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Background Housing First does not, on average, reduce criminal justice involvement. This analysis aims to test whether the overall absence of an impact is due to intervention effect heterogeneity as a function of the pattern of lifetime criminal justice involvement, identified through latent class analysis conducted through earlier work. Methods This analysis relied on data from the Montréal, Toronto and Vancouver sites of the Canadian At Home/Chez Soi randomized controlled trial, merged with administrative records of lifetime criminal charges (N = 1,321). Negative binomial models with interaction terms were used to estimate the impact of Housing First, in comparison to treatment as usual, on violent charges, acquisitive charges (e.g., theft, sex work), and administration of justice charges (e.g., breach of probation), for each pre-identified profile. Results Participants with past criminal justice involvement associated with a chronic history of homelessness or with criminalized substance use experienced a decrease in violent charges as a result of Housing First, whereas those with no or little past criminal justice involvement experienced a marginal increase. Housing First did not affect acquisitive or administration of justice charges, regardless of profile. Conclusions Findings suggest that integrating criminological or forensic mental health tools, knowledge and approaches into the multidisciplinary teams that support Housing First service users may be an effective solution, so that all aspects of their recovery, including potential criminogenic needs, are addressed. Future research should focus on the feasibility and effectiveness of such adjunct interventions.

Objectives Based on clinical experience and literature, this article aims to stimulate reflection among the actors involved concerning the organization of services and the interventions to be favored with young people living both a first episode of psychosis and a situation of residential instability or homelessness. The objective of this article is to provide an overview of the literature on the situation of these young people and their needs, the challenges they face in their pathway within the healthcare system and the various interventions to consider with them both to prevent or exit homelessness. Method This literature review presents a narrative synthesis of articles from literature reviews or primary studies published in French or English between 1995 and March 2021, with a focus on the services and intervention practices implemented in Quebec in recent years. Certain interventions can be made at different periods of time in a young person's journey to change their trajectory and prevent homelessness or limit its duration and consequences. Throughout this article, a case study will illustrate these interventions occurring at different times in the life of a young person. Results The risk of residential instability and homelessness in young people living with emerging psychosis is higher than in the general population. This situation can contribute to the onset or worsening of psychosis due to the stress associated with difficult living conditions and the increased possibilities of victimization experiences. This great precariousness can also be the consequence of psychosis and its associated conditions. However, very few studies focus specifically on young people experiencing both a first episode of psychosis and a situation of homelessness or residential instability. The instability associated with homelessness complicates their pathway to mental health care, delays their access to the appropriate services and interferes with their engagement in follow-up. Interventions aimed at preventing homelessness include support in the transition to adulthood and identifying situations of residential instability. Regarding the organization of care, integrated mental health service centers for young people and the development of partnerships, networking and intersectorality make it possible to overcome certain challenges. Intensive outreach interventions models as well as interventions aiming residential stability are favorable to young people who are already experiencing homelessness. Conclusion Residential instability and homelessness imply several challenges faced by young people living with emerging psychosis concerning the access, the continuity and the quality of mental health services. Integrated interventions both to prevent or exit homelessness can be implemented to stem this problem.

Homeless people are particularly at risk of becoming infected with COVID-19 because their precarious living conditions make prevention measure difficult.We describe an innovative approach with the aim of implementing testing and monitoring adapted to the needs of the homeless people of Marseille (inhabitants of slums, squats or those living on the street).The intervention included 1) the coordination of 18 support organizations for homeless people, 2) the training and the provision of rapid serological and antigenic tests, 3) a mobile outreach team with community mediators in order to provide tests, including COVID-19 PCR on point of care, prevention and monitoring of positive cases. Acceptability of the intervention by participants, field organization was good. The lack of adapted places of accommodation was an important restricting factor for optimal care and support.The emergence of COVID-19 has highlighted discontinuities in health care among homeless people. Specific mobile outreach teams could limit the impact on this high-risk population.

