Abstract
This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender, and age) completed a questionnaire and clinical interview. Data on discharge services were extracted from the electronic health record. Factors associated with access to services were examined using logistic regression models. Despite a similar duration of hospitalization to housed participants, homeless participants were significantly less likely to have outpatient follow-up with a family physician, intensive case management, assertive community treatment, income support or prescription drug coverage at the time of discharge from hospital. Although inpatient hospitalization presents an opportunity to reduce homeless people’s barriers to accessing health and social services, our results show inequities for homeless people persist at the time of discharge.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed, text revision). Arlington: American Psychiatric Association.
Backer, T. E., Howard, E. A., & Moran, G. E. (2007). The role of effective discharge planning in preventing homelessness. Journal of Primary Prevention, 28, 229–243.
Best, J. A., & Young, A. (2009). A SAFE DC: a conceptual framework for care of the homeless inpatient. Journal of Hospital Medicine, 4, 375–381.
Buchanan, D., Doblin, B., Sai, T., & Garcia, P. (2006). The effects of respite care for homeless patients: a cohort study. American Journal of Public Health, 96, 1278–1281.
Canadian Institute for Health Information [CIHI]. (2007). Improving the health of Canadians: Mental health and homelessness. Ottawa: CIHI.
Coldwell, C. M., & Bender, W. S. (2007). The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta-analysis. American Journal of Psychiatry, 164, 393–399.
Dixon, L., Goldberg, R., Iannone, V., Lucksted, A., Brown, C., Kreyenbuhl, J., et al. (2009). Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Psychiatric Services, 60, 451–458.
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. American Journal of Psychiatry, 162, 370–376.
Forchuk, C., Ward-Griffin, C., Csiernik, R., & Turner, K. (2006). Surviving the tornado of mental illness: psychiatric survivors’ experiences of getting, losing, and keeping housing. Psychiatric Services, 57, 558–562.
Forchuk, C., MacClure, S. K., Van Beers, M., Smith, C., Csiernik, R., Hock, J., et al. (2008). Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and ‘no fixed address’. Journal of Psychiatric and Mental Health Nursing, 15, 569–575.
Frankish, C. J., Hwang, S. W., & Quantz, D. (2005). Homelessness and health in Canada research lessons and priorities. Canadian Journal of Public Health, 96(S2), S23–S29.
Fryers, T., Melzer, D., Jenkins, R., & Brugha, T. (2005). The distribution of the common mental disorders: social inequalities in Europe. Clinical Practice and Epidemiology in Mental Health, 1, 14.
Gaetz, S., & O’Grady, B. (2006). The missing link: Discharge planning, incarceration and homelessness. Toronto: Howard Johnson Society of Toronto.
Goering, P., Pyke, J., & Bullock, H. (2004). Health, mental health and addiction treatment needs of people using emergency shelters in Toronto. Toronto: City of Toronto Shelter, Housing and Support Division Community and Neighbourhood Services.
Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., et al. (2006). Lost in knowledge translation: time for a map? The Journal of Continuing Education in the Health Professions, 26, 13–24.
Herman, D., Susser, E., Jandorf, L., Lavelle, J., & Bromet, E. J. (1998). Homelessness among individuals hospitalized for the first time with psychotic disorders: findings from the Suffolk County mental health project. American Journal of Psychiatry, 155, 109–113.
Human Resources and Skills Development Canada. (2009). Low income in Canada: 2000–2007 using the market basket measure. Ottawa: Human Resources and Skills Development Canada.
Hwang, S. W., Gogosis, E., Chambers, C., Dunn, J. R., Hoch, J. S., & Aubry, T. (2011). Health status, quality of life, residential stability, substance use, and health care utilization among adults applying to a supportive housing program. Journal of Urban Health, 88, 1076–1090.
John Howard Society of Toronto. (2010). Homeless and jailed: Jailed and homeless. Toronto: John Howard Society of Toronto. Retrieved June 1, 2011, from John Howard Society website: http://www.johnhoward.ca/document/JHS-Toronto%20Report%20Homeless%20and%20Jailed.pdf.
