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Jackson SW, Castillo EG, Myrick KJ, Goldman ML. Policy, Design, and Critical Reflections on Behavioral Health Crisis Services for People Experiencing Homelessness. Psychiatr Clin North Am 2024; 47:577-593. [PMID: 39122347 DOI: 10.1016/j.psc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
People experiencing homelessness in crisis have unique structural vulnerabilities and social needs, most importantly lack of housing. Ideal crisis services for people experiencing homelessness must safeguard against criminalization and displacement during periods of crisis, prioritize equity, and provide housing interventions alongside mental health treatment at every stage in the crisis continuum. By outlining how to tailor crisis system financing and accountability, service component and capacity, and clinical best practices, the authors aim to provide hope and guidance for communities aiming to create an ideal crisis system for people experiencing homelessness.
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Affiliation(s)
- Samuel W Jackson
- Department of Psychiatry, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
| | - Enrico G Castillo
- Department of Psychiatry, Center for Social Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, 760 Westwood Plaza, Semel B7-435, Los Angeles, CA 90095, USA
| | - Keris Jän Myrick
- Inseparable, 409 7th Street N.W. Suite 350 Washington, DC 20004, USA
| | - Matthew L Goldman
- Department of Psychiatry and Behavioral Sciences, University of Washington, King County Department of Community and Human Resources, 401 5th Avenue, Seattle, WA 98104, USA
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Erickson BR, Ehrie J, Murray S, Dougherty RJ, Wainberg ML, Dixon LB, Goldman ML. A Rapid Review of "Low-Threshold" Psychiatric Medication Prescribing: Considerations for Street Medicine and Beyond. Psychiatr Serv 2023; 74:282-291. [PMID: 36039554 PMCID: PMC9971341 DOI: 10.1176/appi.ps.20220196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE No widely accepted clinical guidelines, and scant directly applicable pragmatic research, are available to guide the prescription of psychiatric medications in "low-threshold" outpatient settings, such as street outreach, urgent care, and crisis care, as well as walk-in, shelter, and bridge and transition clinics. Providers frequently prescribe medications in these settings without patients' having firm psychiatric diagnoses and without medical records to guide clinical decision making. Persons who receive medications in these settings often seek help voluntarily and intermittently for mental illness symptoms. However, because of structural and individual factors, such patients may not engage in longitudinal outpatient psychiatric care. The authors reviewed the literature on psychiatric medication prescribing in low-threshold settings and offer clinical considerations for such prescribing. METHODS The authors conducted a rapid literature review (N=2,215 abstracts), which was augmented with up-to-date clinical prescribing literature, the authors' collective clinical experience, and DSM-5 section II diagnostic criteria to provide considerations for prescribing medications in low-threshold settings. RESULTS For individuals for whom diagnostic uncertainty is prominent, a symptom-based diagnostic and treatment approach may be best suited to weigh the risks and benefits of medication use in low-threshold settings. Practical considerations for treating patients with clinical presentations of psychosis and trauma, as well as mood, anxiety, and substance use disorders, in low-threshold settings are discussed. CONCLUSIONS An urgent need exists to invest in pragmatic research and guideline development to delineate best-practice prescribing in low-threshold settings.
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Affiliation(s)
- Blake R Erickson
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Jarrod Ehrie
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Samuel Murray
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Ryan J Dougherty
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Milton L Wainberg
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
| | - Matthew L Goldman
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Erickson, Ehrie, Wainberg, Dixon); Psychiatry Residency Spokane, Providence Sacred Heart Medical Center, Spokane, Washington (Murray); Division of Medical Ethics, Weill Cornell Medical College, New York City (Dougherty); Department of Psychiatry and Behavioral Sciences, University of California, and San Francisco Department of Public Health, San Francisco (Goldman)
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Ramirez J, Petruzzi LJ, Mercer T, Gulbas LE, Sebastian KR, Jacobs EA. Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings. BMC PRIMARY CARE 2022; 23:338. [PMID: 36572847 PMCID: PMC9792313 DOI: 10.1186/s12875-022-01932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program. METHODS Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model. RESULTS Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change. CONCLUSION To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.