Dedicated care facilities can accommodate homeless people who are in situations that may lead to neglect due to their social insecurity, psychiatric and/or cognitive disorders. This is the case of the reception and hospital care centre in Nanterre (92), in the Paris suburbs. The professionals there provide a humane welcome to people whose physical condition, health and hygiene are often very poor. Taking care of them is the richness of the experience.

Objectives Consolidation of supported housing policies is a primary source of solutions aimed at addressing the problem of homelessness. Transitional housing (TH) offers a sequential housing trajectory from emergency shelters, to TH, to permanent housing with or without supports. Post-TH follow-up may improve residential stability and community integration. Yet little information is available on successful conditions and effectiveness related to post-TH follow-up for improving residential stability and community integration among homeless people, and especially homeless women. This pilot case study aimed to identify the needs of women who were previous TH residents before acquiring permanent housing with supports, the implementation process for post-TH follow-up activities and intensity of services offered and conditions for success of the follow-up, as well as the outcomes of post-TH follow-up in meeting the needs of these homeless women. Methods Two non-profit organizations for housing reintegration in the Montreal area were selected for study. Mixed methods based on a case study approach were used, triangulating the data collected from homeless women, case managers, and housing managers. Two interviews were conducted at 6-month intervals with homeless women (n=10), whose needs and outcomes related to post-TH follow-up were identified through a questionnaire with open and closed questions. To document implementation of the post-TH follow-up, case managers (n=2) recorded information on follow-up activities and intensity of services offered for the 6-month period using contact sheets. Factors facilitating and hindering post-TH follow-up were also identified in a group interview with case managers (n=2) and resource managers (n=4). Results Users identified health maintenance, support for daily activities and improved socialization as their primary needs. Most women were satisfied with activities offered and the frequency of follow-up, ease of access to case managers, and the overall capacity of follow-up to meet their needs. The intensity of follow-up, user/case manager therapeutic alliance, and user motivation to recover were identified as facilitating factors that influenced effectiveness of post-TH follow-up. Factors that hindered effectiveness included: the limited duration of TH before post-TH follow-up particularly among users with major trauma; refractory behavior; reluctance to take medications and consumption of psychoactive substances; problems in accessing health services, particularly specialized mental health services; and for case managers: time constraints, logistical difficulties related to follow-up, and lack of affordable permanent housing adequate to user needs. After six months, 80% of users remained in their housing and no changes were identified in community integration. Conclusion Post-TH follow-up seems particularly adapted to promote residential stability among chronically homeless women with mental health or dependence issues, as the essential first step toward community integration. The study underlined the importance of offering multiple service modalities adapted to user needs and post-TH follow-up geared toward recovery. Better funding of post-TH follow-up, tighter collaboration with other public services, case manager training, and increase in affordable and adequate permanent housing would promote more effective deployment of post-TH follow-up.

Maternity professionals are sometimes required to provide care to migrant women in precarious circumstances. Decisions regarding the future and the social and medical support provided to these mothers and their babies must be made quickly and be efficient and effective, despite having to contend with a lack of resources. A qualitative study focused on professionals' emotional reactions in these contexts combining pregnancy, vulnerability, migration and perinatal care. It enabled an original research protocol to be established favouring professionals' reflexivity.

The missions of the mobile psychiatric team in Lyon involve reaching out to vulnerable people to guide them towards the most appropriate care. Establishing a bond and finding the right words to engage with them constitute a balancing act which the caregiver must undertake with the homeless. It is important to try and understand the situation, the person's life story, invent alternatives, while refraining from pushing them too much, in order to maintain their trust.

