LONDON, Ontario - Mental illness indirectly affects all Canadians at some time through a family member, friend or colleague. Although it affects people of all ages, educational and income levels and cultures, individuals with mental illness are overrepresented in the homeless population. Based on data collected from London, Ontario shelters in 2002, 194 individuals were discharged from a psychiatric hospital to a homeless shelter. Dr. Cheryl Forchuk, Assistant Director at Lawson Health Research Institute (Lawson), and colleagues, including the City of London Community Services and the Canadian Mental Health Association have recently completed a three-phase study evaluating the advantages and disadvantages of intervention during discharge processes. The project was a success; the results encouraging.
Preliminary Approach
The connection between mental illness and homelessness is not thoroughly understood, or well studied. Concern about the number of individuals discharged from a psychiatric hospital to a shelter prompted local researchers to implement a pilot study intervention. The group enrolled 14 individuals with no prior history of homelessness who were about to be discharged without stable housing, seven of whom received intervention upon discharge and were granted fast access to income and housing support. Six months later, all seven were still housed. Of the seven individuals who were provided with "usual care", six remained homeless.
Application of Knowledge
Based on the information obtained through phase I, researchers were determined to evaluate a method for discharging individuals from the hospital to a shelter and to suggest improvements for phase II implementation. In Phase II, the intervention was expanded and offered to all acute psychiatric patients within a general hospital. Phase III followed, intervening patients within a specialized tertiary care psychiatric hospital. Through the Canadian Medical Health Association London Middlesex, patients were provided on-site access to a housing advocate as well as income support staff who specialized in housing support and provided the direct service and community resources to individuals in the hospital. "Through the study, we were hoping to identify the effects of offering the income and housing supports to psychiatric clients at risk of homelessness," explains Forchuk. "We examined the demographics of these individuals, the costs associated with the intervention and evaluated the hospital staff's perceptions of the intervention."
A Successful Outcome
Findings from the study revealed the success of the intervention across both acute and tertiary sites. 243 individuals accessed the service, 92.5 per cent of whom were of imminent risk of being discharged to a shelter. Only three of these individuals became or remained homeless. The research team also found that the majority of those who accessed the service were receiving some form of social assistance, reinforcing one of the hypotheses that most of the participants were of lower socio-economic status. "One of the most interesting findings was related to the cost effectiveness of the program," says Ross Fair,General Manager, Community Services City of London "We determined that the cost of implementing and maintaining the program was less than the increased costs associated with housing individuals in homeless shelters."
The qualitative data collected was equally as satisfying. Through interviews, most individuals were satisfied with the help they received from the Canadian Mental Health Association Housing Advocate. Some clients provided feedback on ways to improve the services in the future; however, the majority of participants noted minimal improvement required. Hospital staff participated in focus groups and were impressed by the positive influence in their clients as a result of the intervention. They also identified how the project influenced other aspects of their clients' care, as housing is directly related to their well-being and piece of mind. "We are thrilled to be working collaboratively with the City of London and local researchers on this important project," says Michael Petrenko, Executive Director of the Canadian Mental Health Association London Middlesex. "It is our hope that through strong community partnerships, effective programs and resources can be implemented across multiple service sectors to help in the transition from hospital to a permanent home.
Funding for this study was provided by Human Resources and Skills Development Canada (HRSDC), Canadian Institutes of Health Research (CIHR) and the City of London.
In addition to her role at Lawson, Dr. Cheryl Forchuk is Associate Director of Nursing Research, Health Sciences and Professor, Department of Psychiatry at the Schulich School of Medicine & Dentistry, The University of Western Ontario.
About Lawson Health Research Institute
As the research institute of London Health Sciences Centre and St. Joseph's Health Care, London, and working in partnership with The University of Western Ontario, Lawson Health Research Institute is committed to furthering scientific knowledge to advance health care around the world.
For more information, please contact:
Melissa Beilhartz, Communications Consultant
Lawson Health Research Institute
519-646-6100 ext. 65516
Melissa.beilhartz@lawsonresearch.com
www.lawsonresearch.com
