Article

Characteristics of Individuals With Mental Illness in Tokyo Homeless Shelters

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Abstract

Objective: Japan has the largest number of psychiatric beds in the world and has been in the process of deinstitutionalization since 2004. The majority of psychiatric inpatients are elderly long-term patients, who are at risk of homelessness after they are discharged. There is little information about homeless people with mental illnesses in Japan, and the aim of this study was to describe characteristics of people with a mental illness in homeless shelters in Tokyo. Methods: A face-to-face survey was conducted from December 2012 to March 2013 by the staff of a nonprofit organization (NPO) that helps socially isolated persons. Of the 1,056 people who received help during the study period, 684 completed the survey. Results: Eighteen percent of the 684 survey participants had a mental illness. Of the 210 individuals who lived in shelters, one-third had a mental illness. The mean age of shelter users with mental illness was 64.9; they tended to be referred from hospitals, and their mental well-being was poorer than other NPO service users in the study. Among the service users with mental illness, those living in shelters were older than those living in the community and more likely to have a history of trouble with alcohol, poor family relationships, and impaired instrumental activities of daily living. Conclusions: Unmet mental health needs were noted among discharged hospital patients living in Tokyo homeless shelters. An integrated and community-based support system with more effective health care delivery, including critical time interventions, is needed.

