The impact of a Housing First intervention and health-related risk factors on incarceration among people with experiences of homelessness and mental illness in Canada

Abstract

Objective

To examine the effect of a Housing First (HF) intervention and health-related risk factors on incarceration among adults with experiences of homelessness and mental illness.

Methods

Participants (N = 508) were recruited at the Toronto site of the At Home/Chez Soi study. The outcome was incarceration in Ontario from 2009 to 2014. Exposures were intervention group (HF vs. treatment as usual), Axis I mental health diagnoses, emergency department (ED) visit, and history of traumatic brain injury (TBI). Logistic regression was used to examine the association between exposures and incarceration.

Results

Of 508 participants, 220 (43.3%) were incarcerated at least once during the study period. Among those incarcerated, 81.9% were male, 52.7% had been diagnosed with alcohol dependence/abuse, 60.9% had been diagnosed with substance dependence/abuse, 65.1% reported having visited an ED within the last 6 months, and 66.4% had a history of TBI. After adjusting for demographic covariates, substance dependence/abuse (aOR: 2.06; 95% CI: 1.40, 3.03), alcohol dependence/abuse (aOR: 1.52, 95% CI: 1.04, 2.22), ED visit (aOR: 1.54; 95% CI: 1.02, 2.32), and history of TBI (aOR: 2.60; 95% CI: 1.75, 3.85) were associated with incarceration. We found no significant effect of the HF intervention on incarceration outcome (aOR: 1.08; 95% CI: 0.76, 1.55).

Conclusions

Among adults with experiences of homelessness and severe mental illness, those with substance and alcohol dependence/abuse disorders, history of TBI, and recent ED visits were at increased odds of incarceration. Strategies are needed to prevent and reduce incarceration for this population, including treatment of mental illness in the community.

Résumé

Objectif

Examiner l’effet d’une intervention de Logement d’abord (LD) et de facteurs de risque liés à la santé sur l’incarcération d’adultes ayant vécu des épisodes de sans-abrisme et de maladie mentale.

Méthode

Les participants (N = 508) ont été recrutés sur le site torontois de l’étude At Home/Chez-Soi. L’issue à l’étude était l’incarcération en Ontario entre 2009 et 2014. Les expositions étaient le groupe d’intervention (LD vs. traitement habituel), les diagnostics de troubles de santé mentale de l’axe I, les visites aux services d’urgence (SU) et les antécédents de traumatisme cranio-cérébral (TCC). Nous avons procédé par régression logistique pour examiner l’association entre les expositions et l’incarcération.

Résultats

Sur 508 participants, 220 (43,3 %) avaient été incarcérés au moins une fois durant la période de l’étude. Chez les personnes incarcérées, 81,9 % étaient des hommes, 52,7 % avaient un diagnostic de dépendance à l’alcool ou d’abus d’alcool, 60,9 % avaient un diagnostic de dépendance à des substances ou d’abus de substances, 65,1 % ont dit avoir visité les SU au cours des 6 mois antérieurs, et 66,4 % avaient des antécédents de TCC. Après ajustement en fonction des covariables démographiques, la dépendance aux substances/l’abus de substances (rapport de cotes ajusté [RCa] : 2,06; IC de 95 % : 1,40, 3,03), la dépendance à l’alcool/l’abus d’alcool (RCa : 1,52, IC de 95 % : 1,04, 2,22), les visites aux SU (RCa : 1,54; IC de 95 % : 1,02, 2,32) et les antécédents de TCC (RCa : 2,60; IC de 95 % : 1,75, 3,85) étaient associés à l’incarcération. Nous n’avons observé aucun effet significatif de l’intervention de LD sur l’issue d’incarcération (RCa : 1,08; IC de 95 % : 0,76, 1,55).

Conclusions

Chez les adultes ayant vécu des épisodes de sans-abrisme et de maladie mentale grave, ceux qui avaient des troubles de dépendance/d’abus de substances et d’alcool, des antécédents de TCC et qui avaient visité les SU récemment présentaient une probabilité accrue d’incarcération. Il faut des stratégies pour prévenir et réduire l’incarcération dans cette population, y compris des stratégies de traitement des maladies mentales hors du milieu carcéral.

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Acknowledgements

We thank the At Home/Chez Soi participants who shared their lives, experiences, and stories with us. We also thank the At Home/Chez Soi project team, site coordinators, and service providers who have contributed to the design, implementation, and follow-up of the project at the Toronto site.

Our further thanks to the Ontario Ministry of the Solicitor General for providing us with access to data regarding the involvement of the study participants with the correctional system.

Funding

This study was supported by a financial contribution from the Health Canada to the Mental Health Commission of Canada, the Ontario Ministry of Health and Long-Term Care (HSRF #259), and the Canadian Institutes of Health Research (CIHR MOP-130405). The funding institutions had no role in the collection, analysis, and interpretation of the data nor in the preparation, revision, or approval of the present manuscript. The views expressed in this publication are the views of the authors.

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Cilia Mejia-Lancheros, Fiona G. Kouyoumdjian, James Lachaud, Stephen W Hwang, and Linh Luong contributed to the study conception and design the study. Linh Luong performed the analysis of the de-identified data. Linh Luong, Cilia Mejia-Lancheros, and James Lachaud interpreted the first results with intellectual inputs provided by Fiona G. Kouyoumdjian and Stephen W Hwang. The first draft of the manuscript was written by Linh Luong and Cilia Mejia-Lancheros and all authors commented on previous versions of the manuscript. All co-authors read and approved the final manuscript.

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Correspondence to Cilia Mejia-Lancheros.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Research Ethics Board of St. Michael’s Hospital in Toronto, Ontario, Canada. REB#09-208) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed written consent was obtained from all individual participants included in the study to both participate in the AH/CS trial and to have their correctional data accessed and linked to the study survey data.

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Luong, L., Lachaud, J., Kouyoumdjian, F.G. et al. The impact of a Housing First intervention and health-related risk factors on incarceration among people with experiences of homelessness and mental illness in Canada. Can J Public Health (2020). https://doi.org/10.17269/s41997-020-00433-z

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Keywords

  • Homeless persons
  • Mental health
  • Prisons
  • Public health
  • Substance-related disorders

Mots-clés

  • Sans-abri
  • santé mentale
  • prisons
  • santé publique
  • troubles liés à une substance