Smelson David A, Perez Cheryl Kennedy, Farquhar Ian, Byrne Thomas, Colegrove Alice
a Department of Psychiatry , University of Massachusetts Medical School , Worcester , Massachusetts , USA.
b Department of Public Health , Bureau of Substance Addiction Services , Boston , Massachusetts , USA.
J Dual Diagn. 2018 Oct-Dec;14(4):247-256. doi: 10.1080/15504263.2018.1506195. Epub 2019 Jan 4.
Among individuals experiencing chronic homelessness, there is a high rate of co-occurring mental health and substance use, which has traditionally been addressed through the delivery of permanent supportive housing along with substance use and mental health services. However, this population often has difficulty engaging in treatment for co-occurring disorders, which can result in exacerbation of symptoms and housing loss. Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION) is a co-occurring mental health and substance use wraparound approach that was pilot-tested alongside Permanent Supportive Housing (PSH) to improve treatment access and engagement. This pilot was part of a state plan to end homelessness in the Boston metro area.
This open pilot study enrolled 136 individuals who were chronically homeless and offered one year of MISSION along with PSH. Program participants also received baseline and 6- and 12-month follow-up assessments.
At one-year follow-up, 82.4% of the program participants were housed in PSH. However, due to limited affordable housing in the Boston metro area, it took on average 6.20 months to house the program participants. Furthermore, while MISSION was feasible to implement alongside PSH, fidelity to the MISSION model was lower than expected. This pilot also examined the role of housing status on clinical outcomes and found that the program participants who were housed at the time of discharge displayed a statistically significant improvement in emergency room visits for mental health complaints, the Psychosis subscale of the Behavior and Symptom Identification Scale (BASIS-32), illegal drug use, and pharmacotherapy treatment.
This pilot study demonstrated that systematically integrating PSH and MISSION can improve access and engagement in care, housing retention, and mental health outcomes. Despite the preliminary success and while taking into account the limitations of the open single-group pre/post design, this study also identified the lack of affordable housing as a potential barrier to placement as well as the critical role of housing for improved clinical outcomes. Randomized controlled trials are needed to test MISSION with PSH as well as perhaps PSH with and without MISSION to tease apart the effects of integrating both approaches simultaneously.
在长期无家可归的人群中，心理健康问题与物质使用问题并发的比例很高，传统上通过提供永久性支持性住房以及物质使用和心理健康服务来解决。然而，这一人群在参与并发疾病的治疗方面往往存在困难，这可能导致症状加重和失去住房。通过系统整合、外展和网络维持独立与清醒（MISSION）是一种针对心理健康和物质使用并发问题的综合方法，它与永久性支持性住房（PSH）一起进行了试点测试，以改善治疗的可及性和参与度。该试点是波士顿都会区一项结束无家可归状态的州计划的一部分。
这项开放性试点研究招募了136名长期无家可归的个体，为他们提供为期一年的MISSION以及PSH。项目参与者还接受了基线评估以及6个月和12个月的随访评估。
在一年的随访中，82.4%的项目参与者入住了PSH。然而，由于波士顿都会区经济适用房有限，项目参与者平均花了6.20个月才入住。此外，虽然MISSION与PSH同时实施是可行的，但对MISSION模式的忠实度低于预期。该试点还研究了住房状况对临床结果的作用，发现出院时已入住的项目参与者在因心理健康问题前往急诊室就诊、行为和症状识别量表（BASIS - 32）的精神病分量表、非法药物使用以及药物治疗方面有统计学上的显著改善。
这项试点研究表明，系统地整合PSH和MISSION可以改善治疗的可及性和参与度、住房保留情况以及心理健康结果。尽管取得了初步成功，同时考虑到开放性单组前后设计的局限性，但本研究也发现经济适用房短缺是安置的潜在障碍，以及住房对改善临床结果的关键作用。需要进行随机对照试验来测试MISSION与PSH以及可能的有MISSION和无MISSION的PSH，以区分同时整合这两种方法的效果。
