Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site

Mejía-Lancheros, Cília; Lachaud, James; Aubry, Tim; Wiens, Kathryn; O’Campo, Patricia; Stergiopoulos, Vicky; Hwang, Stephen W.

doi:10.1007/s00127-021-02093-x

Cited by 7 publications

(5 citation statements)

References 76 publications

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“…Spatial analyses of crime and disorder were conducted in the immediate vicinity of OPCs and comparison sites and, to assess possible spillover effects, in the wider neighborhoods surrounding these sites. Following the methods of prior studies with a similar objective, 27 , 28 , 29 we divided the city into discrete areas by overlaying a block-level map of NYC with a tessellated hexagonal array, centering the hexagons to demarcate areas around OPCs and comparison sites. Hexagons were used because they can be tessellated without geographic omission or the need for alteration and have the least internal variation in their radii.…”

Section: Methodsmentioning

confidence: 99%

Overdose Prevention Centers, Crime, and Disorder in New York City

Chalfin,

del Pozo,

Mitre-Becerril

2023

JAMA Netw Open

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ImportanceThe first government-sanctioned overdose prevention centers (OPCs) in the US opened in New York City (NYC) in November 2021 amid concerns that they may increase crime and disorder, representing a significant political challenge to OPCs.ObjectiveTo identify whether opening the first 2 government-sanctioned OPCs in the US was associated with changes in crime and disorder.Design, Setting, and ParticipantsIn this cohort study, difference-in-differences Poisson regression models were used to compare crime, residents’ requests for assistance for emergencies and nuisance complaints, and police enforcement in the vicinity of NYC’s 2 OPCs with those around 17 other syringe service programs that did not offer overdose prevention services from January 1, 2019, through December 31, 2022.Main Outcomes and MeasuresChanges in the volume of crimes reported by the public or observed by police; arrests for drug possession and weapons; 911 calls and 311 calls regarding crime, public nuisances, and medical events; and summonses issued by police for criminal infractions in both the immediate vicinity of the sites (ie, a hexagonal area spanning about 6 city blocks) and their wider neighborhoods (ie, a tesselated 3-hexagon array spanning about 18 city blocks).ResultsNo significant changes were detected in violent crimes or property crimes recorded by police, 911 calls for crime or medical incidents, or 311 calls regarding drug use or unsanitary conditions observed in the vicinity of the OPCs. There was a significant decline in low-level drug enforcement, as reflected by a reduction in arrests for drug possession near the OPCs of 82.7% (95% CI, −89.9% to −70.4%) and a reduction in their broader neighborhoods of 74.5% (95% CI, −87.0% to −50.0%). Significant declines in criminal court summonses issued in the immediate vicinity by 87.9% (95% CI, −91.9% to −81.9%) and in the neighborhoods around the OPCs by 59.7% (95% CI, −73.8% to −38.0%) were observed. Reductions in enforcement were consistent with the city government’s support for the 2 OPCs, which may have resulted in a desire not to deter clients from using the sites by fear of arrest for drug possession.Conclusions and RelevanceIn this difference-in-differences cohort study, the first 2 government-sanctioned OPCs in the US were not associated with significant changes in measures of crime or disorder. These observations suggest the expansion of OPCs can be managed without negative crime or disorder outcomes.

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Section: Methodsmentioning

confidence: 99%

Overdose Prevention Centers, Crime, and Disorder in New York City

Chalfin,

del Pozo,

Mitre-Becerril

2023

JAMA Netw Open

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“…Our previous systematic review of social interventions for people with SMI ( 10 ) suggested that the supported accommodation MoC can support consumers' social inclusion. This review also provided some evidence that it could improve personal recovery outcomes such as hope and subjective wellbeing ( 74 , 79 ). The studies in the goal-focused and the social and community connection-focused MoCs reported encouraging improvement in some functional and personal recovery outcomes, but we found only limited evidence for the vocational support MoC in improving clinical, personal, or functional recovery ( 80 , 83 , 86 , 87 ).…”

