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Mental illness among 500 people living homeless and referred for psychiatric evaluation in Lisbon, Portugal

Published online by Cambridge University Press:  25 May 2021

Ana Monteiro Fernandes ,
João Gama Marques Open the ORCID record for João Gama Marques [Opens in a new window] ,
António Bento  and
Diogo Telles-Correia
Ana Monteiro Fernandes
Affiliation:
Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
João Gama Marques*
Affiliation:
Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
António Bento
Affiliation:
Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
Diogo Telles-Correia
Affiliation:
Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal Serviço de Psiquiatria e Saúde Mental, Departamento de Neurociências e Saúde Mental, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
*
* Author for correspondence: João Gama Marques Email: [email protected]
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Abstract

Background

Our goal was to identify the demographic profile of the people living homeless with mental illness in Lisboa, Portugal, and their relationship with the national healthcare system. We also tried to understand which factors contribute to the number and duration of psychiatric admissions among these homeless people.

Methods

We used a cross-sectional design, collecting data for 4 years among homeless people, in Lisboa, Portugal, that were referred as possible psychiatric patients to Centro Hospitalar Psiquiátrico de Lisboa (CHPL). In total, we collected data from 500 homeless people, then cross-checked these people in our CHPL hospital electronic database and obtained 467 patient matches.

Results

The most common psychiatric diagnosis in our sample was drug abuse (34%), followed by alcohol abuse (33%), personality disorder (24%), and acute stress reaction (23%). Sixty-two percent of our patients had multiple diagnoses, a subgroup with longer follow-ups, more psychiatric hospitalizations, and longer psychiatric hospitalizations. The prevalence of psychotic disorders was high: organic psychosis (17%), schizophrenia (15%), psychosis not otherwise specified (14%), and schizoaffective disorder (11%), that combined altogether were present in more than half (57%) of our homeless patients.

Conclusion

The people living homeless with multiple diagnoses have higher mental health needs and worse determinants of general health. An ongoing effort is needed to identify and address this subgroup of homeless people with mental illness to improve their treatment and outcomes.