Homelessness is associated with several issues (psychiatric and neurological disorders, neurodevelopmental difficulties, malnutrition…) which are also risk factors for cognitive disorders. However, little is known about the relationship between the cognition of homeless people and these eventual explicative etiologies. The aim of this work is to complete the results of Depp et al. about cognition in homelessness by proposing a systematic review of the neuropsychological disorders of homeless people associated with an analysis of the etiologies likely to explain these disorders.We followed the PRISMA recommendations to build up this work. We analyzed the abstracts of 385 papers found on databases PSYCINFO and PubMed. Twenty-two studies have been selected for respecting our criteria (at least one valid neuropsychological test ; general group of homeless people and not a sub-group of this population ; study published in English). The prevalence quality has been evaluated through the criteria of Loney et al. Cognitive scores and etiological factors have been compared between studies.The 22 studies represent only nine countries. More than half of them are considered as having a poor prevalence quality. In total, 4,256 participants have been evaluated. Their mean age was around 40 years, and 85 % of the participants were men. The results show a prevalence of cognitive disorders (MMSE) in 8.77 % of the sample. The mean IQ was 87.47 and the premorbid IQ 94.59. We also notice possible disorders affecting the episodic memory and the executive functions. Mean scores for short-term memory, speech and visuo-spatial functions are relatively low. None of the studies evaluated the praxia, the gnosia or the social cognition. The heterogeneity of studies and the lack of data did not allow us to give general conclusions about the etiology of these disorders. However, we see that around 40 % of the time subjects had histories of brain injuries and 89 % of childhood trauma. Intellectual disability is found in 49 % of the sample of a single study. Also, 70 % of the homeless population have been diagnosed with substance-related disorders and 65 % with psychiatric disorders. It appears that the only factors correlated with cognitive disorders would be the history of brain injuries and childhood traumas.We confirm that homeless people often suffer from cognitive difficulties, and some of these difficulties (memory, executive functioning) are severe. Yet the etiology of these disorders remain relatively unknown: even if we observe a high prevalence of psychiatric, substance-related, neurodevelopmental and neurological issues by the homeless population, only a few of them (brain injury history and childhood trauma) seem to be correlated with cognition in homelessness. The potential explicative factors have been too rarely explored to bring a powerful explanation of cognitive disorders in homeless people. Further research needs to be done in order to give a more precise neuropsychological profile of the homeless population and to better understand what the disorders are rooted in. Last but not least, all this research and knowledge should be applied more to the care of homeless people by providing neuropsychological assessment and rehabilitation and by training the team to detect cognitive disorders and to support the person with a cognitive disability.

To assess the acceptability for GPS to use the French shared Electronic Health Record (Dossier Médical Partagé, "DMP") when caring for Homeless People (HP).Mixed, sequential, qualitative-quantitative study. The qualitative phase consisted of semi-structured interviews with GPs involved in the care of HP. During the quantitative phase, questionnaires were sent to 150 randomized GPs providing routine healthcare in Marseille. Social and practical acceptability was studied by means of a Likert Scale.19 GPs were interviewed during the qualitative phase, and 105 GPs answered the questionnaire during the quantitative phase (response rate: 73%). GPs had a poor knowledge about DMP. More than half (52.5%) of GPs were likely to effectively use DMP for HP. GPs felt that the "DMP" could improve continuity, quality, and security of care for HP. They perceived greater benefits of the use the DMP for HP than for the general population, notably in terms of saving time (p = 0.03). However, GPs felt that HP were vulnerable and wanted to protect their patients; they worried about security of data storage. GPs identified specific barriers for HP to use DMP: most of them concerned practical access for HP to DMP (lack of social security card, or lack of tool for accessing internet).A shared electronic health record, such as the French DMP, could improve continuity of care for HP in France. GPs need to be better informed, and DMP functions need to be optimized and adapted to HP, so that it can be effectively used by GPs for HP.

Around ten homeless people were invited to take part in a programme of physical activities to improve their health status. Only motricity and walking pathways were followed assiduously for eight weeks. The assessment of the physical condition and quality of life showed an improvement in these areas, in particular for one of the participants. However, the lack of motivation and assiduity remains an obstacle to regular activity.

