A Promising Route Towards Improvement of Homeless Young People’s Access to Mental Health Services: The Creation and Evolution of an Outreach Service Network in Montréal

  • Raphaël Morisseau-Guillot
  • Diane Aubin
  • Julie-Marguerite Deschênes
  • Milena Gioia
  • Ashok Malla
  • Pasquale Bauco
  • Marie-Ève Dupont
  • Amal Abdel-BakiEmail author
Original Paper


Youth homelessness is a complex phenomenon as well as an important public health issue often compounded by mental illness of varying severity, in turn creating numerous deleterious consequences. While emergency health services usage remains high, access to mental health services is arduous and conventional interventions often fall short on providing integrated care and seldom lead to sustained positive outcomes for this group. From this observation, clinicians in Montreal, Canada, initiated collaborative meetings, eventually attended by a growing number of institutional and community stakeholders working with homeless youth. Acknowledging the unique needs of this population, the Réseau d’intervention de proximité auprès des Jeunes de la Rue (RIPAJ) or Montreal Homeless Youth Network was created to engage and seamlessly connect youth with the right resources within the network including mental health services amongst others. The genesis, philosophy and unique features of RIPAJ that allow for effective and cohesive interventions as well as future directions are discussed.


Homeless youth Youth mental health Access to care Network Integrated care 



  1. Abdel-Baki, A., Aubin, D., Morisseau-Guillot, R., Lal, S., Dupont, M.-È., Bauco, P., et al. (2019). Improving mental health services for homeless youth in downtown Montreal, Canada: Partnership between a local network and ACCESS Esprits ouverts (Open Minds), a National Services Transformation Research Initiative. Early Intervention in Psychiatry, 13 (suppl 1), 20–28.Google Scholar
  2. Abdel-Baki, A., Lévesque, I.-S., Ouellet-Plamondon, C., & Nicole, L. (2014). Should we care about homelessness in first episode psychosis? Impact on outcome. Early Intervention in Psychiatry, 8 (suppl 1), 85.Google Scholar
  3. Aubin, D. (2008). Les jeunes en difficulté: Une invitation à la créativité Psychologie Québec, 25(2), 24–27.Google Scholar
  4. Aubin, D., Abdel-Baki, A., Baret, C., Cadieux, C., Hill, T., Lafortune, D., et al. (2011). Des rencontres de proximité: apprendre de l’autre, pour tisser de la solidarité et de l’espoir. Première partie. Santé mentale au Québec, 36(2), 53–76.CrossRefGoogle Scholar
  5. Aubin, D., & Flamand, S. (2002). Prendre le large, une expérience novatrice d’intervention auprès des jeunes toxicomanes. Paper presented at the Forum mondial Drogues et dépendances, enjeux pour la société, Montréal.Google Scholar
  6. Aviles, A., & Helfrich, C. (2004). Life Skill service needs: Perspective for homeless youth. Journal of Youth and Adolescence, 33(4), 331–338.CrossRefGoogle Scholar
  7. Canadian Observatory on Homelessness. (2016). Canadian Definition of Youth Homelessness. Retrieved October 11, 2019, from
  8. Clément, M., & Aubé, D. (2002). La continuité des soins: une solution? Perspective des personnes avec comorbidité. Santé mentale au Québec, 27(2), 180–197.CrossRefPubMedGoogle Scholar
  9. Coates, J., & McKenzie-Mohr, S. (2010). Out of the frying pan, into the fire: Trauma in the lives of homeless youth prior to and during homelessness. The Journal of Sociology & Social Welfare, 37(4), 65–96.Google Scholar
  10. Coldwell, C. M., & Bender, W. S. (2007). The effectiveness of assertive community treatment for homeless populations with severe mental illness: A meta-analysis. The American Journal of Psychiatry, 164(3), 393–399. Scholar
  11. Collins, P., & Barker, C. (2009). Psychological help-seeking in homeless adolescents. International Journal of Social Psychiatry, 55(4), 372–384. Scholar
  12. Doré-Gauthier, V., Côté, H., Jutras-Asward, D., Ouellet-Plamondon, C., & Abdel-Baki, A. (2019a). How to help homeless youth suffering from first episode psychosis and substance use disorders? The creation of a new intensive outreach intervention team. Psychiatry Research, 273, 603–612.CrossRefPubMedGoogle Scholar
  13. Doré-Gauthier, V., Miron, J.-P., Jutras-Asward, D., Ouellet-Plamondon, C., & Abdel-Baki, A. (2019b). Specialized assertive community treatment intervention for homeless youth with first episode psychosis and substance use disorder: A 2-year follow-up study. Early Intervention in Psychiatry. Scholar
  14. Edidin, J. P., Ganim, Z., Hunter, S. J., & Karnik, N. S. (2012). The mental and physical health of homeless youth: A literature review. Child Psychiatry and Human Development, 43(3), 354–375. Scholar
  15. Farmer, O. (2011). Santé mentale au coeur de la ville: au carrefour urbain des différences. Santé mentale au Québec, 36(2), 7–14.CrossRefPubMedGoogle Scholar