Keywords

Homelessmental illnesspsychosisschizophreniaschizoaffectiveorganic psychosis
Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 6 , December 2022 , pp. 699 - 708
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Fazel, S, Khosla, V, Doll, H, Geddes, J. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med. 2008;5(12):e225. doi:10.1371/journal.pmed.0050225.CrossRefGoogle ScholarPubMed
Hossain, MM, Sultana, A, Tasnim, S, et al. Prevalence of mental disorders among people who are homeless: an umbrella review. Int J Soc Psychiatry. 2020;66(6):528–541. doi:10.1177/0020764020924689.CrossRefGoogle ScholarPubMed
FEANTSA. ETHOS—European Typology of Homelessness and housing exclusion. https://www.feantsa.org/download/ethos2484215748748239888.pdf2005. 2005. Accessed October 2020.Google Scholar
Fazel, S, Geddes, JR, Kushel, M, et al. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014;384(9953):1529–1540. doi:10.1016/S0140-6736(14)61132-6.CrossRefGoogle ScholarPubMed
Baggett, TP, Hwang, SW, O’Connell, JJ, et al. Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Intern Med. 2013;173(3):189–195. doi:10.1001/jamainternmed.2013.1604.CrossRefGoogle Scholar
Ventriglio, A, Mari, M, Bellomo, A, et al. Homelessness and mental health: a challenge. Int J Soc Psychiatry. 2015;61(7):621–622. doi:10.1177/0020764015585680.CrossRefGoogle ScholarPubMed
Nielsen, SF, Hjorthøj, CR, Erlangsen, A, et al. Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study. Lancet. 2011;377(9784):2205–2214. doi:10.1016/S0140-6736(11)60747-2.CrossRefGoogle Scholar
Dunne, E, Duggan, M, O’Mahony, J. Mental health services for homeless: patient profile and factors associated with suicide and homicide. Ir Med J. 2012;105(3):71–72, 74.Google ScholarPubMed
Edidin, JP, Ganim, Z, Hunter, SJ, et al. The mental and physical health of homeless youth: a literature review. Child Psychiatry Hum Dev. 2012;43(3):354–375. doi:10.1007/s10578-011-0270-1.CrossRefGoogle ScholarPubMed
Schreiter, S, Bermpohl, F, Krausz, M, et al. The prevalence of mental illness in homeless people in Germany. Dtsch Arztebl Int. 2017;114(40):665–672. doi:10.3238/arztebl.2017.0665.Google ScholarPubMed
Desai, RA, Liu-Mares, W, Dausey, DJ, et al. Suicidal ideation and suicide attempts in a sample of homeless people with mental illness. J Nerv Ment Dis. 2003;191(6):365–371. doi:10.1097/01.NMD.0000071584.88965.E1.CrossRefGoogle Scholar
Bauer, LK, Baggett, TP, Stern, TA, et al. Caring for homeless persons with serious mental illness in general hospitals. Psychosomatics. 2013;54(1):14–21. doi:10.1016/j.psym.2012.10.004.CrossRefGoogle ScholarPubMed
Folsom, DP, Hawthorne, W, Lindamer, L, et al. Prevalence and risk factors for homelessness and utilization of mental health services among 10 340 patients with serious mental illness in a large public mental health system. Am J Psychiatry. 2005;162(2):370–376. doi:10.1176/appi.ajp.162.2.370.CrossRefGoogle Scholar
Philippot, P, Lecocq, C, Sempoux, F, et al. Psychological research on homelessness in Western Europe: a review from 1970 to 2001. J Soc Issues. 2007;63:483–504.CrossRefGoogle Scholar
Shelton, KH, Taylor, PJ, Bonner, A, et al. Risk factors for homelessness: evidence from a population-based study. Psychiatr Serv. 2009;60(4):465–472. doi:10.1176/appi.ps.60.4.465.CrossRefGoogle ScholarPubMed
Nilsson, SF, Nordentoft, M, Hjorthøj, C. Individual-level predictors for becoming homeless and exiting homelessness: a systematic review and meta-analysis. J Urban Health. 2019;96(5):741–750. doi:10.1007/s11524-019-00377-x.CrossRefGoogle ScholarPubMed
Foster, A, Gable, J, Buckley, J. Homelessness in schizophrenia. Psychiatr Clin North Am. 2012;35(3):717–734. doi:10.1016/j.psc.2012.06.010.CrossRefGoogle ScholarPubMed
Winkleby, MA, White, R. Homeless adults without apparent medical and psychiatric impairment: onset of morbidity over time. Hosp Community Psychiatry. 1992;43(10):1017–1023. doi:10.1176/ps.43.10.1017.Google ScholarPubMed
Muñoz, M, Vázquez, C, Koegel, P, et al. Differential patterns of mental disorders among the homeless in Madrid (Spain) and Los Angeles (USA). Soc Psychiatry Psychiatr Epidemiol. 1998;33(10):514–520. doi:10.1007/s001270050088.Google ScholarPubMed
Leach, J. Providing for the destitute. In: Wing, JK, Olsen, R, eds. Community Care of the Mentally Disabled. New York: Oxford University Press; 1979:90–105.Google Scholar
Bhugra, D. Homelessness and Mental Health. Cambridge: Cambridge University Press; 1996 CrossRefGoogle Scholar
Arce, AA, Vergare, MJ. Identifying and characterising the mentally ill among the homeless. In: Lamb, HR, ed. The Homeless Mentally Ill. Washington, DC: American Psychiatric Association; 1984:75–90.Google Scholar
