Latimer Eric A, Rabouin Daniel, Cao Zhirong, Ly Angela, Powell Guido, Aubry Tim, Distasio Jino, Hwang Stephen W, Somers Julian M, Stergiopoulos Vicky, Veldhuizen Scott, Moodie Erica E M, Lesage Alain, Goering Paula N
Affiliations: Department of Psychiatry (Latimer), McGill University; Douglas Mental Health University Institute (Latimer, Rabouin, Cao, Ly, Powell), West Island Integrated University Health and Social Services Centre, Montréal, Que.; Centre for Research on Educational and Community Services and School of Psychology (Aubry), University of Ottawa, Ottawa, Ont.; Department of Geography (Distasio), University of Winnipeg, Winnipeg, Man.; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Centre for Urban Health Solutions (Hwang), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry (Somers), Simon Fraser University, Burnaby, BC; Department of Psychiatry (Stergiopoulos), University of Toronto, Toronto, Ont.; McMaster University (Veldhuizen), Hamilton, Ont.; Department of Epidemiology and Biostatistics (Moodie), McGill University; Centre de recherche de l'Institut universitaire en santé mentale de Montréal and Department of Psychiatry (Lesage), Université de Montréal, Montréal, Que.; Centre for Addiction and Mental Health (Stergiopoulos, Goering [deceased]) and Department of Psychiatry (Goering), University of Toronto, Toronto, Ont.
CMAJ Open. 2017 Jul 18;5(3):E576-E585. doi: 10.9778/cmajo.20170018.
Limited evidence on the costs of homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that homeless people with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs.
As part of the At Home/Chez Soi trial of Housing First for homeless people with mental illness, 990 participants were assigned to the usual-treatment (control) group in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montréal and Moncton) between October 2009 and June 2011. They were followed for up to 2 years. Questionnaires ascertained service use and income, and city-specific unit costs were estimated. We adjusted costs for site differences in sample characteristics. We used generalized linear models to identify individual-level characteristics associated with higher costs.
Usable data were available for 937 participants (94.6%). Average annual costs (excluding medications) per person in Vancouver, Winnipeg, Toronto, Montréal and Moncton were $53 144 (95% confidence interval [CI] $46 297-$60 095), $45 565 (95% CI $41 039-$50 412), $58 972 (95% CI $52 237-$66 085), $56 406 (95% CI $50 654-$62 456) and $29 610 (95% CI $24 995-$34 480), respectively. Net costs ranged from $15 530 to $341 535. Distributions of costs across categories varied significantly across cities. Lower functioning and a history of psychiatric hospital stays were the most important predictors of higher costs.
Homeless people with mental illness generate very high costs for society. Programs are needed to reorient this spending toward more effectively preventing homelessness and toward meeting the health, housing and social service needs of homeless people.
关于加拿大无家可归者成本的证据有限。我们从社会角度估算了患有精神疾病的无家可归者的年均总成本及各类成本。我们还确定了与较高成本相关的个体特征。
作为针对患有精神疾病的无家可归者的“在家/ chez soi”优先住房试验的一部分，2009年10月至2011年6月期间，990名参与者被分配到加拿大5个城市（温哥华、温尼伯、多伦多、蒙特利尔和蒙克顿）的常规治疗（对照组）。对他们进行了长达2年的跟踪。通过问卷调查确定服务使用情况和收入，并估算特定城市的单位成本。我们针对样本特征的地点差异对成本进行了调整。我们使用广义线性模型来确定与较高成本相关的个体层面特征。
937名参与者（94.6%）有可用数据。温哥华、温尼伯、多伦多、蒙特利尔和蒙克顿每人的年均成本（不包括药物）分别为53144加元（95%置信区间[CI]46297 - 60095加元）、45565加元（95%CI 41039 - 50412加元）、58972加元（95%CI 52237 - 66085加元）、56406加元（95%CI 50654 - 62456加元）和29610加元（95%CI 24995 - 34480加元）。净成本从15530加元到341535加元不等。各城市各类成本的分布差异显著。功能较低和有精神病住院史是成本较高的最重要预测因素。
患有精神疾病的无家可归者给社会带来了非常高的成本。需要开展相关项目，将这笔开支重新导向更有效地预防无家可归，以及满足无家可归者的健康、住房和社会服务需求。
