Tag: Housing First

Reading of the Week: The Homeless – Who Are They? How Can We Help Them? Also, Shannon Jones on Her Son & His Homelessness

From the Editor

For much of her admission, she was disorganized and, at times, agitated. But when the medications started to work, Tanya talked about her years of homelessness and the stresses of finding a warm place to stay on a cold night, which often involved sleeping on buses – and “that’s not easy, I’m almost elderly.” 

This week, we take a closer look at homelessness and mental illness.

In the first selection, Richard Barry (of the University of Calgary) and his co-authors describe a systematic review and meta-analysis of mental disorders and homelessness for JAMA Psychiatry. They included 85 studies involving more than 48 000 people globally. “The findings demonstrate that most people experiencing homelessness have mental health disorders.” We explore the paper and its implications.

Street art in Quebec City

In the second selection, Nick Kerman and Dr. Vicky Stergiopoulos (both of the University of Toronto) examine different aspects of homelessness. In a comprehensive review for Nature Mental Health, they analyze the origins of the problem in high-income nations: focusing on deinstitutionalization. They also point to a way forward, noting the successes of Housing First and other interventions. “Homelessness among people with mental illness is a prevalent and persisting problem.”

And in the third selection, Shannon Jones writes about her son, who was homeless, in a deeply personal essay for The Washington Post. She discusses his childhood and the trips they took as a family. Also, she describes his illness and his death. “There are an estimated 600,000 homeless people in America, 75,000 of them in Los Angeles County. The number who die each year is increasing, with drug overdoses the leading cause. And every one of them has a story.”


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Reading of the Week: Acupuncture for PTSD – the New JAMA Psych Study; Also, Chronic Homelessness & Hope, and Dr. Suzanne Koven on Mentorship

From the Editor

He survived a terrible car accident and recalls his worst memory: being pinned for hours in his Honda as rescuers attempted to free him, eventually with the Jaws of Life. The mental recovery proved more complicated than the physical one, with flashbacks and nightmares and the resulting substance misuse. He tried different therapies, but would he have benefitted from alternative treatments?

Dr. Michael Hollifield (of George Washington University) and his co-authors look at acupuncture for PTSD in a new JAMA Psychiatry study. They did an impressive randomized clinical trial involving 93 combat veterans with PTSD who received either verum or sham acupuncture. “[V]erum acupuncture had a large pretreatment to posttreatment effect and was statistically superior to sham needling for reducing PTSD symptoms and enhancing fear extinction.” We consider the paper and its clinical implications.

Across North America, there are more people than ever before who are chronically homeless. Who are they? What psychiatric problems do they have? How can we help them? In the second selection, Dr. Vicky Stergiopoulos (of the University of Toronto) considers those who are chronically homeless in a podcast interview for Quick Takes. “The problem is visible. It’s in our streetcars and buses, our subways, our streets, and it’s hard to ignore.”

And in the third selection, Dr. Suzanne Koven (of Harvard University) writes about mentorship in The New England Journal of Medicine. She discusses how a mentor’s advice transformed her career and then considers what makes for good mentorship. “A mentor is someone who has more imagination about you than you have about yourself.”


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Reading of the Week: Housing First & Mental Health Care – the new Health Affairs Paper; Also, Safe Supply & Outcomes and Antipsychotics for Delirium

From the Editor

With the shelter system overcrowded, my patient slept the previous four nights in the train station. “Where else was I to go?” Many major cities across North America have seen a rise in the number of those who are chronically homeless. Housing First – the idea that stable housing is needed for people to better access health care – is one option, though the concept has been increasingly criticized. Is it a good fit for our urban problems?

In the first selection from Health Affairs, Devlin Hanson and Sarah Gillespie (both of the Urban Institute) consider Housing First for a specific population: the chronically homeless population who have had frequent arrests and jail stays; most of them, not surprisingly, have major mental illness or substance problems. Hanson and Gillespie analyzed data from Denver, Colorado, where people were randomized into Housing First or a control group. “We found that within the two-year study period, people in the intervention group had significantly more office-based care for psychiatric diagnoses, fewer ED visits, more unique medications, and greater use of other health care than people in the control group.” We review the study and its implications.