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Affiliation(s)
- Jahanett Ramirez
- grid.89336.370000 0004 1936 9924The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Liana J. Petruzzi
- grid.89336.370000 0004 1936 9924Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX USA
| | - Timothy Mercer
- grid.89336.370000 0004 1936 9924Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,CommUnityCare Health Centers, Austin, TX USA
| | - Lauren E. Gulbas
- grid.89336.370000 0004 1936 9924The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Katherine R. Sebastian
- grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA
| | - Elizabeth A. Jacobs
- grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,grid.416311.00000 0004 0433 3945Maine Medical Center Research Institute, MaineHealth Institute for Research, Scarborough, ME USA
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Grotts JH, Mead MM, Rab S, Walker IJ, Choi KR. Geospatial analysis of associations among mental health need, housing need, and involuntary psychiatric hospitalizations of people experiencing homelessness in Los Angeles County. Soc Sci Med 2022; 311:115343. [PMID: 36126473 DOI: 10.1016/j.socscimed.2022.115343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/15/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to use geospatial indicators of mental health need and homelessness in Los Angeles County Service Planning Areas (SPAs) and a psychiatric sample of adults who were homeless to investigate 1) overlap between SPA level of mental health need and corresponding volume of involuntary psychiatric hospitalizations over time; 2) overlap between SPA level of unsheltered homelessness and corresponding volume of involuntary psychiatric hospitalizations over time; and 3) associations between SPA level of mental health need, SPA level of unsheltered homelessness, and initiation of a mental health conservatorship for grave disability. A sample of 373 adults who were homeless and hospitalized on an involuntary psychiatric hold from 2016 to 2018 were linked to data from the Greater Los Angeles Homeless Count on unsheltered homelessness and from the California Health Interview Survey on need for mental health services and suicidality, using admission zip codes to link variables at the SPA level. Geospatial mapping and bivariate tests were used to examine geographic overlap of SPA mental health need and unsheltered homelessness with volume of involuntary psychiatric admissions over the study period. Multiple logistic regression modeling was used to examine associations of SPA mental health need and unsheltered homelessness with conservatorship initiation. The volume of patients admitted from SPAs with higher levels of mental illness need grew from 2016 to 2018 (Tau = 0.27, P < 0.001; Tau = 0.40, P < 0.001), but there were fewer patients admitted from SPAs with higher levels of unsheltered homelessness over the same years (Tau of -0.33, P < 0.001). Being admitted from SPAs with the highest levels of unsheltered homelessness was associated with higher odds of conservatorship initiation (OR = 1.73, 95% CI = 1.82-16.74). Results suggest a need for targeted mental health and housing services to reach areas of highest need in Los Angeles County.
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Affiliation(s)
- Joseph H Grotts
- School of Nursing, UCLA; 700 Tiverton Ave Los Angeles, CA, 90049, USA
| | - Meredith M Mead
- Gateways Hospital and Mental Health Center, 1891 Effie St Los Angeles, CA, USA
| | - Shayan Rab
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Imani J Walker
- Gateways Hospital and Mental Health Center, 1891 Effie St Los Angeles, CA, USA
| | - Kristen R Choi
- School of Nursing, UCLA; 700 Tiverton Ave Los Angeles, CA, 90049, USA; Gateways Hospital and Mental Health Center, 1891 Effie St Los Angeles, CA, USA; Department of Health Policy & Management, Fielding School of Public Health, UCLA; 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA.
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Choi KR, Castillo EG, Seamans MJ, Grotts JH, Rab S, Kalofonos I, Mead M, Walker IJ, Starks SL. Mental Health Conservatorship Among Homeless People With Serious Mental Illness. Psychiatr Serv 2022; 73:613-619. [PMID: 34704772 PMCID: PMC9132544 DOI: 10.1176/appi.ps.202100254] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to examine associations between homelessness and length of psychiatric hospitalization and to explore the role of mental health conservatorship in determining discharge location for patients who are homeless and have a grave disability from serious mental illness. METHODS This observational study used administrative data from a safety-net psychiatric hospital in Los Angeles. The sample included 795 adults (≥18 years) who were hospitalized on an involuntary psychiatric hold between 2016 and 2018. The outcome variables were length of stay (days) and discharge location (home, locked psychiatric facility, unlocked psychiatric facility, unhoused). The predictor variables were homelessness status and whether a mental health conservatorship was initiated during hospitalization. Multiple regression models were used to estimate associations between variables. RESULTS Homelessness status was associated with 27.5 additional days (SE=3.5 days) of hospitalization in adjusted models. Homeless patients for whom conservatorship was initiated comprised 6% of the sample but 41% of total inpatient days. Among people who were homeless, initiation of a conservatorship was associated with significantly longer length of inpatient stay (mean=154.8 days versus 25.6 days for the whole sample) but also with lower odds of being unhoused at the time of discharge (risk ratio=0.19, 95% confidence interval=0.09-0.34). CONCLUSIONS A mental health conservatorship can be a mechanism for helping homeless people with a grave disability from mental illness to transition from the streets to residential psychiatric treatment, but it requires substantial resources from facilities that initiate such conservatorships and does not guarantee resolution of long-term supportive housing needs.
