Abstract
Objectives: The Vancouver At Home (VAH) Study is part of a multi-site Canadian program of research that seeks policy relevant evidence surrounding service interventions for adults who are homeless and mentally ill. This paper provides an overview of the local VAH study design, including demographic and mental health characteristics of the baseline sample. Participants: Eligible participants included those aged 19 years or older, with a serious mental illness and who lacked a regular, fixed shelter or whose primary residence was a single room occupancy, rooming house, or hotel/motel. Participants were randomly assigned to a housing intervention or treatment as usual, based upon level of need. Setting: Individuals were recruited for participation through referrals from a wide variety of agencies throughout Vancouver. Intervention: Participants with high needs were randomized to Housing First with Assertive Community Treatment, Congregate Housing with on-site supports or treatment as usual. Participants with moderate needs were randomized to Housing First with Intensive Case Management or treatment as usual. Outcomes: A majority of individuals in the high needs group presented with psychotic disorder and substance dependence problems while a substantial minority met criteria for major depression. Among the moderate needs group, just over half of the sample met criteria for major depression and substance dependence with one-third of the group meeting criteria for post-traumatic stress disorder. Conclusion: The characteristics of the sample provide insight into the breadth and differential patterns of mental health problems facing homeless individuals and speak to the need for interventions that meet the broad service needs of this vulnerable population.
Highlights
Homelessness has become a major health and social problem across Canada
As one would expect based upon the sample selection criteria, the High Needs (HN) group presents with high rates of psychotic disorder and substance dependence where the most common drugs used were marijuana (47 percent) and crack cocaine (33 percent)
The study’s randomized trial design is the gold standard approach for evaluation of service provider interventions and provides a powerful opportunity to assess a broad range of outcomes. While this analysis does not address co-occurring problems, the rates of substance dependence in the HN and Moderate Needs (MN) groups indicate that co-occurring mental health and substance use problems are prevalent
Summary
Over the past 30 years, a steady increase in the rate of homelessness has been documented [1,2] This increase has been accompanied by a more diverse homeless population, including a large and rapidly rising number of women, families, youth, and aboriginal individuals [2,3,4,5]. In Vancouver, the overlap between homelessness, mental illness, and substance use has become a civic crisis. Between 2005 and 2008, the Metro Vancouver Homeless Count found that 1,017 people had been homeless for a year or more in 2008, compared with 628 people in 2005 [8] This finding represents a 62 percent increase in the number of people who have been homeless for a long period of time. Self-reported rates of mental illness and addictions increased substantially [8]
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