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We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to assess the long-term course of schizophrenia in four key domains (symptoms, treatment, residence, and work) over two time periods (past two years, entire period of illness). The subjects were 27 consecutive admissions to a schizophrenia research unit. The LCS was filled out by pairs of raters, blinded to each others' ratings, using the same data (interview with subject and chart). Reliability was examined for 45 LCS ratings selected from all four domains and both time periods. Selected ratings pertained to the duration of specified experiences, the quality of these experiences, and the long-term time trend. The kappa statistic and the intra-class correlation coefficient (ICC) were used to determine inter-rater reliability for continuous and categorical ratings, respectively. LCS ratings proved reliable in all four key domains and both time periods. The reliability was fair to excellent for ratings of duration of experience (ICC ranged from 0.53 to 0.99), quality of experience (kappa ranged from 0.46 to 0. 92) and long-term time trends (kappa ranged from 0.66 to 0.94). The LCS can be used to obtain reliable ratings of the long-term course of schizophrenia in multiple domains.

Available evidence suggests that individuals with schizophrenia and other severe mental illnesses are at increased risk for homelessness in contemporary societies with diverse cultures and socioeconomic conditions. Yet the prevention of homelessness among individuals with mental illness has rarely been a focus of global health programs. We propose that it should be. In any given society, the overall risk of homelessness will reflect broad societal factors such as income inequality, housing, migration, economic conditions, and family ties. We strongly advocate for addressing these societal causes of homelessness. We also believe, however, that we need to develop special programs in parallel to prevent homelessness among individuals with severe mental illness. We use historical examples to draw attention to ways in which individuals with mental illness have been – and still are – explicitly excluded from societies. We suggest that this social exclusion requires us to take special measures to protect the rights of individuals with mental illness, and to develop programs to ensure they have access to basic necessities including a home. The form these measures take will of necessity vary widely according to local conditions. We describe mental health initiatives in two middle-income countries (Brazil and Argentina) which illustrate different approaches, and allude more briefly to efforts being made in other countries including low-income countries. Finally, we consider some of the efforts that are already being made by various international groups to further this agenda within the global health movement.