HIV infection risks among homeless, mentally ill, chemical misusing men

This study attempts to identify the specific role that each of three conditions afflicting homeless, mentally ill, chemically misusing (HMICM) men plays in exposing these men to the risk of HIV infection. Three hundred and fifteen HMICM men (33 of whom were HIV+) were interviewed on intravenous drug use (IVDU) and sex practices. Two scales of risky IVDU practices and sex conducts were constructed and analyzed in relation to HIV status. The severity of homelessness, mental illness, and chemical misuse, then, were analyzed as possible predictors of risky IVDU and sex practices. Strong correlations were found between IVDU practices and HIV seropositivity, and between risky sex conduct and HIV seropositivity. Serious depression was the strongest predictor of risky IVDU practices. Prolonged homelessness was the condition most associated with risky sexual conduct. This study concludes that HMICM men are at high risk for HIV infection, stemming, predominately, from two conditions: depression, leading to risky IVDU practices, and homelessness, leading to risky sex conduct with two separate types of risky behavior.     

Clinical and treatment correlates of access to Section 8 certificates for homeless mentally ill persons

OBJECTIVE: The study assessed how clients' housing preference and other variables were related to the acquisition of Section 8 certificates, facilitating independent living, for homeless persons with severe mental illness who were being served by an experimental assertive community treatment team. METHODS: For 77 clients, demographic and clinical differences between receivers and nonreceivers of certificates were examined, and correlates of time from referral to the team to completion of the Section 8 application were analyzed. Reasons clients did not receive certificates and housing outcomes were summarized in relation to client preference. RESULTS: The 34 clients who received certificates (44 percent) had significantly less psychopathology after three months than did nonreceivers and tended to have affective disorders rather than schizophrenia. Of the 43 nonreceivers, the two largest groups were 19 clients who did not want certificates and ten clients who wanted certificates but whom staff considered unable to live safely in an unsupervised apartment. The mean +/- SD length of time for application for a certificate was 5.7 +/- 5.8 months. Longer time to apply was significantly associated with having schizophrenia, having the team as a representative payee, and showing increased psychotic symptoms at referral and at three months. CONCLUSIONS: The study suggests that it is possible to honor the housing preferences of the majority of homeless persons with severe mental illness if adequate resources are provided. However, staff may view persons who have schizophrenia and more symptoms as needing more supervision than those clients prefer. Homeless mentally ill persons may also take longer than more symptomatic persons to pursue independent living through a Section 8 certificate.     

Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans

OBJECTIVES: The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans. METHODS: Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments. RESULTS: Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements. CONCLUSION: This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.     

Recruitment and retention of homeless mentally ill participants in research.

Are the unstable residential and personal lives of homeless mentally ill (HMI ) individuals so difficult as to preclude their inclusion in rigorous, longitudinal research protocols? The continued presence of HMI individuals in U.S. society has prompted the mental health research community to reconsider the question of whether clinical trial and demonstration research protocols are feasible with this population. This article briefly examines the existing research literature on recruitment and retention rates in recent studies of this population and, in more detail, the specific strategies used by researchers to recruit and retain HMI individuals as research participants. In general, with sufficient resources and the persistent use of existing strategies for recruitment and retention, HMI individuals can be successfully studied over time. Finally, to demonstrate this potential, the recruitment and retention strategies of the San Diego McKinney Homeless Mentally Ill Demonstration Research Program are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between victimization and cognitive schemata among episodically homeless, seriously mentally ill women

This study explored the extent to which specific aspects of violent victimization are associated with cognitive schemata in the context of ongoing, often lifelong, trauma and negative life events. Specifically, we examined the relationships between cognitive schemata (safety, self- and other esteem, intimacy, and trust) and three dimensions of physical and sexual assault histories (recentness, frequency, and variety) among 91 predominantly African American, episodically homeless, seriously mentally ill women. Findings indicated that even in the context of pervasive violence, more frequent, recent, and varied abuse was associated with more negative cognitive schemata. We discuss these findings in the context of research and practice with disenfranchised populations at high risk for violent victimization.     

The homeless assessment program: A service-training model for providing disability evaluations for homeless, mentally ill individuals.

