When homeless people with mental illness, are given a place to live without any preconditions like sobriety or seeing a psychiatrist coupled with intensive case management are shown to have lesser alcohol associated problems, says a new study. On this note, a program known as 'Housing First' was initiated in the US.
These interventions also improve housing stability and community functioning for this population, said lead author Dr. Vicky Stergiopoulos, psychiatrist-in-chief at St. Michael's Hospital.
In a study published in the online journal PLOS ONE
, Dr. Stergiopoulos followed 378 homeless people with mental illness in Toronto, Canada's largest and most diverse urban center, for 24 months. Half were randomized into a Housing First program with intensive case management while the other half received treatment as usual.
There was a significant 53% drop in the number of days spent experiencing alcohol-related problems among the Housing First group compared with the treatment-as-usual group. At the start of the study, participants in the Housing First group on average experienced alcohol problems on 4.3 out of 30 days. By the end of the study, this number decreased to 1.7 days. In comparison, the treatment-as-usual group experienced alcohol problems on 3.4 out of 30 days at the start of the study start, which decreased to 2.9 days by the end.
In addition, the amount of money they spent on alcohol in the previous 30 days dropped significantly. The severity of substance use fell by 28% after 12 months for Housing First compared to treatment-as-usual participants, but wasn't statistically significant at 24 months.
Although the number of Emergency Department visits and days spent in hospital did not differ significantly between the two groups, fewer Housing First participants reported one or more hospitalizations over the 24 months (70% vs. 81%).
The study participants were primarily men in the 40s. The most common mental health diagnoses were substance dependence or abuse (46%), major depression (45%), alcohol dependence of abuse (40%), post-traumatic stress disorder (29%) and psychotic disorder (26%).
"Housing First' is an approach to ending homelessness developed in the United States that centers on quickly moving people experiencing homelessness into independent and permanent housing and then providing additional supports and services as needed. The underlying principle is that people are better able to move forward with their lives if they are first housed."