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Affiliation(s)
- Kristen R Choi
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Enrico G Castillo
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Marissa J Seamans
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Joseph H Grotts
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Shayan Rab
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Ippolytos Kalofonos
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Meredith Mead
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Imani J Walker
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Sarah L Starks
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
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Lo E, Lifland B, Buelt EC, Balasuriya L, Steiner JL. Implementing the Street Psychiatry Model in New Haven, CT: Community-Based Care for People Experiencing Unsheltered Homelessness. Community Ment Health J 2021; 57:1427-1434. [PMID: 34059983 DOI: 10.1007/s10597-021-00846-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
"Street psychiatry" is an innovative model that serves people experiencing unsheltered homelessness, a vulnerable population with increased rates of mental illness and substance use disorders. Through community-based delivery of mental health and addiction treatment, street psychiatry helps the street-dwelling population overcome barriers to accessing care through traditional routes. Throughout the United States, street psychiatry programs have arisen in multiple cities, often in partnership with street medicine programs. We discuss the philosophy of street psychiatry, document operational highlights involved in the development of a street psychiatry program in New Haven, CT, suggest key ingredients to implementing a street psychiatry program, and explore challenges and future frontiers. Street psychiatry is an effective person-centered model of service delivery with the potential to be applied in a variety of urban settings to serve people experiencing street homelessness.
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Affiliation(s)
- Emma Lo
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park St, New Haven, CT, 06519, USA.
| | - Brooke Lifland
- Department of Psychiatry, Yale University School of Medicine, 300 George St, New Haven, CT, 06511, USA
| | - Eliza C Buelt
- Massachusetts Mental Health Center, 20 Vining St, Boston, MA, 02115, USA
| | - Lilanthi Balasuriya
- Yale National Clinician Scholars Program, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Jeanne L Steiner
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park St, New Haven, CT, 06519, USA
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Dotson S, Ogbu-Nwobodo L, Shtasel D. The Importance of an Evidence-Based Structural Approach in Public and Community Psychiatry. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210508-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dotson S, Ciarocco S, Koh KA. Disaster psychiatry and homelessness: creating a mental health COVID-19 response. Lancet Psychiatry 2020; 7:1006-1008. [PMID: 32763148 PMCID: PMC7402664 DOI: 10.1016/s2215-0366(20)30343-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/03/2020] [Accepted: 07/17/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Samuel Dotson
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Katherine A Koh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Boston Health Care for the Homeless Program, Boston, MA, USA.
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Gama Marques J, Bento A. Homeless, nameless and helpless: John Doe syndrome in treatment resistant schizophrenia. Schizophr Res 2020; 224:183-184. [PMID: 32933814 DOI: 10.1016/j.schres.2020.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- João Gama Marques
- Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Portugal; Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - António Bento
- Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Portugal
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Glick ID, Shader RI. The problem of medical-psychiatric illness in the homeless and its occurrence in the midst of a viral pandemic: A commentary. Psychiatry Res 2020; 290:113118. [PMID: 32593807 DOI: 10.1016/j.psychres.2020.113118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
This article has the purpose of examining the problem of getting help for the medical-psychiatric-substance use group of "homeless" people on the streets of our cities, who refuse treatment. The problem has gradually worsened since closure of state hospitals and subsequent lack of community resources. It has been stalemated, in part, by advocates, who argue for personal autonomy and freedom rather than involuntary diagnosis and treatment over the life of these people. It has reached a crisis situation secondary to such potential patients being imprisoned and/or sick with COVID-19 being potential health and legal threats. We review A) the nature of the problem, B) the current social-legal availability of treatment and long-term management (or lack of one) in the context of societal rejection of these potential patients, and C) suggest what might be done, locally and nationally. Mandating scientifically-based medical orders to citizens regardless of personal freedom - are now being implemented to manage the COVID-19 pandemic. We argue for creating a similar med-psych short- and long-term system as a new approach to help this group. They are now mostly being ignored "to die on the streets."
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Affiliation(s)
- Ira D Glick
- Professor Emeritus, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA.
| | - Richard I Shader
- Professor Emeritus, Departments of Immunology and Psychiatry, Tufts University School of Medicine, USA
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