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Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial
- Source :
- Epidemiology and Psychiatric Sciences
- Publication Year :
- 2020
- Publisher :
- Cambridge University Press (CUP), 2020.
-
Abstract
- Aims Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. Methods We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. Results Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76–1.21)) or ED visits (0.89 (0.66–1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48–0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103–128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48–0.78)) and residential costs (0.07 (0.05–0.11)). Conclusion An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.
- Subjects :
- Adult
Male
medicine.medical_specialty
Bipolar Disorder
Housing First
Substance-Related Disorders
Epidemiology
Assertive community treatment
Comorbidity
Quality of life (healthcare)
Outcome Assessment, Health Care
Severe mental illness
Health care
medicine
Humans
Psychiatry
business.industry
Public Health, Environmental and Occupational Health
Homelessness
Emergency department
Mental illness
medicine.disease
Mental health
Community Mental Health Services
Hospitalization
Substance abuse
Alcoholism
Psychiatry and Mental health
Ill-Housed Persons
Housing
Quality of Life
Schizophrenia
Female
Original Article
France
Emergency Service, Hospital
business
Program Evaluation
Health care services
Subjects
Details
- ISSN :
- 20457979 and 20457960
- Volume :
- 29
- Database :
- OpenAIRE
- Journal :
- Epidemiology and Psychiatric Sciences
- Accession number :
- edsair.doi.dedup.....f612c3c4b2205657ba9e6211a6c7aac1