Housing satisfaction, preference and need among the chronically mentally disabled in Hamilton, Ontario

NB housing study protocol: investigating the relationship between subsidized housing, mental health, physical health and healthcare use in New Brunswick, Canada

BACKGROUND

Income and housing are pervasive social determinants of health. Subsidized housing is a prominent affordability mechanism in Canada; however, waitlists are lengthy. Subsidized rents should provide greater access to residual income, which may theoretically improve health outcomes. However, little is known about the health of tenants who wait for and receive subsidized housing. This is especially problematic for New Brunswick, a Canadian province with low population density, whose inhabitants experience income inequality, social exclusion, and challenges with healthcare access.  METHODS: This study will use a longitudinal, prospective matched cohort design. All 4,750 households on New Brunswick's subsidized housing wait list will be approached to participate. The survey measures various demographic, social and health indicators at six-month intervals for up to 18 months as they wait for subsidized housing. Those who receive housing will join an intervention group and receive surveys for an additional 18 months post-move date. With consent, participants will have their data linked to a provincial administrative database of medical records.  DISCUSSION: Knowledge of housing and health is sparse in Canada. This study will provide stakeholders with a wealth of health information on a population that is historically under-researched and underserved.

Preference for Independent Housing of Persons with Mental Disorders: Systematic Review and Meta-analysis

Choice of housing has become an important political and therapeutic goal for psychiatric rehabilitation. We conducted a systematic review and meta-analysis of proportions of studies on preference for independent housing. A subgroup analysis compared studies with homeless and non-homeless consumers. The meta-analysis included 8 studies with 3134 consumers. The overall proportion of consumers who had expressed a preference for living independently was 0.84. There were only marginal differences between studies with homeless and non-homeless consumers. In a given service planning area, the rate of independent housing settings should exceed the rate of more institutionalized settings by a wide margin.

Residents' View of Quality in Ordinary Housing with Housing Support for People with Psychiatric Disabilities

The aim of the present study was to investigate the quality of housing support provided in housing services for people with psychiatric disabilities living in ordinary housing with housing support from the residents' perspective, by using the QPC-H instrument. A sample of 174 residents in ordinary housing, receiving housing support from 22 housing support services in nine Swedish municipalities, participated in this study. The results show that the quality of psychiatric care in housing services was mainly rated highly as measured with the QPC-H instrument. The dimensions Encounter and Secluded Environment were the aspects that were rated as the two with the highest quality of housing service. The dimensions Participation and Secure Environment were rated as those with the lowest quality. There were more residents who totally disagreed with the statements in the dimensions Participation and Housing Specific than in the other dimensions. The perceived lower quality in Encounter, Participation, Support and the Housing Specific dimensions was associated with a low frequency of psychiatric outpatient clinic contacts. A conclusion is that the support staff could be more observant regarding the residents' need for support and also talk more with them about what could be done to assist them. It also seems important that the support staff discuss with the residents regarding how they can help them to feel more secure in their accommodation.

Striving for meaning-Life in supported housing for people with psychiatric disabilities

The aim of this study was to develop a grounded theory about people with psychiatric disabilities, living in supported housing. Interviews as well as observations during the interviews were analyzed together with secondary analyses of quantitative and qualitative material from previous studies. Being deprived of self-determination emerged as the main concern for residents in supported housing and striving for meaning emerged as the pattern of behavior through which this group resolves their main concern. Striving for meaning involves living in the present, striving for self-determination, strengthening self-esteem, emotional processing and resting from the present. The strategies facilitate each other and are used singly, together simultaneously, or alternately. If they are successful, a meaning in the present is perceived. If all the strategies fail repeatedly, escaping from the present is used in order to deal with being deprived of self-determination. The implications of the findings suggest prioritizing a reduction of the institutional nature of the social and physical environment, and to support the residents' self-determination.

Inclusiveness: A Community Dimension of Spirituality

Personal dimensions of spirituality are important but insufficient for understanding the full transformative potential in spirituality. Communities which extend equal respect and opportunities to people of differing abilities and characteristics create an energizing interconnected-ness based on a community spirituality of inclusiveness. This paper offers a critical analysis of inclusiveness as a community dimension of spirituality. Inclusiveness emerged as an implicit yet practical component of everyday practice during an ethnographic study of occupational therapy in adult, mental health day programmes. There were no explicit goals to foster a spirituality of community inclusiveness, yet occupational therapists continually emphasized the worth of everyone's contributions to chores and other occupations which turn day programmes into inclusive communities. Nevertheless, occupational therapy is constrained by organizational processes which control what can be done in everyday practice. Two organizational constraints, medical classification and individualized accountability, are highlighted and shown to interact with risk management, confidentiality, management information, workload measurement, and other policies which form a ruling apparatus that emphasizes the safe management of individual cases or patients. In light of this analysis, occupational therapists are encouraged to make spirituality, inclusiveness and community activism an explicit and accountable part of practice.

