arrests were for minor crimes (10.8%), there were also substantial rates of arrest for major (2.7%) and substance-related charges (2.0%). The prevalence of a history of conduct disorder behavior was also substantial (55% in male subjects, 40% in female subjects), and conduct disorder was a strong predictor of recent criminal justice involvement, even after controlling for other predictors of arrest (odds ratio = 1.76 for major crimes, 1.49 for minor crimes, and 1.98 for substance-related crimes). Recent literature has criticized a trend to criminalize homeless mentally ill persons for attempting to get needed food, shelter, or medical attention. However, these data indicate that at least some proportion of arrests in this population are of people who have been exhibiting antisocial behavior since early adolescence, and that early antisocial behavior is a strong predictor of all types of recent arrests in this population.

Adult↗
PubMed1990

Will we save the homeless mentally ill?

Progress in alleviating the plight of the homeless mentally ill has been very slow and disappointing. After reviewing the needs of the homeless mentally ill, the author makes recommendations for immediate action. Extensive case management services should be implemented rather than simply discussed. All incompetent and/or dangerous or gravely disabled homeless mentally ill persons should be brought to hospitals, involuntarily if necessary. Cost-effective alternatives to hospitals with varying degrees of structure should be provided. Involuntary mechanisms such as conservatorship and outpatient commitment should be used when needed. The emphasis should be on timely transfer to acceptable treatment and living situations rather than waiting for the ideal.

Ambulatory Care↗
PubMed1992

Gender differences among clients of a case management program for the homeless.

Differences between 24 female and 35 male clients were assessed at entry into an intensive case management program serving homeless shelter residents and again nine months later. Both men and women were socially isolated, with small social networks and severe deficits in social functioning. Histories of homelessness were similar for both genders, and there were no gender differences in psychopathology at baseline or follow-up. At entry into the program women had higher levels of social skills, larger and more supportive networks, and better housing conditions than men, but these differences disappeared after the subjects spent nine months in the program. Inadequate living conditions may have contributed to the more negative initial picture for men. Although there were more similarities than differences between the men and women in this sample, more research on gender differences is needed to design and evaluate programs for homeless mentally ill persons.

Adult↗
PubMed1993

Quality and cost of services for seriously mentally ill individuals in British Columbia and the United States.

OBJECTIVE: To better understand the strengths and weaknesses of systems of services for seriously mentally ill individuals in Canada and the United States, the quality and cost of services in the province of British Columbia (population 3.2 million) were compared with those of services in the 50 states. METHODS: A survey of selected psychiatric facilities, data from the Canadian Ministry of Health, and information from families and consumers were assessed using methods similar to those used in a 1990 survey that rated services for individuals with serious mental illness in the 50 states. Separate scores were given for hospitals, outpatient and community support services, rehabilitation services, housing, and children's services. RESULTS: British Columbia scored higher than any single state in the United States and more than twice as high as 40 states on the quality of services for seriously mentally ill individuals. Compared with the states, British Columbia ranked ninth in cost of services per capita. When ratings of quality and cost were combined, British Columbia appeared to be delivering services almost twice as good as those in New York State at about half the cost. However, recent trends, such as shortages of inpatient beds and increasing numbers of seriously mentally ill persons among the homeless population, suggest that British Columbia's services may be deteriorating. CONCLUSIONS: Probable reasons for the superior services for seriously mentally ill individuals in British Columbia include single-source funding, a strong mandate to treat such individuals, and a comprehensive approach to providing services. The Canadian health system, as implemented in British Columbia, has definite advantages for individuals with serious mental illnesses.

Adult↗
PubMed1993

Health care utilization and costs after entry into an outreach program for homeless mentally ill veterans.

OBJECTIVE: This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. METHODS: Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of clinical need and to participation in the outreach program. RESULTS: Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. CONCLUSIONS: Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.

Adult↗
PubMed1995

Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans.

OBJECTIVES: The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans. METHODS: Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments. RESULTS: Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements. CONCLUSION: This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.

Adult↗
PubMed1994

Health needs of homeless clients accessing nursing care at a free clinic.

Homeless people need emotional support, caring professionals, and resources that work within their frame of reality. Each homeless community will have different demographics and health needs. The common denominators are the obstacles encountered when trying to access health care: bureaucracy, transportation, accessibility, present-time orientation, limited resources, frustration, and anxiety. Nurse-managed free clinics are an effective means of serving the needs of homeless and indigent populations. Through these clinics, clients can receive continuity of care, proper follow-up, referrals, and teaching to aid in the prevention of illness. A free clinic was established in a northwestern Georgia community to meet the health needs of homeless and indigent persons. This article describes the demographics, attitudes, values, perceived support systems, and health needs of clients accessing care at this nursing clinic.

Adult↗
PubMed1993

Comprehensive assessment of health needs 2 months after Hurricane Andrew--Dade County, Florida, 1992.

