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Colton J, Misra R, Woznick E, Wiedermann R, Huh A. Reaching the Unreachable: Intensive Mobile Treatment, an Innovative Model of Community Mental Health Engagement and Treatment. Community Ment Health J 2024; 60:839-850. [PMID: 38485797 PMCID: PMC11169053 DOI: 10.1007/s10597-024-01243-0] [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] [Received: 09/14/2023] [Accepted: 01/26/2024] [Indexed: 06/13/2024]
Abstract
In this paper we introduce the Intensive Mobile Treatment (IMT) model, which arose from a 2016 New York City initiative to engage individuals who were "falling through the cracks" of the mental health, housing, and criminal justice systems. People who are referred to IMT often have extensive histories of trauma. They experience structural racism and discrimination within systems and thus can present as distrustful of treatment teams. We detail the structure of the program as we practice it at our non-profit agency and outline the psychodynamic concepts that inform our work with challenging populations. We acknowledge IMT's role in engaging in advocacy and addressing social justice in our work. We also discuss how through this model we are able to both mitigate and tolerate risk in participants with difficult-to-manage behaviors. This is typically a long-term, non-linear process. We address how this impacts the team dynamic as a whole and explain how with long-term, trusting therapeutic relationships, participants can change and grow over time. We also explain the ways in which our non-billing model plays an integral role in the treatment we are able to provide and identify several challenges and areas for program growth. In outlining our model and its methodology, we hope to empower other practitioners to adapt IMT to other settings beyond the New York City area.
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Affiliation(s)
- Jana Colton
- Center for Urban Community Services, 1789 Madison Avenue, New York, NY, 10035, USA.
| | - Roshni Misra
- Center for Urban Community Services, 1789 Madison Avenue, New York, NY, 10035, USA
| | - Elise Woznick
- Center for Urban Community Services, 1789 Madison Avenue, New York, NY, 10035, USA
| | - Rachel Wiedermann
- Center for Urban Community Services, 1789 Madison Avenue, New York, NY, 10035, USA
| | - Anna Huh
- Center for Urban Community Services, 1789 Madison Avenue, New York, NY, 10035, USA
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Henriques-Calado J, Gama Marques J. Homeless people: a review of personality disorders. Front Psychiatry 2024; 15:1362723. [PMID: 38779545 PMCID: PMC11110170 DOI: 10.3389/fpsyt.2024.1362723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Personality disorders in homeless people pose a challenge to the medical community and society, requiring specialized approaches for these super-difficult patients. The prevalence of personality disorders is higher in homeless populations than in the general population. However, there is a knowledge gap regarding personality disorders among people experiencing homelessness, and the implications of this lack of recognition are substantial. This paper provides a brief narrative review of personality disorders among homeless individuals. The primary importance and specificity of these disorders in this population remain unexplored. We searched PubMed and Web of Science databases in February and November 2023 using the keywords 'homeless' and 'personality disorder', and selected fifty-eight studies to be included in this literature review. The main themes of the results were personality disorders in homeless individuals and comorbid psychiatric disorders; risk factors and other psychological and behavioral data; clinical and intervention outcomes; and challenges linked to assessment, treatment, and intervention. The homeless population experiences significant diagnostic variability and the diagnosis of personality disorders is still evolving, contributing to difficulties in diagnosis, assessment, and treatment. A future challenge is to raise clinical awareness and optimize research knowledge, assessment, and intervention in personality disorders among homeless individuals with comorbid psychiatric disorders.
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Affiliation(s)
- Joana Henriques-Calado
- Centro de Investigação em Ciência Psicológica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - João Gama Marques
- Centro de Investigação em Ciência Psicológica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
- Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos (HJM), Unidade Local de Saúde São José (ULSSJ), Centro Clínico Académico de Lisboa (CCAL), Lisboa, Portugal
- Clínica Universitária de Psiquiatra e Psicologia Médica (CUPPM), Faculdade de Medicina, Universidade de Lisboa (FMUL), Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
- Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa), Santé Mentale et Exclusion Sociale (SMES) Europa, Lisboa, Portugal
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Abstract
BACKGROUND Homeless people present high rates of psychopathology, including personality disorders. Given the link between personality disorders and attachment, and the potential importance of these two traits for understanding homeless populations. AIMS Our aim was to review all studies focusing on attachment and on the full assessment of personality disorders in the homeless. METHOD Overall, 213 studies were screened through title and abstract. Of these, 63 articles were chosen for full-text assessment. RESULTS A total of 14 articles met eligibility criteria and were included in the present review. Six studies evaluated personality disorders and eight studies assessed attachment in the homeless. In general, reports suggested that personality disorders are highly common in the homeless, with frequencies ranging between 64% and 79% for any personality disorder. The most common personality diagnoses were paranoid (14%-74%), borderline (6%-62%), avoidant (14%-63%), and antisocial (4%-57%) personality disorders. Attachment reports differed in the methods used and presented diverse results and correlates. Even so, insecure types of attachment dominated in the homeless, accounting for 62% to 100% of the samples. CONCLUSIONS The high prevalence of personality disorders and insecure types of attachment in the homeless may impact intervention strategies for these people. The available literature evaluating attachment and the full assessment of personality disorders in the homeless is scarce, which supports the need for more research on these two topics.