Section: Narrative Synthesismentioning

confidence: 99%

Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis

Harvey,

Zirnsak,

Brasier

et al. 2023

Front. Psychiatry

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ObjectiveThis study aims to assess the effectiveness of community-based models of care (MoCs) supporting the recovery of individuals who experience persistent and complex mental health needs.MethodWe conducted a systematic review and narrative synthesis of MoC studies reporting clinical, functional, or personal recovery from October 2016 to October 2021. Sources were Medline, EMBASE, PsycInfo, CINAHL, and Cochrane databases. Studies were grouped according to MoC features. The narrative synthesis was led by our researchers with lived experience.ResultsBeneficial MoCs ranged from well-established to novel and updated models and those explicitly addressing recovery goals and incorporating peer support: goal-focused; integrated community treatment; intensive case management; partners in recovery care coordination; rehabilitation and recovery-focused; social and community connection-focused; supported accommodation; and vocational support. None of our diverse group of MoCs supporting recovery warranted a rating of best practice. Established MoCs, such as intensive case management, are promising practices regarding clinical and functional recovery, with potential for enhancements to support personal recovery. Emerging practice models that support personal and functional recovery are those where consumer goals and priorities are central.ConclusionEvidence for established models of care shows that there is a need for inevitable evolution and adaptation. Considering the high importance of effective MoCs for people experiencing persistent and complex mental health needs, further attention to service innovation and research is required. Greater emphasis on the inclusion of lived and living experience in the design, delivery, implementation, and research of MoCs is needed, to enhance MOCs' relevance for achieving individual consumer recovery outcomes.

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“…An umbrella review of the literature on the prevalence of mental health disorders among PEH found a high prevalence of depressive disorders, substance use disorders, stress disorders, and bipolar and mood disorders among adults who were homeless (Hossain et al, 2020). In a study of the association between mental health disorders and well-being, a higher number of mental comorbidities, a higher severity of mental health symptoms, or having alcohol and substance use disorders, were associated with lower well-being profiles (Mejia-Lancheros et al, 2021). Homelessness, early life poverty, mental illness, and substance use were linked with a lower physical and emotional health status and decreased well-being (Fazel et al, 2014).…”

Section: Literature Reviewmentioning

confidence: 99%

Coping With Stressors and General Resistance Resources Used by Individuals Experiencing Homelessness in Minneapolis Tent Camps

Aagard,

Keeler

2023

IJOH

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Homelessness remains a significant public health issue across the United States, particularly in urban areas. Individuals become and remain homeless for multifaceted and complex reasons that are linked to well-being. The aim of this study was to understand the well-being of persons experiencing homelessness (PEH) and living in tent camps using Aaron Antonovsky’s salutogenic model of health (SMH). To address well-being, we conducted a basic qualitative study with thirty adults over age 18 who self-identified as homeless and living in tent camps within the city of Minneapolis. With a semi-structured interview guide that centered on the SMH, we analyzed data using Johnny Saldaña’s qualitative coding method. Sources of stress themes, including (1) “family trauma” (depression/trauma related to the death of a loved one and drugs, imprisonment, and abuse), (2) “mental health” (depression/trauma related to the death of a loved one, loneliness living in tent camps, substance use, mental illness), and (3) “change and threats” (constant fear of aggression, lack of stability of the tent camp, bad people causing problems, cliques in the camp). Themes of general resistance (GRRs) resources (coping with stress), or GRRs emerged, including (1) “systems knowledge,” (2) “coping strategies,” (3) “sense of community,” (4) “camp stability,” and (5) “human dignity” emerged during data collection and analysis. These findings can inform policy decisions related to increasing services to exit homelessness, funding for sustainable tent camps, and sweeps of tent camps in the city of Minneapolis and beyond.

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Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site

Cited by 7 publications

References 76 publications

Overdose Prevention Centers, Crime, and Disorder in New York City

Overdose Prevention Centers, Crime, and Disorder in New York City

Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis

Coping With Stressors and General Resistance Resources Used by Individuals Experiencing Homelessness in Minneapolis Tent Camps

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