Mental disorders may result in severe precariousness of housing, with a worsening of the disorders, inappropriate hospitalizations, homelessness, substance abuse or even suicide. The « housing first » model offers direct access to housing with the support of a mobile psychiatric team, which bypasses the usual steps hospital - fostered home - independent housing. The goal of this article is to describe a « housing first » pilot project conducted in Lausanne. Demographics, clinical and services' use data were collected from participants 12 months before and after the integration into the program. 16 people have been integrated into housing. The average length (from 81 to 15 days) and the average number of psychiatric hospitalizations (from 1.31 to 0.44) declined significantly for 30%-60% less direct costs as compared to fostered homes. However, several obstacles remain to be overcome in order to continue this program.Les troubles psychiatriques peuvent avoir pour conséquence une grave précarité de logement, avec une aggravation des troubles, des hospitalisations inappropriées, des périodes sans-abri, la consommation de substances, voire le suicide. Le modèle « chez soi d’abord »

Homelessness is a complex issue linked to poverty and structural conditions. It is increasing in Western countries with younger people and multiple generations being affected. Hard and unstable living conditions and inappropriate access to care predispose people to increase morbidity with poor health outcomes. This article reviews recent evidence about homeless health and strategies to improve health outcomes while harnessing societal benefits.Le défaut de logement stable est fortement lié à la pauvreté et à des causes structurelles. Les sans-abri constituent une population croissante dans les pays occidentaux, diverse dans son degré de précarité et d’accès au logement, de plus en plus jeune et multigénérationnelle. Leur santé est fortement influencée par les conditions de vie précaires et leur accès aux soins souvent mal adaptés aux besoins. Cet article passe en revue les données épidémiologiques et cliniques récentes et présente des stratégies innovantes de prise en charge globale susceptibles d’apporter des bénéfices à l’échelle de l’individu, du système de santé et de la société.

French national surveys among the homeless population in 2001 and 2012 provided a general description of the homeless beneficiaries of medical and social aids. However, given the increasing number of women in this population, mostly born abroad and accompanied by their children, a descriptive study of homeless women according to the fact of being born in France or abroad was conducted.A probability sample of 1470 French-speaking homeless women was recruited for the Insee-Ined 2012 survey. Socio-demographic characteristics, life trajectories, work and employment over the last 12 months, perceived health, reported morbidity, use of care and medical coverage have been described, comparing homeless women born abroad with those born in France.Homeless women are young (median age=34 y.), often single (55%), without a partner (71%) and often accompanied by children (52%). The vast majority (60%) reported no salary during the previous 12 months. Housing conditions were less precarious in women born in France, but these women had a more difficult life history, a more unfavorable perception of their health status, and a higher frequency of chronic health problems. Homeless women born abroad seemed to have more precarious conditions of life and more difficulties to access aids and medical coverage. Overall, despite a relatively good availability of medical insurance, homeless women, regardless of the place of birth, often reported health problems, which were not treated.This study suggests that homeless women often have to deal with chronic health problems that are not treated. Homeless women born abroad are characterized by more precarious living conditions that women born in France. Although younger, with an overall favorable perception of their health and declaring less often an addiction, their general state of health appears to be as fragile as for women born in France. Actions towards homeless women should be implemented to promote their access to care.

The hospital is the last refuge for sick homeless people when their illness makes life on the street impossible. The teams often consider these patients as different, difficult and not easy to place in a specific type of care. In palliative care, fewer questions are raised as the patients are hospitalised for their terminal phase. The difficulties often lie in diagnosing the disease and recognising its seriousness and the patient's social situation.

The problems faced by homeless people are varied and complex. They require numerous qualities on the part of professionals. Living on the streets often means dying on the streets. Professionals are thereby confronted with practical and ethical questions. They have a key role both in listening and providing support. This article shows the example of the Les Morts de la Rue collective.

Considering the patient as a partner or a collaborator is becoming more and more popular in the field of mental health research. Nevertheless, relational dynamics between patients and researchers and the issues raised by them aren't much studied. This article aims to open the debate from a case study: the participation of a peer worker to two research teams of a research and demonstration project in the field of mental health and homelessness. The story of his experience in the project explores how the realities that affects him--at the intersection of mental health problems, experience in the street and the world of consumption--have an impact on his relationships with his colleagues. Conversely, his working conditions seem to negatively affect him and produce a certain loss of identity leading him, among other things, to leave the project. The analysis suggests that conflicts that arise between the peer and his colleagues reflect hierarchies between social status and legitimate knowledge (or that needs to be recognized as valid) in the field of research.