Many of the nation's homeless people suffer from unrecognized mental illnesses and do not have access to the kind of disability benefits they would be entitled to when properly assessed. The current system of disability evaluations for Social Security income claims is frequently inadequate and leaves these individuals without any source of income, health insurance, and mental health treatment. This article introduces a model of providing psychological assessments for homeless, mentally ill individuals by supervised student examiners, a model that could be replicated by other psychologists and training institutions. The authors argue that there may be a large number of homeless adults who suffer from disabling mental conditions but who are not properly diagnosed and, therefore, do not qualify for benefits. The authors propose that the model presented can help to fill a gap in services and may serve as a model of socially relevant clinical training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of assertive community treatment on the social relationships of people who are homeless and mentally ill

Two randomized experiments compared the effectiveness of the assertive community treatment (ACT) team against other treatments (outpatient therapy, drop-in center, and brokered case management) in improving the social relationships of individuals who were both homeless and suffered from severe and persistent mental illness. In both studies clients assigned to ACT teams reported having more professionals in their social networks than clients assigned to the other treatments. Clients did not report significant differences between treatment conditions on most of the other social relationship dimensions. Further attention to developing social skills and network interventions within ACT teams are recommended.     

Mental health services for homeless mentally ill persons: Federal initiatives and current service trends.

Recent research suggests that approximately one third of the population of homeless single adults suffer from severe mental illnesses. Despite multiple health, mental health, and social welfare needs, this population is often unable to obtain necessary housing and community-based services. For this reason, since 1982, the National Institute of Mental Health (NIMH) has undertaken a number of federal initiatives to encourage research and assist states and localities in improving services focused on this vulnerable subgroup of the homeless population. This article describes the target population, NIMH research findings, and current mental health programs—with particular emphasis on two mental health programs established under the Stewart B. McKinney Homeless Assistance Act. Proposed future directions for federal research and evaluation efforts in this area are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-report and observer measures of substance abuse among homeless mentally ill persons in the cross-section and over time

The comparability of self-report and observer measures of substance abuse among 118 homeless mentally ill persons was assessed using cross-sectional and longitudinal measures. Possible correlates of nondisclosure were identified from demographic variables and clinical indicators. Lifetime abuse reported at baseline was a sensitive predictor of subsequent abuse behavior in the project, but cross-sectional measures based only on self-report or observer ratings failed to identify many abusers. A total of 17% of the subjects never disclosed abuse that was observed during the project. The level of substance abuse is likely to be severely underestimated among homeless mentally ill persons when only one self-report measure is used at just one point in time. This problem can, however, largely be-overcome by incorporating information from observers and from multiple follow-ups or by focusing on lifetime rather than current abuse. We also conclude that underreporting may bias estimates of some correlates of substance abuse.     

Issues of special concern to chronically mentally ill women.

Discusses sex differences with respect to the treatment of chronically mentally ill women and suggests that attention to these areas will aid understanding of their disorders and enhance the quality of their existence. The lives of chronically mentally ill women in relation to marital and family roles, other instrumental roles, social and sexual roles, rape and sexual exploitation, and physical health are described. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of housing programs to aid in the treatment of tuberculosis in homeless individuals: a pilot study

A long forehead disrupts the harmony among the facial components and may contribute to the semblance of facial aging. Slight forehead length disharmony on a senescent face can be corrected by placing the incision at the hairline, elevating the eyebrows through subcutaneous or subgaleal dissection, and removing excess skin without posterior scalp immobilization. For moderate to major reduction of the forehead length, the scalp is elevated back to the occipital region through a pretrichial incision, and relaxation incisions are made at a right angle to the vector of advancement. The entire scalp is then repositioned anteriorly, advancing the hairline caudally and shortening the forehead. Retraction of the scalp or excessive elevation of the eyebrows is prevented by anchoring the galeal fascia to the cranial bone using a bone-tunneling technique in one to three rows. The number of fixation rows is commensurate to the amount of advancement and rigidity of the scalp. The more immobile the scalp preoperatively, the more relaxation incisions and fixation tunnels are necessary. Following caudal repositioning of the scalp, the non-hair-bearing skin is excised, and a meticulous repair is done. These procedures have been performed in 180 patients with a high degree of satisfaction. Temporary hair loss was experienced in one smoker who underwent the most advancement through posterior scalp elevation and continued to smoke postoperatively. Also, on three patients in the subcutaneous forehead rhytidectomy group, two of whom were smokers, delayed healing was observed in the temple area because of compromised circulation requiring secondary revision.     