Inclusiveness: A Community Dimension of Spirituality

Personal dimensions of spirituality are important but insufficient for understanding the full transformative potential in spirituality. Communities which extend equal respect and opportunities to people of differing abilities and characteristics create an energizing interconnectedness based on a community spirituality of inclusiveness. This paper offers a critical analysis of inclusiveness as a community dimension of spirituality. Inclusiveness emerged as an implicit yet practical component of everyday practice during an ethnographic study of occupational therapy in adult, mental health day programmes. There were no explicit goals to foster a spirituality of community inclusiveness, yet occupational therapists continually emphasized the worth of everyone's contributions to chores and other occupations which turn day programmes into inclusive communities. Nevertheless, occupational therapy is constrained by organizational processes which control what can be done in everyday practice. Two organizational constraints, medical classification and individualized accountability, are highlighted and shown to interact with risk management, confidentiality, management information, workload measurement, and other policies which form a ruling apparatus that emphasizes the safe management of individual cases or patients. In light of this analysis, occupational therapists are encouraged to make spirituality, inclusiveness and community activism an explicit and accountable part of practice.

Satisfaction with housing and housing support for people with psychiatric disabilities

The aim of this study was to investigate the degree of satisfaction with housing and housing support for people with psychiatric disabilities in Sweden. A total of 370 residents, in supported housing and in ordinary housing with housing support, completed a new questionnaire and reported a high degree of overall satisfaction, but many of them wanted to move somewhere else. Differences were found between the two different types of housing concerning satisfaction with housing support, social life and available choices. Security and privacy, as well as other's influence on the choice of residential area and dwelling proved to be important predictors for satisfaction.

Validity and reliability of a Swedish questionnaire for assessing satisfaction with housing and housing support for persons with psychiatric disabilities

The aim of this study was to investigate the reliability and validity of a questionnaire for studying satisfaction with housing and housing support for people with psychiatric disabilities. Most items were gathered from English language questionnaires. These were translated and adapted to a Swedish context and items concerning housing support were added. Two studies were conducted. The first, a test-retest reliability analysis, was performed in a pilot study with 53 participants; in the second study, which had 370 participants, a five factor solution with good internal consistency emerged. Further development of the questionnaire is discussed.

Les préférences résidentielles des personnes souffrant de troubles mentaux graves : une étude descriptive

Cet article présente les résultats d’une étude exploratoire portant sur les préférences résidentielles de 315 personnes souffrant de troubles mentaux graves hébergées dans sept types d’hébergement à Montréal. Le portrait d’ensemble qui se dégage de cette étude met en évidence que 22,0 % des usagers préféreraient habiter dans leur propre appartement, 16,0 % dans les HLM ou OSBL, 14,1 % dans les appartements supervisés et 11,5 % dans les ressources de type familial. On note aussi que 31,7 % d’entre eux préfèrent le type de logement dans lequel ils habitaient au moment de l’étude. Notre réflexion sur les résultats de cette étude nous amène à conclure qu’une variété de types de ressources résidentielles demeure nécessaire pour rencontrer la diversité de besoins des usagers.

Building Life Around the Foster Home vs. Moving On: The Competing Needs of People Living in Foster Homes

OBJECTIVE

This article reports findings on the competing needs of people living in psychiatric foster homes in Montreal, Canada.

METHODS

Semi-structured interviews were conducted with 33 residents. Consumers describe the tensions associated with foster home life.

RESULTS

Two overall competing needs emerged: the need to build their lives around the foster home and the need to build life beyond the foster home. Residents describe their need for security and support versus their need for greater personal autonomy, the dilemmas associated with communal living, and their struggle to envisage a positive future.

CONCLUSIONS

These findings have important implications for mental health professionals mandated to dismantle foster homes for more autonomous housing.

The values and qualities of being a good helper: a qualitative study of adult foster home caregivers for persons with serious mental illness

BACKGROUND

Canadian foster homes for adults with serious mental illness are operated by non-professional caregivers, usually women, whose mandate is to support residents and reintegrate them into the community. While mental health professionals recognize that adult foster homes are an important service for this population, there is little understanding of how caregivers impact on the lives of their residents.

AIMS AND OBJECTIVES

This article draws on the findings of a larger study which examined both caregiver and resident perspectives on the helping relationship in adult foster homes. Caregiver perspectives on the values and qualities required to help people living in foster homes are reported.

DESIGN AND METHODS

With no pre-set theoretical framework, this qualitative study employed an inductive approach within a naturalistic paradigm. Semi-structured interviews were conducted with 20 caregivers. Data analysis was an ongoing, 2-year process, involving the identification of categories and themes through several distinct stages.

SETTING

The study included Montreal adult foster homes (n=242) for persons with serious mental illness, supervised by two university-affiliated psychiatric hospitals.

PARTICIPANTS

Twenty caregivers, selected according to years of experience and number of residents in the home, were diverse in terms of age, cultural background, family composition, education and occupational background.