Kuhn, R, Culhane, DP. Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data. Am J Community Psychol. 1998;26(2):207–232. doi:10.1023/a:1022176402357.CrossRefGoogle Scholar
Schütz, C, Choi, F, Jae Song, M, et al. Living with dual diagnosis and homelessness: marginalized within a marginalized group. J Dual Diagn. 2019;15(2):88–94. doi:10.1080/15504263.2019.1579948.CrossRefGoogle ScholarPubMed
Fischer, PJ, Breakey, WR. The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol. 1991;46(11):1115–1128. doi:10.1037//0003-066x.46.11.1115.CrossRefGoogle ScholarPubMed
Salhi, BA, White, MH, Pitts, SR, et al. Homelessness and emergency medicine: a review of the literature. Acad Emerg Med. 2018;25(5):577–593. doi:10.1111/acem.13358.CrossRefGoogle ScholarPubMed
Kaduszkiewicz, H, Bochon, B, van den Bussche, H, et al. The medical treatment of homeless people. Dtsch Arztebl Int. 2017;114(40):673–679. doi:10.3238/arztebl.2017.0673.Google ScholarPubMed
Bonin, JP, Fournier, L, Blais, R, et al. Health and mental health care utilization by clients of resources for homeless persons in Quebec city and Montreal, Canada: a 5-year follow-up study. J Behav Health Serv Res. 2010;37(1):95–110. doi:10.1007/s11414-009-9184-0.CrossRefGoogle Scholar
North, CR. Access to psychiatric services for homeless mentally ill people. Br J Nurs. 1994;3(9):446–449.CrossRefGoogle ScholarPubMed
Padgett, DK. Homelessness, housing instability and mental health: making the connections. BJPsych Bull. 2020;44(5):197–201. doi:10.1192/bjb.2020.49.CrossRefGoogle ScholarPubMed
O’Neill, A, Casey, P, Minton, R. The homeless mentally ill—an audit from an inner city hospital. Ir J Psychol Med. 2007;24(2):62–66. doi:10.1017/S0790966700010259.CrossRefGoogle Scholar
Tulloch, AD, Khondoker, MR, Fearon, P, et al. Associations of homelessness and residential mobility with length of stay after acute psychiatric admission. BMC Psychiatry. 2012;12:121. doi:10.1186/1471-244X-12-121.CrossRefGoogle ScholarPubMed
Salit, SA, Kuhn, EM, Hartz, AJ, et al. Hospitalization costs associated with homelessness in New York City. N Engl J Med. 1998;338(24):1734–1740. doi:10.1056/NEJM199806113382406.CrossRefGoogle ScholarPubMed
Cebola, L. Psiquiatria Social. Lisboa: Livraria Central; 1931 Google Scholar
FEANTSA (2017). Homelessness in Portugal (FEANTSA) Country Fiche, Issue. https://www.feantsa.org/download/portugal-20178706366150042850260.pdf. 2017. Accessed October 2020.Google Scholar
Rede Social de Lisboa. II Diagnóstico Social de Lisboa, 2015–2016. https://www.am-lisboa.pt/documentos/1518709936A8sST5fr2Qg86FJ5.pdf. 2017. Accessed October 2020.Google Scholar
Cruz, AM, Bento, A, Barreto, E. Sem-Amor Sem-Abrigo: A Propósito de 1000 Casos. Cidade Solidária Revista da Santa Casa da Misericórdia de Lisboa. 2002;9:86–93.Google Scholar
Carnot, MJ, Gama Marques, J. “Difficult patients”: a perspective from the tertiary mental health services. Acta Médica Portuguesa. 2018;31(7–8):370–372.CrossRefGoogle ScholarPubMed
Barreto, E, Bento, A, Luigi, L, et al. Dignity and Well-Being: Practical Approaches to Working with Homeless People with Mental Health Problems. Lisboa: European Union; 2019 Google Scholar
Gama Marques, J. Pharmacogenetic testing for the guidance of psychiatric treatment of a schizoaffective patient with haltlose personality disorder. CNS Spectr. 2019;24(2):227–228. doi:10.1017/S1092852917000669.CrossRefGoogle Scholar
Gama Marques, J, Bento, A. Marontology: comorbidities of homeless people living with schizophrenia. Acta Med Port. 2020;33(4):292. doi:10.20344/amp.13561.CrossRefGoogle ScholarPubMed
Aldridge, RW, Story, A, Hwang, SW, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet. 2018;391(10117):241–250. doi:10.1016/S0140-6736(17)31869-X.CrossRefGoogle ScholarPubMed
World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision. 2nd ed. Malta: World Health Organization; 2004 Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000 Google Scholar
Reis Oliveira, C, Gomes, N. Indicadores de Integração de Imigrantes: Relatório Estatístico Anual 2019. https://www.om.acm.gov.pt/documents/58428/383402/Indicadores+de+Integra%C3%A7%C3%A3o+de+Imigrantes.+Relat%C3%B3rio+Estat%C3%ADstico+Anual+2019/98bf34e6-f53f-41b9-add6-cdb4fc343b34. 2019. Accessed October 2020.Google Scholar
Laporte, A, Vandentorren, S, Détrez, MA, et al. Prevalence of mental disorders and addictions among homeless people in the Greater Paris area, France. Int J Environ Res Public Health. 2018;15(2):241. doi:10.3390/ijerph15020241.CrossRefGoogle ScholarPubMed
Fekadu, A, Hanlon, C, Gebre-Eyesus, E, et al. Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia. BMC Med. 2014;12:138. doi:10.1186/s12916-014-0138-x.CrossRefGoogle ScholarPubMed
