WEDNESDAY, Jan. 19, 2022 (HealthDay News) — Homelessness is hard enough, but when exacerbated by serious mental health issues, the result can be an inability to function even at the most basic level.
This sometimes leads to involuntary hospitalizations around the clock, and when this occurs, a state-appointed psychiatrist can take over critical health care decisions for a person considered mentally unstable.
But new research out of California warns that once a reserve is established, there is a very real risk that a homeless individual could end up in a psychiatric hospital for weeks or months – far beyond what is needed and much longer than the inpatient care provided. for patients. who are not homeless.
The bottom line, according to lead researcher Kristen Choi, is that “our mental health care systems fall short of meeting the needs of homeless individuals at every level.” She is an assistant professor in the Schools of Nursing and Public Health at the University of California, Los Angeles (UCLA).
Taxpayers are also paying a heavy price: Choi’s team estimates it costs $767 a day (nearly $280,000 annually) to care for a homeless person in a California psychiatric ward, compared to less than $14,000 to provide them with housing throughout the year. Most patients in the study were uninsured.
Option of last resort
In their research, the UCLA team tracked the progress of nearly 800 Los Angeles residents, ages 18 to 56, who were forcibly hospitalized within a nonprofit psychiatric facility “safety net” at some point. between 2016 and 2018.
Slightly more than half of the patients did You have a residence and you did not end up placing it in guardianship. Choi’s team found that in these cases, if they are hospitalized, it is usually for less than two weeks.
But nearly half of those admitted to psychiatric care were homeless. According to the report, among this group, one in seven has been placed under mental health guardianship.
Once this step was taken, Choi said, these patients often experienced “extremely long hospital stays,” averaging around five months, although some have gone longer.
She added that maintaining mental health was a “strict legal process”. In California, Choi explained, this is a very restrictive, time-limited type of last resort option in order to protect mentally handicapped patients who have “exhausted all other treatment options.”
“The mental health portfolio is for individuals who have ‘serious disabilities’ due to serious mental illnesses, such as schizophrenia, bipolar disorder, or other mental health disorders,” she said. If these patients are unable to feed, dress or house themselves, these patients may be considered to need a guardian who can intervene to make mental health treatment decisions.
(As such, this arrangement is not to be confused with the much-publicized Britney Spears case, which was her preservation of finances/diversity of wills; and the pop star has never lost the ability to make her own health care decisions.)
Once patients are stable enough, mental health maintenance operations are supposed to end, with patients switching from an involuntary psychiatric hospital setting to a voluntary community-based care model instead.
But housing is crucial to this transformation.
“It is difficult, if not impossible, to stabilize the mental illness of individuals whose basic needs, including housing, are not being met,” Choi explained.
Even if psychological stability is achieved, she added, all patients face “a very long family waiting list with low levels of care, such as psychotherapy facilities, psychiatric rehabilitation facilities, and group homes.”
Choi noted that this means custodial patients “have no choice but to wait in hospital” after stabilization, sometimes for weeks or months.
Too few options
This waiting ends up being a particularly heavy burden for homeless patients, given that 14% of the homeless patients in the study were placed on guard compared to only 3% of housing patients.
Overall, although homeless people’s admissions to psychiatric care under guardianship made up only 6% of all patients in the study, they ended up accounting for more than 40% of the total time spent in hospital during the study period, the researchers found.
None of this is useful to anyone, said Choi. But she believes that “hospitals have few options” when it comes to dealing with such patients, because there has been very little progress in improving access to housing or community mental health services.
“It is important to note that the vast majority of people who experience homelessness do not have a mental illness,” Choi stressed. “Homelessness is ultimately a problem of lack of housing, not lack of mental health care, and we must be careful not to confuse homelessness with mental illness.”
But she believes that “Wills are not appropriate or humane for the majority of mentally ill people,” homeless or otherwise.
Hoping to address the situation in Los Angeles, Choi said she and her colleagues connect street homeless outreach teams — such as the Los Angeles Homeless Outreach Program and Mobile Engagement (HOME) — with inpatient psychiatric services at facilities like Gateways Hospital and the Mental Health Center.
Housing and health care
Of course, the problem is not limited to California. Alleviating mental illness among the homeless is an uphill battle everywhere, according to child and adolescent psychiatrist Dr. Nicole Kozloff.
“The lack of stable housing makes managing a serious mental illness an almost impossible task,” said Kozloff, co-director of the Slate Family Center for Youth in Transition at the Campbell Institute for Mental Health Research in Toronto.
In an ideal world, Kozlov said, mental health treatment would include psychotherapy appointments, daily medication regimens, blood tests, and physicals. But life on the streets is far from an ideal world.
“It’s very difficult to maintain this routine if you have to prioritize your basic needs, you don’t have a special place to store your belongings, (and) you can’t afford transportation,” Kozloff said. Furthermore, the stress of homelessness can exacerbate existing mental health problems.
Kosloff agreed with Choi that the solutions lie in improving access to affordable permanent housing, along with the broader availability of “mental health support geared to a person’s needs and choices.”
Choi’s team recently published their findings in the online version of Psychiatric services.
There’s more about counties in the Family Caregiver Alliance.
Sources: Christine R. Choi, PhD, RN, Assistant Professor, School of Nursing and UCLA Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles; Nicole Kosloff, Child and Adolescent Psychiatrist, Clinical Scientist, and Associate Director, Slaight Family Center for Youth in Transition in the Emerging Children, Youth, and Adult Program, Campbell Institute for Family Mental Health Research, Toronto, Ontario, Canada; Psychiatric servicesOctober 2021
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