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Affiliation(s)
- Andreia Neves Horácio
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - António Bento
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
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Ulysses Coercion Through Psychiatric Advanced Directives in Homeless People With Substance Use Disorder: A Qualitative Study of the Colombian Perspective. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW We report evidence on the negative psychological effects of pandemics in people with personality disorders (PDs) and on the role of personality pathology in compliance with mitigation-related behaviors. Considering the paucity of studies, after a description of the main features of PDs, on the basis of the current literature on pandemic and quarantine mental health impact, we trace some clinical hypotheses. RECENT FINDINGS Paranoid traits and detachment (cluster A) might lead to worse psychological outcomes. Cluster B patients may show more intense stress-related reactions and react strongly to social distancing, especially considering borderline personality disorder. Cluster C patients might be particularly prone to anxiety and stress due to fear of contagion and may be less flexible in adaptation to new routines. Evidence on compliance with mitigation measures is mixed, with lower compliance in cluster B patients and higher in cluster C ones. We suggest that PD patients might be particularly affected by pandemics. Furthermore, they might react differently, according to their main diagnosis. Similarly, compliance with mitigation measures may differ according to specific PDs. Our results should be considered as a starting point to reflect on therapeutic strategies to be adopted in the post-COVID-19 situation.
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Affiliation(s)
- Emanuele Preti
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.
| | - Rossella Di Pierro
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Erika Fanti
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
- Department of Adult Psychiatry, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France
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Ruiz MA, Dorritie MT. Clinical Utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in a Residential Treatment Program for Homeless Individuals. Assessment 2020; 28:353-366. [PMID: 31955592 DOI: 10.1177/1073191119899481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current study examined the clinical utility of the Restructured Form of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2-RF) in a residential treatment program for homeless individuals. MMPI-2-RF scale scores from 146 participants with valid profiles were correlated with variables obtained at intake and during treatment. The sample was then followed 12 months postdischarge to test preregistered hypotheses regarding MMPI-2-RF predictors of hospital readmissions. The results indicated that a variety of MMPI-2-RF scale scores were correlated with historical and diagnostic variables at intake and with measures of treatment outcome, including behavioral problems and successful outcome. A broad range of MMPI-2-RF scale scores were related to readmissions postdischarge and many of these relationships remained significant when tested in Poisson regression models containing other predictors. However, the postdischarge findings were generally inconsistent with our predictions and were of small effect size. The clinical implications of MMPI-2-RF results for residential treatment programs are discussed.
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Affiliation(s)
- Mark A Ruiz
- James A. Haley Veterans' Hospital and Clinics, Tampa, FL, USA
| | - Mary T Dorritie
- James A. Haley Veterans' Hospital and Clinics, Tampa, FL, USA
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Nicholls TL, Crocker AG, Seto MC, Wilson CM, Charette Y, Côté G. The national trajectory project of individuals found not criminally responsible on account of mental disorder. Part 5: how essential are gender-specific forensic psychiatric services? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:135-45. [PMID: 25886689 PMCID: PMC4394713 DOI: 10.1177/070674371506000308] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 10/01/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To state the sociodemographic characteristics, mental health histories, index offence characteristics, and criminal histories of male and female forensic psychiatric patients. Clinicians and researchers advocate that mental health and criminal justice organizations implement gender-specific services; however, few studies have sampled forensic patients to evaluate the extent to which men's and women's treatment and management needs are different. METHOD Data were collected from Review Board files from May 2000 to April 2005 in the 3 largest Canadian provinces. Using official criminal records, participants were followed for 3 to 8 years, until December 2008. The final sample comprised 1800 individuals: 15.6% were women and 84.4% were men. RESULTS There were few demographic differences, but women had higher psychosocial functioning than men. Both men and women had extensive mental health histories; women were more likely diagnosed with mood disorders and PDs and men were more likely diagnosed with schizophrenia spectrum disorders and SUDs. The nature of the index offence did not differ by gender, except women were more likely to have perpetrated murders and attempted murders. For offences against a person, women were more likely to offend against offspring and partners and less likely to offend against strangers, compared with men. Women had significantly less extensive criminal histories than men. CONCLUSIONS Not criminally responsible on account of mental disorder-accused women have a distinct psychosocial, clinical, and criminological profile from their male counterparts, which may suggest gender-specific assessment, risk management, and treatment in forensic services could benefit patients. The findings are also consistent with traditional models (Risk-Need-Responsivity) and ultimately demonstrate the importance of individual assessment and client-centred services.
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Affiliation(s)
- Tonia L Nicholls
- Associate Professor, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Senior Research Fellow, Forensic Psychiatric Services Commission, BC Mental Health & Substance Use Services, Coquitlam, British Columbia
| | - Anne G Crocker
- Associate Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Associate Director, Policy and Knowledge Exchange, Douglas Mental Health University Institute Research Centre, Montreal, Quebec
| | - Michael C Seto
- Director of Forensic Rehabilitation Research, Royal Ottawa Health Care Group, Brockville, Ontario
| | - Catherine M Wilson
- Post-doctoral Research Fellow, University of British Columbia and British Columbia Forensic Psychiatric Services Commission, BC Mental Health & Substance Use Services, Coquitlam, British Columbia
| | - Yanick Charette
- Post-doctoral Fellow, Department of Sociology, Yale University, New Haven, Connecticut
| | - Gilles Côté
- Professor, Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec; Director, Philippe-Pinel Institute Research Centre, Montreal, Quebec
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