  16. Folsom, D. P., Hawthorne, W., Lindamer, L., Gilmer, T., Bailey, A., Golshan, S., et al. (2005). Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. The American Journal of Psychiatry, 162(2), 370–376. Scholar
  17. Gaetz, S. (2012). The real cost of homelessness: Can we save money by doing the right thing? Retrieved October 11, 2019, from Toronto
  18. Gaetz, S. (2014). Can housing first work for youth? European Journal of Homelessness, 8(2), 159–175.Google Scholar
  19. Gaetz, S., O’Grady, B., Buccieri, K., Karabanow, J., & Marsolais, A. (2013). Youth homelessness in Canada: Implications for policy and practice. Retrieved October 11, 2019, from Toronto
  20. Gaetz, S., O’Grady, B., Kidd, S., & Schwan, K. (2016). Without a home: The national youth homelessness survey. Retrieved October 11, 2019, from Toronto
  21. Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., et al. (2014). National at home/Chez Soi final report. Retrieved October 11, 2019, from Calgary
  22. Goodman, L., Saxe, L., & Harvey, M. (1991). Homelessness as psychological trauma. Broadening perspectives. American Psychologist, 46(11), 1219–1225.CrossRefPubMedGoogle Scholar
  23. Hadland, S. E., Marshall, B. D., Kerr, T., Zhang, R., Montaner, J. S., & Wood, E. (2011). A comparison of drug use and risk behavior profiles among younger and older street youth. Substance Use and Misuse, 46(12), 1486–1494. Scholar
  24. Hetrick, S. E., Bailey, A. P., Smith, K. E., Malla, A., Mathias, S., Singh, S. P., et al. (2017). Integrated (one-stop shop) youth health care: Best available evidence and future directions. Medical Journal of Australia, 207(10), S5–S18.PubMedGoogle Scholar
  25. Hwang, S. W., Stergiopoulos, V., O’Campo, P., & Gozdzik, A. (2012). Ending homelessness among people with mental illness: The At Home/Chez Soi randomized trial of a Housing First intervention in Toronto. BMC Public Health, 12, 787. Scholar
  26. Iyer, S. N., Boksa, P., Lal, S., Shah, J., Marandola, G., Jordan, G., et al. (2015). Transforming youth mental health: A Canadian perspective. Irish Journal of Psychological Medicine, 32, 51–60.CrossRefGoogle Scholar
  27. Janus, M. D., Archambault, F. X., Brown, S. W., & Welsh, L. A. (1995). Physical abuse in Canadian runaway adolescents. Child Abuse and Neglect, 19(4), 433–447.CrossRefPubMedGoogle Scholar
  28. Kamieniecki, G. W. (2001). Prevalence of psychological distress and psychiatric disorders among homeless youth in Australia: A comparative review. Australian and New Zealand Journal of Psychiatry, 35(3), 352–358. Scholar
  29. Karabanow, J., & Clement, P. (2004). Interventions with street youth: A commentary on the practice-based research literature. Brief Treatment and Crisis Intervention, 4(1), 93–108.CrossRefGoogle Scholar
  30. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. Scholar
  31. Kidd, S. A. (2006). Factors precipitating suicidality among homeless youth. Youth & Society, 37(4), 393–422.CrossRefGoogle Scholar
  32. Kidd, S., Slesnick, N., Frederick, T., Karabanow, J., & Gaetz, S. (2018). Mental health and addiction interventions for youth experiencing homelessness: Practical strategies for front-line providers. Retrieved October 11, 2019, from Toronto
  33. Malla, A., Iyer, S., Shah, J., Joober, R., Boksa, P., Lal, S., et al. (2019). Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts). Early Intervention in Psychiatry, 13, 697–706.CrossRefPubMedGoogle Scholar
  34. Martijn, C., & Sharpe, L. (2006). Pathways to youth homelessness. Social Science and Medicine, 62(1), 1–12. Scholar
  35. Martin, I., Lampinen, T. M., & McGhee, D. (2006). Methamphetamine use among marginalized youth in British Columbia. Canadian Journal of Public Health, 97(4), 320–324.CrossRefPubMedGoogle Scholar
  36. Merriam-Webster Dictionary. (2018). Nonbinary|definition of nonbinary. Retrieved from
  37. Muir-Cochrane, E., Fereday, J., Jureidini, J., Drummond, A., & Darbyshire, P. (2006). Self-management of medication for mental health problems by homeless young people. International Journal of Mental Health Nursing, 15(3), 163–170. Scholar
  38. Roy, É., Haley, N., & Leclerc, P. (2004). Mortality in a cohort of street youth in Montreal. JAMA, 292(5), 569–574.CrossRefPubMedGoogle Scholar
  39. Solorio, M. R., Milburn, N. G., Andersen, R. M., Trifskin, S., & Rodriguez, M. A. (2006). Emotional distress and mental health service use among urban homeless adolescents. The Journal of Behavioral Health Services & Research, 33(4), 381–393. Scholar
  40. Whitbeck, L. B., Johnson, K. D., Hoyt, D. R., & Cauce, A. M. (2004). Mental disorder and comorbidity among runaway and homeless adolescents. Journal of Adolescent Health, 35, 132–140.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry, Faculty of MedicineUniversity of MontréalMontréalCanada
  2. 2.Dans La RueMontréalCanada
  3. 3.Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)MontréalCanada
  4. 4.Department of PsychiatryMcGill UniversityMontrealCanada

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