Drug abuse day treatment: a randomized clinical trial comparing day and residential treatment programs

Clients entering a therapeutic community (TC)-oriented drug treatment program were randomly assigned to day or residential conditions and interviewed at 2 weeks and 6 months after admission. Outcomes included Addiction Severity Index composite scores and summary scores for the Beck Depression Inventory, Symptom Checklist-90-R, and a social support scale. Only clients who remained in treatment for at least 2 weeks were included. The mean age of the sample (N = 261) was 32.9 (SD = 6.7 years) and the mean education level was 12.1 years (SD = 1.9 years); 30% were women. Comparison of outcome scores at 6 months between groups, while controlling for baseline values, indicated greater improvement for residential clients on social problems and psychiatric symptoms. The groups were similar on the 8 remaining outcomes, including measures of alcohol and drug problems. Overall, the level of improvement among day treatment clients was not significantly different from that of residential clients.     

An integrative ideology to guide community-based multidisciplinary care of severely mentally ill patients

Most practitioners working in community support settings understand the need to provide a comprehensive array of well-coordinated services to individuals with severe mental disabilities. However, a lack of consensus about the conceptual basis of mental health care, especially between advocates of psychosocial rehabilitation and psychiatric practitioners who favor a more medically oriented approach, has hindered efforts to optimize the effectiveness of the multidisciplinary teams found in most community support programs. The authors articulate 18 basic assumptions that have been helpful in their clinical practice in building an integrative ideology among professionals with disparate training and orientations. The assumptions attempt to balance the reality of psychiatric disorders with a fundamental interest in maintaining the autonomy and dignity of people with severe mental disorders.     

Building bridges: Psychologists and families of the mentally ill.

Describes problems faced by families of the mentally ill, particularly since the caregiving system in the US provides only incomplete solutions. Psychologists have provided important support to family members coping with seriously mentally ill relatives; however, psychology's response has been incomplete. Families have helped themselves in the initiation in 1979 of the National Alliance for the Mentally Ill (NAMI), an advocacy and education organization that originated as a network of mutual support groups. The history of communication between NAMI and the American Psychological Association (APA) is outlined. The need for "building bridges" between psychologists and families of the mentally ill resulted in 2 conferences between APA and NAMI. Other steps to enhance communication between psychologists and these families are listed, including communication with legislatures and the general public about public policy agendas on mental health services and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Labeling the mentally ill and the attribution of personal traits.

Data from 900 community college students indicate that labeling, including both the labels themselves and the labelers, has no significant independent effect on the attributes imputed to a labeled individual, although it may produce some effects in interaction with other variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes and feelings of criminal justice personnel toward the mentally ill

The present study compared the attitudes and feelings of law-enforcement, corrections, parole and probation personnel, and college students toward mental illness. Modified versions of the Criminally Insane Scale (Khanna, Pratt, & Gardiner, 1962) and Attitudes Toward Mental Illness Scale (Cohen & Struening, 1962) were used in assessing these attitudes. Law-enforcement and corrections personnel tended to believe many of the stereotypic causes of mental illness, while the college students based their views on more current thinking. In addition, law-enforcement and corrections personnel indicated greater fear of the criminally insane than the other two groups. Possible causes and ramifications of these differences are discussed.     

Task analysis training of case managers to assist seriously mentally ill patients find roommates and housing

This study examined the efficacy of task analysis training for case managers helping seriously mentally ill patients find roommates and housing. Behavioral objectives and task analysis were used to develop the task-oriented behavioral training program. Case managers were trained to use a checklist for every session with patients, which included the goal of the session, tasks required to accomplish that goal and lists of all the sub-tasks. The results of this study suggest that this methodology: (1) reduced the time required for patients to find roommates and housing; (2) increased the percentage of patients finding housing; and (3) decreased hospitalization rates occurring during the process of looking for roommates and housing.