Jones, K., Colson, P. W., Holter, M. C., Lin, S., Valencia, E., Susser, E., et al. (2003). Cost-effectiveness of critical time intervention to reduce homelessness among persons with mental illness. Psychiatric Services, 54, 884–890.
Leal, D., Galanter, M., Dermatis, H., & Westreich, L. (1999). Correlates of protracted homelessness in a sample of dually diagnosed psychiatric inpatients. Journal of Substance Abuse Treatment, 16, 143–147.
Mental Health Policy Research Group. (1997). Mental illness and pathways into homelessness: Findings and implications, presented at the Mental Illness and Pathways Into Homelessness Conference in Toronto, Ontario, on November 3.
Metraux, S., & Culhane, D. P. (2006). Recent incarceration history among a sheltered homeless population. Crime and Delinquency, 523, 504–517.
Mojtabai, R. (2005). Perceived reasons for loss of housing and continued homelessness among persons with mental illness. Psychiatric Services, 56, 172–178.
Montauk, S. L. (2006). The homeless in America: adapting your practice. American Family Physician, 74(7), 1132–1138.
Nelson, G., Aubry, T., & Lafrance, A. (2007). A review of the literature on the effectiveness of housing support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. American Journal of Orthopsychiatry Mental Health and Social Justice, 77, 350–361.
North, C. S., Pollio, D. E., Smith, E. M., & Spitznagel, E. L. (1998). Correlates of early onset and chronicity of homelessness in a large urban homeless population. Journal of Nervous and Mental Disease, 186, 393–400.
Olfson, M., Mechanic, D., Hansell, S., Boyer, C. A., & Walkup, J. (1999). Prediction of homelessness within three months of discharge among inpatients with schizophrenia. Psychiatric Services, 50, 667–673.
Overall, J. E., & Gorham, D. P. (1984). Brief psychiatric rating scale-anchored. Washington: Department of Health and Human Services.
Patterson, T. L., Boldman, S., McKibbin, C. L., Hughs, T., & Jeste, D. V. (2001). UCSD performance-based skills assessment: development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Research, 48, 351–360.
Pickett, K. E., & Wilkinson, R. G. (2010). Inequality: an underacknowledged source of mental illness and distress. The British Journal of Psychiatry, 197, 426–428.
Prince, J. (2006). Practices preventing re-hospitalization of individuals with schizophrenia. Journal of Nervous and Mental Disease, 194, 397–403.
Prowse, L., & Coombs, T. (2009). The use of the Health of the Nation Outcome Scales (HoNOS) to inform discharge and transfer decisions in community mental health services. Australian Health Review, 3391, 13–18.
Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption II. Addiction, 88, 791–804.
Skeem, J. L., Manchak, S., & Peterson, J. K. (2010). Correctional policy for offenders with mental illness: creating a new paradigm for recidivism reduction. Law and Human Behavior Apr 14 [Epub ahead of print].
Skinner, H. A. (1982). The drug abuse screening test. Addictive Behaviors, 7, 363–371.
Stergiopoulos, V., Burra, T. A., Rourke, S. B., & Hwang, S. W. (2011). Housing ang cognitive status affect functional capacity in patients with schizophrenia. Journal of Nervous and Mental Diseases, 199, 854–860.
Steriopoulos, V., Dewa, C. S., Tanner, G., Chau, N., Pett, M., & Connelly, J. L. (2010). Addressing the needs of the street homeless a collaborative approach. International Journal of Mental Health, 39, 3–16.
Susser, E., Valencia, E., Conover, S., Felix, A., Tsai, W. Y., & Wyatt, R. J. (1997). Preventing recurrent homelessness among mentally ill men: a “critical time” intervention after discharge from a shelter. American Journal of Public Health, 87, 256–262.
Weiden, P., Kozma, C., Grogg, A., & Locklear, J. (2004). Partial compliance and risk of re-hospitalization among California Medicaid patients with schizophrenia. Psychiatric Services, 55, 886–891.
Funding and support
This study was funded by a Dean’s Fund Grant, University of Toronto.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Burra, T.A., Hwang, S.W., Rourke, S.B. et al. Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital. Int J Ment Health Addiction 10, 778–789 (2012). https://doi.org/10.1007/s11469-012-9392-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11469-012-9392-3