On August 24, 1992, Hurricane Andrew struck southern Florida. More than 28,000 houses, mobile homes, and apartment buildings were destroyed, and approximately 107,000 additional dwellings sustained major damage. An estimated 180,000 persons were left homeless; insured damages were estimated at $15.5 billion and total damages at more than $30 billion. During the recovery period, many private and public health-care facilities damaged or destroyed in the storm were not functional. During November 3-13, to help prioritize health needs and direct public health resources, the Dade County Public Health Unit of the Florida Department of Health and Rehabilitative Services conducted a survey to assess health needs and the availability of health-care services during the recovery phase with funds provided by the Federal Emergency Management Agency (FEMA). This report summarizes the results of the survey.

Disasters↗
PubMed1996

[Pulmonary tuberculosis revealed by lupus vulgaris].

The incidence of pulmonary tuberculosis in Hungary had been significantly decreased until the 1980s and its common cutaneous manifestation was found to be extremely rare. During the past years an increasing number of reports were dealing the novel increasing incidence of tuberculosis, mostly on homeless and immunocompromized persons. The present report dealt with a pulmonary tuberculotic patient on whom severe cutaneous TBC manifestations (lupus vulgaris) that was heralded the underlying systemic tuberculotic disease.

Humans↗
PubMed2006

Food insecurity among homeless and runaway adolescents.

OBJECTIVE: The purpose of this study was to investigate the prevalence of food insecurity and factors related to it among homeless and runaway adolescents. DESIGN: Computer-assisted personal interviews were conducted with homeless and runaway adolescents directly on the streets and in shelters. SETTING: Interviews were conducted in eight Midwest cities: Des Moines, Cedar Rapids, Iowa City, Kansas City, Lincoln, Omaha, St. Louis and Wichita. SUBJECTS: The subjects were 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years. Average age of the adolescents was 17.4 (standard deviation 1.05) years. RESULTS: About one-third of the adolescents had experienced food insecurity in the past 30 days. Factors associated with food insecurity were age of adolescent, a history of caretaker neglect and abuse, having ever spent time directly on the street, a small post-runaway social network, and engaging in deviant and non-deviant street food-acquisition strategies. CONCLUSIONS: Based on these findings, our conservative estimate is that nationally more than 165,000 homeless and runaway adolescents experienced food insecurity in the past 30 days. These adolescents are largely hidden from public notice and they are usually missed in studies that address national hunger.

Adolescent↗
PubMedDate not supplied

The individual and beyond: a socio-rational choice model of service participation among homeless adults with substance abuse problems.

While substance user service programs can help homeless adults solve their substance use and housing problems, relatively few needy individuals use and complete these programs. The lack of participation is poorly explained by typical empirical studies, most of which consider the role in service participation of various personal traits and client problems. The current article instead seeks to explain service participation through the application of an alternative, "socio-rational choice" model. This model has three premises: Clients weigh the costs and benefits of participating in services against alternative uses of their time and resources. The clients' weighing procedures reflect their personal situations and perceptions of the treatment environment. The perceptions of their personal situations and perceptions of the treatment environment are affected by the manner in which clients react to representatives of service systems, members of their social network including both housed and homeless persons, and other individuals. Secondary evidence supports many of the model's hypotheses and generally suggests that homeless clients may be heavily affected by their experiences with individuals and systems with which they come into contact.

Adult↗
PubMed2004

ASAM Patient Placement Criteria treatment levels: do they correspond to care actually received by homeless substance abusing adults?

We report findings from a community-based two-city survey of homeless adults comparing the level of substance abuse treatment assigned to them using the ASAM Patient Placement Criteria with care actually received during the previous 12 months. Overall 531 adults were surveyed with 382 meeting DSM-IIIR criteria of being in need of treatment or having a demand for treatment. Of those with a treatment need, 1.5% met criteria for outpatient care, 40.3% intensive outpatient/partial hospitalization care, 29.8% medically monitored care and 28.8% managed care levels. In contrast, of those receiving treatment (50.5%, 162 persons), almost all care received by this cohort was either inpatient or residential based (83.6%). Unsheltered homeless persons and those without insurance were significantly more likely to report not receiving needed treatment. Lack of treatment availability or capacity, expense, and changing one's mind while on a wait list were the most commonly cited reasons for no treatment.

Adolescent↗
PubMed1989

A psychiatric nurse's role.

1. Homelessness in America is a result of complex social, political, and economic forces; approximately one third to one half of the homeless have severe emotional problems. 2. The person with chronic mental illness who is also homeless will face numerous obstacles when the need for psychiatric care arises. 2. The person with chronic mental illness who is also homeless will face numerous obstacles when the need for psychiatric care arises. 3. The federal government is beginning to address the problems of the homeless chronically mentally ill population by establishing pilot programs in Veterans Administration hospitals. 4. The psychiatric nurse is in a unique position to provide services to those who are homeless and mentally ill.

Adult↗