The health status of the so-called "Roma" is usually much poorer than that of neighbouring non-Roma populations with a life expectancy gap of 5-15 years. This results from prolonged exposure to adverse determinants of health and to persistent exclusion from social and political arenas. Scientific and social research has only poorly addressed the health issues of Roma and evidences are scarce. Insufficient access to public services, including to health care and non optimal clinical practices are modifiable factors. If correctly addressed, this could contribute to reduce health disparities, including in Switzerland.

The homeless population is difficult to define and its number difficult to evaluate. In France, it is estimated that almost 4 million people living in substandard accommodation, and 85,000 homeless people. Most homeless people rarely frequent public spaces. One-third have a job, one-quarter live with children, and one-third are between 18 and 29 years old. Shared characteristics include a collapse of social ties and a complete lack of stable accommodation. There are no illnesses specific to homeless people, but their epidemiology differs from the general population: the incidence rate of tuberculosis is 30 times higher, for example. Medical care often arrives far too late. As a result, functional deficits are common, often following serious accidents, and hospitalization is three times more frequent. A chronic disease is present in 45% of cases. Average life expectancy is only 47.6 years-between 30 and 35 years lower than for the general French population. Medical care can only be fully effective if these patients' social and housing issues are dealt with too.

In today's society, the most destitute, and particularly those forced to live outdoors, are deprived of everything: work, money, accommodation,family, etc. Their body is the sole and last resource they have, but is subject to over-exploitation in response to the physical and social survival environment in which they live. Many homeless people have a chaotic life trajectory, often starting in childhood, leaving them with little hope for improvement. How can we adapt medical and social care to each individual? All members of society must question their place and function if precariousness is to bedealt with effectively.

Risk factors lead to social exclusion and their accumulation can lead to homelessness. This inevitably contributes to a progressive increase in psychological distress or aggravates a pre-existing mental illness. Over the years, homeless people, who are never happy, develop various survival strategies and mental defenses that can sometimes prove effective. Other individuals who are less"adapted" to living in the street may suffer from both mental and physical collapse. Proactive programs designed to facilitate access to healthcare and welfare have been created in order to offer solutions designed to enable homeless people to leave the street, through access to medical care, accommodation and civil rights. The psychiatric sector has been slow to adapt to the needs of this population, although several teams specializing in mental illness and precariousness have been created These teams explore every possible avenue to help homeless people with mental health issues to recover a psychological balance that allows them to choose a recovery pathway and thus to regain a dignified lifestyle.

Samusocial is an organisation which provides emergency and longer-term medical respite beds in Paris. They offer, for a duration ranging from a few days to a few years, shelter for homeless people requiring medical care but which no longer merits hospitalisation. The nursing role consists in supporting as part of a multi-professional team these people whose self-esteem and body image have been damaged, to help them construct their life project.

This paper explores the experience of families supporting a homeless relative with mental illness. The authors investigate the types of support offered by families; they also examine the relational and personal dimensions which can support a redefining of the role and consequently a modulation of the level of support. Using a qualitative research, semi-structured interviews were realized with 14 family members. The results indicate that housing and the financial support are the types of support most frequently stopped while the emotional and the social support tend to be pursued. The control in the relation, the emotionalism and the perception of future appear as important element for the initiation of a role redefining process.

This article presents a study of organizations serving people who are homeless or at risk of becoming homeless (PHRH) in Montreal, as well as the determinants of their inter-organizational relationships. The study shows that greater inter-organizational collaboration is needed, particularly within the network of health and social services (NHSS), to deal with the concomitant problems faced by PHRH. Among determinants that have an impact on the extent of inter-organizational relationships are the number of services offered, the appreciation of the relationships between organizations within the NHSS, and the ratio of Anglophones among the homeless and of individuals with gambling problems.

