Faculty Bibliography

OBJECTIVE: The study examined the long-term effectiveness of approaches to housing homeless persons with serious mental illness. METHODS: A total of 2,937 persons placed in high-, moderate, -and low-intensity housing were followed for up to five years. Intensity reflected on the amount of structure and degree of clients' independence. The outcome variable was tenure in housing. Cox stepwise regression was used to calculate risk ratios of becoming discontinuously housed. RESULTS: Thirty percent of the sample were initially placed in high-intensity settings, 18 percent in moderate-intensity settings, and 52 percent in low-intensity settings. Those in high-intensity settings tended to be younger, to be referred from hospitals, and to have a history or diagnosis of substance abuse. Individuals in moderate-intensity settings were more likely to be female and were least likely to have substance abuse problems. Individuals in low-intensity settings were more likely to be referred by municipal shelters and to have lived in municipal shelters for four or more months. After one, two, and five years, 75 percent, 64 percent, and 50 percent, respectively, of the sample were continuously housed. Older age was associated with longer tenure, and having a history of substance abuse was associated with shorter tenure. Individuals referred from a state psychiatric center had a greater risk of shorter tenure than other types of referrals. CONCLUSIONS: Results show that homeless persons with serious mental illness can remain in stable housing for periods of up to five years, supporting the premise that long-term residential stability can be enhanced by providing access to safe and affordable supportive housing

Over the past decade, researchers have documented the range of needs and devised new methods for increasing our understanding of the homeless severely mentally ill population. Clinicians have developed an appreciation of the difficulty and complexity of effectively treating this population, and policymakers have become increasingly aware of the barriers to developing services and housing. In this article, the progress-to-date in research, the evolution of new service approaches, and the development of federal, state, and local policies to meet the needs of homeless mentally ill individuals are assessed. The many challenges that remain are also considered

In a one-year study of 49 homeless chronic mentally ill patients, the subjects, selected at admission for inpatient treatment, were randomly assigned to one of two groups. One group was placed in an experimental residential treatment program following discharge, and the other group received standard postdischarge care. Subjects were interviewed every four months during the year as well as at index hospitalization and discharge. Although the study remains exploratory due to the small sample size and case attrition, the authors found that compared with the control group, the subjects in the residential treatment program spent significantly more nights in adequate shelter, spent fewer nights in hospitals or undomiciled, and were more satisfied with and committed to their living arrangements

The plight of the homeless in New York City and other urban areas has become the focus of increasing attention. In an effort to clarify and understand the problems of the homeless, the authors studied the demographic characteristics, psychiatric diagnoses, histories, and dispositions of 100 homeless patients treated at Bellevue Psychiatric Hospital's emergency service. The most striking finding was that 96.6 percent of the sample had had a previous psychiatric hospitalization. Seventy-two percent of these homeless patients were diagnosed as suffering from schizophrenia; the second most common diagnosis was personality disorder, which accounted for 13.3 percent of the sample. The authors discuss other demographic findings of their study and explore the roots of the problem of homelessness, review the psychiatric literature on the subject, and delineate some of the unique treatment needs of this population

The results of a study comparing the structure and function of the social networks of a group of first-admission schizophrenics with those of a group of multiple-admission schizophrenics are presented. Structurally, the networks of the first-admission patients are larger and more interconnected. Functionally, their networks have a greater percentage of multiplex and nondependent links. On the basis of these data, it is concluded that the most dramatic changes in social networks develop after the patient's first hospitalization. The dissolution of the patient's network is attributed to the antagonistic attitudes and reactions of those close to the patient, as well as to the patient's impaired social competence. Schizophrenia seemingly is a network crisis not only for the individual but for the network as a whole. It is suggested that active intervention at the time of the first psychotic episode may be helpful in avoiding network collapse and the patient's resultant social isolation