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... Our participants were only men using the shelters. Moreover, there is a high prevalence of psychological disorders and intellectual disabilities among homeless people (Morikawa et al., 2011;Nishio et al., 2015;Okamura et al., 2015;Okuda, 2010), and those with severe mental illness, including alcohol use disorder and intellectual disabilities, were not in scope in this study. However, because homeless subgroups are a diverse and hard-to-reach population, we consider this study's setting suitable for an epidemiological study. ...
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Internationally, the prevalence of gambling disorder has been reported to be higher among homeless people than the general population; however, little is known about the factors associated with gambling disorder in this population. The present study aimed to investigate the prevalence of gambling disorder and its associated factors among homeless men using shelters in Osaka City. A cross-sectional survey was conducted from 30 to 2018 to 4 January 2019, using the 2017 Japanese National Survey of Gambling (JNSG) questionnaire, supplemented with questions about homeless experiences, drinking, and smoking. Using the South Oaks Gambling Screen, the presence of gambling disorder was determined by a score ≥ 5 out of 20. Multivariate logistic regression was conducted to explore factors associated with lifetime gambling disorder. Lifetime and past-year prevalence of gambling disorder among 103 participants was 43.7% (95% confidence interval [CI]: 34.5–53.3) and 3.9% (95% CI: 1.5–9.6), respectively, which are higher than the 6.7% and 1.5% found among men in the 2017 JNSG. Reasons reported for currently gambling less were primarily financial. Factors associated with lifetime GD included “more than 20 years since the first incidence of homelessness” (adjusted odds ratio [AOR]: 4.97, 95% CI: 1.50–16.45) and “more than five incidences of homelessness” (AOR: 4.51, 95% CI: 1.06–19.26). When homeless individuals with gambling disorder try to rebuild and stabilize their lives, the presence or resurgence of gambling disorder may hinder the process and pose a risk of recurring homelessness. Comprehensive support services for homeless individuals with gambling disorder are required. (250 words)
... A Japanese study found that unmet mental health needs were noted among discharged hospital patients living in Tokyo homeless shelters (Okamura et al., 2015). It was suggested that this amounted to one-third of the residents. ...
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Introduction This project had two aims: to gain an understanding of the profile and expressed needs of people seen by the Homeless Emergency Department Liaison Officer in the emergency department in comparison to general hospital presentations, and to explore the potential role for occupational therapy to respond to this population. Method The Emergency Department Information Systems database and Homeless Emergency Department Liaison Officer files were examined to gather data on all individuals who presented to the hospital emergency department over a 16-month period. The viability of a discipline-specific role to respond to this population was then considered by senior occupational therapists. Results The results revealed that the majority of homeless people seen were male and in the early middle age group, with more than half arriving at the emergency department by way of ambulance services. The most common reasons for presentation were medical, mental health and drug- and alcohol-related issues. Conclusion It was found that a large percentage of people seen in the emergency department were discharged back to the streets. Senior occupational therapists have the potential to provide brief assessments and interventions that could reduce the ongoing demand on emergency department resources by people who are homeless.
... Eine nationale Registerstudie in Dänemark ergab bei 62,4% der Männer und 58,2% der Frauen eine diagnostizierte psychiatrische Störung (23). Neuere populationsbasierte Studien in Großstädten bestätigen diese Angaben (24)(25)(26). Wohnungslose mit psychischen Störungen zählen sehr häufig zu den chronisch Wohnungslosen oder Langzeitwohnungslosen mit multiplen sozialen Exklusionserfahrungen (9,27). Für diese Gruppe sind die klinischen Out-comes noch schlechter als für die Gesamtgruppe wohnungsloser Menschen (5). ...
Article
Background: Homelessness is noticeable in many places, but widely ignored on a macrosocial level. People with mental illness and co-occurring addictive disorder are frequently among the homelessness. Method: An international systematic review and a Germanspeaking research in the database of the network for healthcare service research were conducted. The aim was to present current results of interventions for the homeless with mental illness. Results: Anglo-American literature describes community-based approaches like Housing First and Assertive Community Treatment. Both deliver robust results for housing stability and quality of life. The results for mental health outcomes are inconsistent. Research in Germany is comparatively insufficient. Outlook: Low-threshold or outreach services are beneficial. But the findings could not be transferred to local conditions because of social and legal differences. Currently, the problem is aggravated by social structural factors like the large numbers of refugees.
... Eine nationale Registerstudie in Dänemark ergab bei 62,4% der Männer und 58,2% der Frauen eine diagnostizierte psychiatrische Störung (23). Neuere populationsbasierte Studien in Großstädten bestätigen diese Angaben (24)(25)(26). Wohnungslose mit psychischen Störungen zählen sehr häufig zu den chronisch Wohnungslosen oder Langzeitwohnungslosen mit multiplen sozialen Exklusionserfahrungen (9,27). Für diese Gruppe sind die klinischen Out-Review comes noch schlechter als für die Gesamtgruppe wohnungsloser Menschen (5). ...
Article
Zusammenfassung Hintergrund: Wohnungslosigkeit ist ein vielerorts kaum zu übersehendes und trotzdem gesamtgesellschaftlich weitgehend ignoriertes Phänomen. Menschen mit psychischen Problemen und bestehender Abhängigkeitserkrankung finden sich überzufällig häufig in der Gruppe Wohnungsloser. Methode: Eine internationale systematische Literaturrecherche wurde mit einer deutschsprachigen Recherche in der Datenbank des Netzwerkes für Versorgungsforschung kombiniert, um aktuelle Ergebnisse von Interventionen für Wohnungslose mit psychischen Erkrankungen darzustellen. Ergebnisse: Insbesondere im anglo-amerikanischen Sprachraum werden viele gemeindenahe Ansätze wie Housing First und Assertive Community Treatment beschrieben, die gute Ergebnisse für Wohnstabilität und Lebenszufriedenheit zeigen. Gemischt sind die Ergebnisse für die psychische Gesundheit. Forschung im deutschsprachigen Raum ist vergleichsweise defizitär. Ausblick: Niedrigschwellige oder aufsuchende Angebote scheinen vorteilhaft zu sein. Doch die Befunde lassen sich aufgrund sozialrechtlicher Unterschiede nicht per se auf die hiesigen Gegebenheiten übertragen. Das Problem wird gegenwärtig durch den sozialstrukturellen Wandel mit dem Aufkommen Geflüchteter verschärft.
... 1 We previously reported that the mean age of shelter users in Tokyo was around 65 years. 2 This is older than the mean age reported in Western countries, which one systematic review reported to be 40.1 years. 3 According to Ennis et al., 4 having cognitive impairment increases the risk of becoming and remaining homeless because it may interfere with an individual's ability to function independently in the community. ...
Article
Recent studies in Western countries reported that approximately half of older homeless persons entered homelessness for the first time in later life (late-onset homelessness). Characteristics of these individuals are reported to be different from those experiencing early-onset homelessness. However, studies investigating this issue in non-Western societies are lacking. We conducted a study on older homeless people aged 65 and over at the time they arrived at the shelters which are managed by one non-profit organization in Tokyo, Japan. During the recruitment period, a total of 58 people were admitted to the shelters; among these, 38 were 65 years and older, and 24 of those ≥65 years participated in this study. Among these, 14 participants were classified as experiencing homelessness for the first time in later life. These individuals had stable employment and housing histories, and no history of street dwelling or incarceration, suggesting that the concept of late-onset homelessness might be valid in non-Western settings.
Chapter
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This study was carried out with three goals: (1) to determine the prevalence of suicidal ideation and suicide attempts among the homeless; (2) to determine what aspects of homelessness predict suicidality, and (3) to determine which aspects remain predictive after controlling for key covariates, such as mental illness. A sample of 330 homeless adults were interviewed. Sixty-one percent of the study sample reported suicidal ideation and 34% had attempted suicide. Fifty-six percent of the men and 78% of the women reported prior suicidal ideation, while 28 percent of the men and 57% of the women had attempted suicide. Childhood homelessness of at least 1 week without family members and periods of homelessness longer than 6 months were found to be associated with suicidal ideation. Psychiatric diagnoses were also associated with suicidality in this sample.
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