Yim, LC, Leung, HC, Chan, WC, et al. Prevalence of mental illness among homeless people in Hong Kong. PLoS One. 2015;10(10):e0140940. doi:10.1371/journal.pone.0140940.CrossRefGoogle ScholarPubMed
Gama Marques, J, Bento, A. Schizophrenia: the great imitated (by many great imitators and small imitators). J Clin Neurosci. 2020;80:79. doi:10.1016/j.jocn.2020.08.002.CrossRefGoogle ScholarPubMed
Gama Marques, J. Organic psychosis causing secondary schizophrenia in one-fourth of a cohort of 200 patients previously diagnosed with primary schizophrenia. Prim Care Companion CNS Disord. 2020;22(2):19m02549. doi:10.4088/PCC.19m02549.Google Scholar
Gama Marques, J, Ouakinin, S. Schizophrenia–schizoaffective–bipolar spectra: an epistemological perspective. CNS Spectr. 2019;1–5. doi:10.1017/S1092852919001408.Google ScholarPubMed
Ayano, G, Tesfaw, G, Shumet, S. The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis. BMC Psychiatry. 2019;19(1):370. doi:10.1186/s12888-019-2361-7.CrossRefGoogle ScholarPubMed
Ding, K, Yang, J, Cheng, G, et al. Hospitalizations and hospital charges for co-occurring substance use and mental disorders. J Subst Abuse Treat. 2011;40(4):366–375. doi:10.1016/j.jsat.2010.12.005.CrossRefGoogle ScholarPubMed
Stenius-Ayoade, A, Haaramo, P, Erkkilä, E, et al. Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland. BMC Health Serv Res. 2017;17(1):428. doi:10.1186/s12913-017-2372-3.CrossRefGoogle ScholarPubMed
Khan, S. Concurrent mental and substance use disorders in Canada. Health Rep. 2017;28(8):3–8.Google ScholarPubMed
Russolillo, A, Moniruzzaman, A, Parpouchi, M, et al. A 10-year retrospective analysis of hospital admissions and length of stay among a cohort of homeless adults in Vancouver, Canada. BMC Health Serv Res. 2016;16:60. doi:10.1186/s12913-016-1316-7.CrossRefGoogle ScholarPubMed
Gama Marques, J, Bento, A. Homeless, nameless and helpless: John Doe syndrome in treatment resistant schizophrenia. Schizophr Res. 2020;224:183–184. doi:10.1016/j.schres.2020.08.027.CrossRefGoogle Scholar
Fuller Torrey, E. Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill. 1st ed. New York: Harper Collins; 1989 Google Scholar
Bento, A, Barreto, E. Sem-Amor, Sem-Abrigo. 1st ed. Lisboa: Climepsi Editores; 2002 Google Scholar
World Health Organization. ICD-11: international statistical classification of diseases and related health problems: eleventh revision. World Health Organization; 2018. https://icd.who.int/browse11/l-m/en.Google Scholar
Blewett, DR, Barnett, GO, Chueh, HC. Experience with an electronic health record for a homeless population. Paper presented at: Proceeding of the AMIA Symposium; 1999:481–485.Google Scholar
Booth, RG. Using electronic patient records in mental health care to capture housing and homelessness information of psychiatric consumers. Issues Ment Health Nurs. 2006;27(10):1067–1077. doi:10.1080/01612840600943713.CrossRefGoogle ScholarPubMed
Cavacuiti, C, Svoboda, T. The use of electronic medical records for homeless outreach. J Health Care Poor Underserved. 2008;19(4):1270–1281. doi:10.1353/hpu.0.0090.CrossRefGoogle ScholarPubMed
Health Care Home Program Clinicians’ Network. Electronic information systems in homeless health care. Healing Hands. 2002;6(3):1–6. https://nhchc.org/wp-content/uploads/2019/08/Apr2002HealingHands.pdf.Google Scholar
Stefanidis, N, Pennbridge, J, MacKenzie, RG, et al. Runaway and homeless youth: the effects of attachment history on stabilization. Am J Orthopsychiatry. 1992;62(3):442–446. doi:10.1037/h0079343.CrossRefGoogle ScholarPubMed
Taylor-Seehafer, M, Jacobvitz, D, Steiker, LH. Patterns of attachment organization, social connectedness, and substance use in a sample of older homeless adolescents: preliminary findings. Fam Community Health. 2008;31(Suppl 1):S81–S88. doi:10.1097/01.FCH.0000304021.05632.a1.CrossRefGoogle Scholar
Rodríguez-Pellejero, JM, Núñez, JL. Relationship between attachment and executive dysfunction in the homeless. Soc Work Health Care. 2018;57(2):67–78. doi:10.1080/00981389.2017.1344754.CrossRefGoogle ScholarPubMed
Buchheim, A, Heinrichs, M, George, C, et al. Oxytocin enhances the experience of attachment security. Psychoneuroendocrinology. 2009;34(9):1417–1422. doi:10.1016/j.psyneuen.2009.04.002.CrossRefGoogle ScholarPubMed
Bento, A, Guedes Silva, M. Um grupo com mais de 1000 utentes: Análise de Grupo Psicoterapêutico Aberto num Hospital Público. Revista da Sociedade Portuguesa de Grupanálise e Psicoterapia Analítica de Grupo. 2017;Nova Série:1–15. https://grupanalise.pt/wp-content/uploads/2018/02/UM-GRU-1.DOC.pdf Google Scholar