Roy Laurence, Abdel Baki Amal, Crocker Anne, De Benedictis Luigi, Latimer Éric, Thibeault Esther, Bérubé Félix-Antoine, Roy Marc-André
Université McGill, Québec, Canada.
Université de Montréal, Québec, Canada.
Sante Ment Que. 2024 Spring;49(1):123-144.
Objectives Access to stable, safe, and affordable housing is an important determinant of health and community integration among people living with mental illness. Previous studies on housing stability, housing satisfaction and residential preferences among people living with mental illness have primarily been conducted among those with extensive service use experiences. First-time mental health service users, and youth in particular, are likely to present with distinct housing needs. The current study aimed to explore the housing experiences of new mental health service users, as well as the perceived obstacles and facilitators to their residential stability. Methods Projet AMONT is a longitudinal mixed-methods cohort study on the residential trajectories of service users in the 36 months after their initial contact with psychiatric services. The qualitative component consisted in a qualitative descriptive study. Semi-structured individual interviews were conducted with fourteen individuals at the beginning of their service use trajectory. Findings The thematic analysis uncovered how the emergence of mental illness and initial contacts with psychiatric services are associated with transformations in the area of housing and, for many, with housing instability. This instability might occur in continuity with adverse early life trajectories, or through the disruption caused by the emergence of mental illness. Informal social support emerged as the main protective factor against housing instability. Housing satisfaction was associated with multiple and sometimes conflicting needs regarding privacy, safety, social interactions, response to basic needs, performance of activities of daily living, and community integration. The specific developmental issues of youth at the beginning of their service use trajectories influence housing stability and satisfaction. Their housing then becomes a reflection of and laboratory for identity exploration and consolidation. Conclusion The findings highlight the importance of adopting a homelessness prevention lens among people living with a first episode of mental illness, particularly youth with adverse early life trajectories. Many existing approaches could be implemented or strengthened: cross-sector partnerships with all actors present in the trajectories of people with emerging mental illness; family approaches in early intervention, peer support, and screening for unstable housing situations. Adapting practices to the specific developmental characteristics of youth seem to be a key for homelessness prevention for this population.
目标 获得稳定、安全且负担得起的住房是精神疾病患者健康和融入社区的重要决定因素。先前关于精神疾病患者住房稳定性、住房满意度和居住偏好的研究主要是在那些有广泛服务使用经历的人群中进行的。首次使用心理健康服务的人群，尤其是青少年，可能有不同的住房需求。本研究旨在探索新的心理健康服务使用者的住房经历，以及他们在居住稳定性方面所感知到的障碍和促进因素。方法 “阿蒙项目”是一项纵向混合方法队列研究，研究服务使用者在首次接触精神科服务后的36个月内的居住轨迹。定性部分包括一项定性描述性研究。在服务使用轨迹开始时，对14名个体进行了半结构化的个人访谈。结果 主题分析揭示了精神疾病的出现以及与精神科服务的首次接触如何与住房领域的转变相关联，并且对许多人来说，与住房不稳定相关联。这种不稳定可能与不利的早期生活轨迹持续相关，或者是由精神疾病的出现所导致的破坏引起的。非正式社会支持成为防止住房不稳定的主要保护因素。住房满意度与在隐私、安全、社交互动、基本需求的满足、日常生活活动的开展以及社区融入等方面的多种且有时相互冲突的需求相关。青少年在服务使用轨迹开始时的特定发展问题会影响住房稳定性和满意度。他们的住房随后成为身份探索和巩固的一种反映和场所。结论 研究结果凸显了在首次发作精神疾病的人群中，尤其是那些有不利早期生活轨迹的青少年中，采用预防无家可归视角的重要性。许多现有方法可以实施或加强：与精神疾病初发者轨迹中所有相关行为者建立跨部门伙伴关系；早期干预中的家庭方法、同伴支持以及对不稳定住房情况的筛查。使实践适应青少年的特定发展特征似乎是预防该人群无家可归的关键。