In the context of the French National Health Service, a free access to healthcare facilities (the PASS: "permanence d'accès aux soins de santé") has been implanted in 2000 for patients without health insurance or those dealing with financial hardship. There is few data about socio-demographic characteristics of the patients using these services. The objective of this study was to provide descriptive data about socio-demographic characteristics and motivation of those patients who use these clinics.This descriptive cross-sectional study was conducted between April an May 2008, in 5 PASS clinics from academic tertiary hospitals in Paris. Descriptive data on patient were collected by general practitioners at the end of their consultations.This study included 581 patients. The mean age was 42 years, and 65% of patients were males. Only 50.9% declared a salary income and 38.5% had a health insurance. Half of the patients were homeless, and 80% were migrants. The main reasons to visit these health facilities were direct access (no appointment needed), being in financial difficulty and having a medical record in the same hospital. Half of the patients had one chronic disease at least, while only a third of them saw regularly a physician. A total of 834 diseases were found among the 581 patients, including 411 chronic diseases, and 17% of the patients had a psychologic or a psychiatric disorder. Prognosis was divided in three grades: good, low and poor. Almost a half of the patients were considered by the doctor as having a low or a poor prognosis if they would not receive a therapy.The findings of this study suggest that the PASS carry out their mission: most of the patients frequenting these facilities live under poor conditions and are in poor health status compared to the patients having access to conventional outpatient services.

In 2007, a national survey estimated to up to 800,000 the number of homeless individuals in France. Ten percent of them live constantly in the street; often very dissocialized and in precarious conditions. Thereby it remains difficult for homeless to have access to a medical and social support. In order to identify the medical and social needs of this population, we performed a one year observational prospective study in two reception centres in Perpignan. 629 (99%) out of 635 answers were analysed. The most represented age group is 39-49 years (29,2%) with an over-representation of males (82,7%). The most frequent pathologies are psychological distress (43,9% of requests, including anxious problems 23%, and sleep disturbances 24,4%). Medical affections represented 15,7% of the cases (mainly nutritional deficiency), and skin diseases 15,%. Addictive behaviour was frequent including tobacco (84%), alcohol (17%), and drug addiction (9%). 21,7% of this population had a regular work, and 97,8% with fixed term contracts, but 45,1% did not have any health cover 17,6% of homeless did not obtain any answer to their medical request (lack of suitable medicine, or an impossibility to pull out further tests in order). To solve some aspects of that problem, family doctor can rely on a medical and social network (PASS, MAO, ANPAA).

Outreach work with youths in a precarious situation raises emotions and questions in workers while confronting them with their own suffering and fragility. In order to help them help as well as counter the risk of vicarious traumatisation, spaces for talking and exchanging with a third party have been created in various intervention settings. The objective is to allow them to elaborate on what their work makes them feel and thus preserve their stability and their ability to think. Through group or individual clinical discussions, these exchanges favor distancing and allow new perspectives on their work. That is why peer support appeared as an essential element for psychologists and therapists who support not only youths but the workers who help them. The setting up of our outreach meetings-a result of our observation, allows keeping the flame alive without risking being burned. In this article, the issue of marginality in professionals working with homeless youths-as well as our own-is raised. It sometimes translates in the absence of a fixed location for a meeting symbolizing traditional stability, sometimes in the necessary flexibility of a framework to reach this population, sometimes in the openness to otherness and more precisely to a difference that disturbs when anxiety that this disaffiliated being raises, could well be our very self! Is it really marginality or a particular positioning aiming at constructive denunciation of stigmatization, unjust exclusion that youths with mental health and addiction problems sustain that place them at risk of homelessness? Neither missionaries, nor saviors are needed, but only hopeful facilitators working alongside people who want to stand up and take their place in society.

Testimony about the learning and working experience of twenty years of clinical practice with mental illness and homeless people; the author describes the therapeutic paradigm and clinical strategies the psychiatrist must learn and employ to encounter these patients, engage them in a treatment and rehabilitation towards a personalised life project to the recovery. The author then reviews some perspectives for the future care of this population.

Homeless people are even more vulnerable to the harsh conditions of life on the street when they are old and in poor health. Torn between respecting the individual's choice and performing its mission to provide care, the nursing team aims to find the most adapted solution. Seeking to convince without restraining it is guided by an attitude of care and concern.