Denver: mountains, fresh air, and Housing First

In the second selection, Hai V. Nguyen (of Memorial University) and his co-authors look at safe supply and opioid outcomes in British Columbia. In a JAMA Internal Medicine paper, they used data from that province, contrasting it with Manitoba and Saskatchewan, and focused on the number of prescriptions and hospitalizations. “Two years after its launch, the Safer Opioid Supply Policy in British Columbia was associated with higher rates of prescribing of opioids but also with a significant increase in opioid-related hospitalizations.”

Delirium is common in the elderly admitted to hospital, and antipsychotics are often prescribed. In the third selection, Dr. Christina Reppas-Rindlisbacher (of the University of Toronto) and her co-authors comment on use of this medication in aCMAJ Practice paper. They offer much advice, including: “They should be prescribed at the lowest effective dose for the shortest possible duration and be reevaluated at or shortly after discharge.”


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Reading of the Week: “Your Smartphone Will See You Now” – Torous on Digital Psychiatry; Also, the Costs of Homelessness

From the Editor

A few weeks ago, a patient’s daughter called. She was deeply concerned: the patient was acting differently, she explained. “He’s sick again.” She noted that he was starting to go on long walks at night, and to different neighbourhoods – something he does when he’s starting to get ill with his bipolar. She feared that, without a change in medications and careful follow up, he would end up in the hospital again. As a psychiatrist, that type of information can be invaluable – a clue that a patient is doing less well.

Could technology help us find clues for emerging illness, maybe even before family members or patients themselves?

This week, the first selection weighs this question. Harvard University’s Dr. John Torous considers big data and mental health. In his essay, “Your Smartphone Will See You Now,” he reviews current trends and writes: “I predict that this technology will have an enormous impact on psychiatry.”

mjkxndi1nwClever cover – promising future?

In the second selection, we consider a new paper that looks at the costs of homelessness in Canada. As part of the work of At Home/Chez Soi, the authors answer a basic and important question: what are the costs of homelessness?

Please note: there will be no Readings for the next two weeks.


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Reading of the Week: Are Cats Making Us Sick? The Solmi et al. Paper, and Prescribing Housing in Hawaii

From the Editor

A few years ago, Czech scientist Jaroslav Flegr made a splash by arguing that our feline friends were causing psychosis in people – The Atlantic provocatively titled their article on him: “How Your Cat is Making You Sick.” Flegr’s argument was based in part on several papers (including by prominent researcher E. Fuller Torrey) noting that cat ownership confers an increased risk of psychotic disorders like schizophrenia.

So, are cats safe for household use?

In our first selection, we look at a new Psychological Medicine paper that, with a cohort study, finds no connection between cat ownership and psychotic symptoms.

Good news, tabby: you can stay

How to help the homeless? In our second selection, drawing from The Guardian, we look at a Hawaiian effort to prescribe the housing to the homeless – literally.

Please note that there will be no Readings for the next two weeks. Enjoy the March break.

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Reading of the Week: Housing First and At Home/Chez Soi

Homelessness is a significant social problem in Toronto, Canada’s largest and most ethnically diverse urban center, where approximately 29,000 individuals use shelters each year and roughly 5,000 people are homeless on any given night.

So opens this week’s Reading. The sentence is simple and direct; the facts conveyed are haunting. But this week’s Reading is ultimately a good news story. Actually, it’s a very good news story.

The Reading: “Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial” by Vicky Stergiopoulos et al., which has just been published in PLOS ONE.

Dr. Vicky Stergiopoulos

Here’s a quick summary: offer the homeless housing, and they not only gain housing stability but end up drinking less and are hospitalized less. Continue reading