RESULTS

Caregivers possess a clearly articulated value system, and 21 specific qualities which reflect the attributes of both professional and informal helpers. These values and qualities provide caregivers with a "professional" or "vocational" orientation.

CONCLUSIONS

A deeply held system of values and qualities is critically important to caregiver effectiveness and job satisfaction. Findings suggest that caregivers are highly motivated, and should be recognized as full participants in the mental health system at both policy and practice levels.

Are nursing homes appropriate for older adults with severe mental illness? Conflicting consumer and clinician views and implications for the Olmstead decision

OBJECTIVES

In response to the recent Olmstead decision, to compare consumer and clinician perspectives on the appropriateness of nursing home settings for older adults with severe mental illness (SMI) in relation to clinical characteristics and care needs.

DESIGN

Cross-sectional, descriptive, correlational study.

SETTING

Ten community mental health centers and two state-funded nursing homes specializing in long-term care for older persons with SMI.

PARTICIPANTS

Consumers of mental health services in the community (n=115) and in nursing homes (n=106), aged 60 and older, with SMI. Sixty-four clinicians (51% registered nurses, 29% masters-level clinicians, and 20% certified social workers) conducted ratings.

MEASUREMENTS

Consumers and their clinicians were independently asked to determine the most appropriate care setting for each consumer based on care needs from three alternatives: nursing home, congregate (group) living setting, or individual apartment/home. Clinical characteristics of participants with SMI were rated using the Mini-Mental State Examination, Brief Psychiatric Rating Scale, Specific Level of Function Scale, Cumulative Illness Rating Scale for Geriatrics, a modified memory and orientation subscale from the Clinical Dementia Rating Scale, and an item from the Minimum Data Set related to reasoning.

RESULTS

Of nursing home residents with SMI who did not have severe cognitive impairment, 40% (n=42) and 51% (n=54) were considered by consumers or by their clinician, respectively, to be more appropriate for a community-based setting, but there was a low level of agreement (only 27.6%; no better than chance) between consumers and clinicians on which nursing home residents were most appropriate for living in the community. Determinations by clinicians were associated with clinical need (diagnosis and less-severe behavioral problems), whereas there was no association between clinical needs and level of care determinations by consumers. Finally, clinicians considered a group home necessary for 93.7% of nursing home residents judged to be more appropriate for a community-based setting, whereas 90.5% of consumers stated that an apartment or individual home was indicated.

CONCLUSION

State implementation of the Olmstead decision will need to consider major differences in perspectives between clinicians and consumers on the most appropriate long-term care setting for older persons with SMI.

A housing support programme for the mentally ill: need profile and satisfaction among users

Housing support has become an integrated part of the community psychiatric service during the past years. In this study, the need profile, satisfaction rates and clinical characteristics of the users of a housing support programme in Copenhagen are described. Among the 45 residents interviewed, schizophrenia was by far the dominant diagnosis. The Camberwell Assessment of Needs procedure revealed a total of 8.3 needs, including 3.4 unmet needs per resident, within the 22 need areas investigated. The needs were most prevalent within the areas of psychological and social functioning. Agreement between residents and staff on the presence of needs was generally low. Satisfaction rates were moderate to high, and a substantial proportion of the residents reported their general quality of life to be improved during participation in the programme. The type of support provided seemed to fit important need areas, suggesting that the programme is appropriate.

Assessing homeless mentally ill persons for permanent housing: screening for safety

Although placement in community housing is a frequent intervention with populations of seriously mentally ill homeless individuals, there has been little formal investigation of the criteria used by clinicians in screening individuals for such placement. In this paper, we describe screening a population of 303 homeless people with severe mental illness for placement in independent apartments. We assess subjects' level of risk along multiple dimensions and determine the contribution of each risk dimension to the final safety decision. In addition, we evaluate the validity of the risk measures with other measures of clinical condition. Two-thirds of the sample were judged as safe for independent living. Assaultiveness was the most frequent risk identified, followed by self-destructiveness, substance abuse, and medication non-compliance. The final safety decision was associated most strongly with assaultiveness, self-destructiveness, and medication non-compliance. We conclude that it is possible to assess risk with measures that are available from shelter and medical records, and call for more research on the role of medication non-compliance in safety decisions and for longitudinal research to validate risk assessments.

Social network transactions of psychiatric patients

In this research we examine self-reported social network transactions of former psychiatric inpatients residing in different types of housing in the community. Unlike earlier research, we found considerable reciprocity in network transactions with family and friends. Only professionals provided more support than they received from patients. Providing emotional support to others was positively correlated with positive affect, community integration, and mastery. Respondents reported more supportive than unsupportive transactions with network members and more supportive transactions with friends than with family or professionals. Finally, residents of supportive apartments and group homes provided and received support more frequently than residents of board-and-care homes. We discuss the results in terms of their implications for policy and future research.