Interventions for Homeless With Mental Illness

Topics: Illness, Mental Illness Words: 1161 Pages: 3

Doulas, A. V., & Lurigio, A. J. (2010). Youth crisis intervention teams (CITs): A response to the fragmentation of the educational, mental health, and juvenile justice systems. Journal of Police Crisis Negotiations, 10(1–2), 241–263. doi:10.1080/15332586.2010.481893

In this article, the researchers conduct a non-systematic literature review to explore preliminary and anecdotal evidence regarding the effects of youth crisis intervention teams (CITs) on deinstitutionalization, criminalization, and deviant behaviors in young people with mental and psychiatric issues. As an intervention, youth CITs in the U.S. are programs that adapt the adult CIT model to adolescent populations and are based on partnerships between mental health and law enforcement agencies, enabling communities to refer delinquent young people to relevant services. As per the source, the intervention’s feasibility and relevance to addressing homelessness among mentally unstable young people are unknown due to the lack of evidence from controlled research. Even anecdotal evidence from some U.S. states, including Illinois, Texas, Colorado, and Tennessee, does not suggest the strategy’s tangible effects on homelessness rates among young people with mental health issues, thus revealing a huge research gap. As for ethical considerations, age-specific neurodevelopmental characteristics might contribute to misdiagnosis cases, thus creating a situation in which police officers in youth CIT programs mistake adjustment issues or some psycho-emotional changes during adolescence for serious mental disorders.

Maskay, M. H., Cabral, H. J., Davila, J. A., Whitlock Davich, J. A., Marcus, R., Quinn, E. K., & Rajabiun, S. (2018). Longitudinal stigma reduction in people living with HIV experiencing homelessness or unstable housing diagnosed with mental health or substance use disorders: An intervention study. American Journal of Public Health, 108(S7), S546–S551. doi:10.2105/AJPH.2018.304774

The authors use a quantitative survey study to assess the effects of a nationwide care coordination intervention for American adults who are homeless or face housing instability and are diagnosed with addiction or mental health disorders. The used approach is based on four principles, including the presence of navigators to offer client-centered services, participants’ access to HIV services, partnerships with property managers to facilitate access to permanent housing, and primary care and behavioral health services for those with HIV. Focusing on the intervention’s anti-stigma effects, the authors do not address feasibility-related issues, but successful implementation and flexibility for local service providers might imply the approach’s practicability. As per the results, decreases in external stigma associated with homelessness can motivate homeless people with mental disease and HIV to stay in care. This might imply the intervention’s indirect impacts on improving housing stability in the given population. While following the principles listed above, health promotion strategies could vary across different locations since local teams were free to individualize programs to address site-specific challenges, and this fact makes ethical assessments problematic. However, the program’s guiding principles do not feature any deviations from ethical values.

Pakzad, S., Bourque, P. É., Bourque, J., Aubry, T., Gallant, L., LeBlanc, S. R., & Tivendell, J. (2017). A comparison of the use of physical and mental health services by homeless people with severe mental health problems in the Moncton area through the At Home/Chez Soi program. Canadian Journal of Community Mental Health, 36, 77–105. doi:10.7870/cjcmh-2017-024

In this randomized controlled trial, the researchers evaluate the At Home/Chez Soi program and quantify its effects on healthcare service utilization among those with mental health issues and homelessness history. The intervention is based on the Housing First model in which homeless individuals are not obliged to address behavioral concerns and addictions to access housing. Another component is ongoing support from the Assertive Community Treatment (ACT) team consisting of healthcare professionals, social workers, and coordinators. Regarding feasibility, although the strategy is promising for addressing homelessness in the short term, its effects on promoting long-term health improvement and self-care behaviors in the form of mental healthcare use require further investigation. Specifically, the RCT did not find significant differences between the intervention and control (users of preexisting services) groups in healthcare use, but this finding could be explained by medical necessity differences and intensive support from the ACT providers. The intervention is appropriate and unproblematic from the ethical viewpoint since it does not involve misinformation or coercion linked with one’s mental health. Also, it promotes the equality of opportunity in accessing housing.

Ponka, D., Agbata, E., Kendall, C., Stergiopoulos, V., Mendonca, O., Magwood, O., Saad, A., Larson, B., Sun, A. H., Arya, N., Hannigan, T., Thavorn, K., Andermann, A., Tugwell, A., & Pottie, K. (2020). The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review. PloS One, 15(4), 1–21. doi:10.1371/journal.pone.0230896

Using a structured literature search process and nine professional databases, the researchers conducted a systematic literature review study to explore case management (CM) interventions’ effectiveness and financial feasibility. As an intervention, CM comprises four different approaches, including standard (SCM), intensive (ICM), assertive community treatment (ACT), and critical time (CTI) tailored interventions. In CM, professional case managers provide the homeless with assistance, including service coordination in SCM, comprehensive needs-based interventions in ICM and ACT, and efforts to promote care continuity during transitions between temporary housing and living independently in CTI. The findings suggest that all approaches but SCM are effective in addressing homelessness by promoting housing stability, and ACT strategies have the largest positive effect on homeless individuals’ mental health status. Regarding financial feasibility, ACT outperforms SCM, CTI, and ICM in cost-effectiveness for homeless people with serious mental health concerns. From the viewpoint of ethics, despite the possibility of ethical concerns when dealing with individual cases, the principles of service provision that inform the four approaches do not contain any obviously problematic elements.

Simmons, M. M., Gabrielian, S., Byrne, T., McCullough, M. B., Smith, J. L., Taylor, T. J., O’Toole, T. P., Kane, V., Yakovchenko, V., McInnes, D. K., & Smelson, D. A. (2017). A hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA homeless primary care treatment programs. Implementation Science, 12(1), 1–10. doi:10.1186/s13012-017-0563-2

The authors hypothesize on the potential of the Mission-Vet (MV) intervention within Homeless Primary Care Treatment Program (NPACT) teams by planning a cluster-randomized trial, a subtype of RCT. In this intervention, peer teams led by case managers provide services to veterans, approximately 2.5 hours of support per veteran every week. MV involves more than ten sessions of dual recovery therapy (DRT) psychoeducation and critical time interventions (CTI) to address homelessness among veterans. As per the researchers’ hypothetical calculations, MV is likely to promote both housing stability and recovery in homeless veterans across the mental health spectrum, making it promising for addressing homelessness in the mentally ill. In terms of feasibility, the researchers anticipate MV to produce healthcare cost savings by reducing the need for expensive services, such as relapses requiring hospitalization and medical detoxification services in emergency departments. Due to being categorized as a quality improvement project, the described intervention is exempt from ethical review. Nevertheless, information about the intervention provided by the researchers does not indicate the presence of ethical concerns.

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