ASSESSMENT AND PLANNING

Assessment and Planning for Population Health

Assessment and Planning for Population Health

Introduction

The phenomenon of homelessness is not new and there were already among the homeless, before the era of deinstitutionalization of the mentally ill or people with disorders caused by alcohol and drugs. Thus, in 1963 in areas frequented, by homeless U.S., it was estimated, that there were 20% of the mentally ill (Bachrach, 2004). However, what is new since the early 80s is the increase in the proportion of the mentally ill become homeless. Between 1980 and 1987, there is the United States increased from 500 to 900% among homeless and psychiatric patients and 500% among alcoholic patients (Bachrach, 2004). Patients previously hospitalized in psychiatric long-term, however, have not been rendered homeless by the treatment team. Instead, they have patiently been reintegrated into the community and they are usually well attended.

However, deinstitutionalization has been accompanied, by three profound changes in the way of giving psychiatric care. First, it better reflects the choice of people in decisions affecting them. Respect for autonomy has become over the last fifty years the undisputed value of a humanist psychiatry, finally freed from the role of social control which had confined the absence of effective therapeutic means. For his part, anxious to protect patients from abuses of the old psychiatric asylum, the legislature has made it more difficult opportunities to hospitalize and treat patients against their will. Finally, indications for psychiatric hospitalization are much more restrictive today than in the 70's due to a significant reduction in the number of beds (we went to Quebec to 20,000 beds from 1965 to 3440 beds in 2004 almost six times less. Most of the psychiatric care is now given, on an outpatient basis (Fischer, 2006).

These changes are beneficial for most patients but, they precipitate a growing number of people weakened by illness in poverty. These people, sometimes disturbing but not dangerous according to the usual criteria, choose the "freedom" rather than care but do not have the capacity to bear the consequences of their choice (Craig, 2006). The lack of affordable housing and almost daily loss of jobs requiring no special qualifications only aggravate the risks of precariousness. The street becomes a good number of patients the only option available. This first analysis shows immediately that psychiatrists and lawyers are a priori affected by the phenomenon of homelessness since the reforms they have known their wishes to protect the rights of patients unfortunately, create "collateral" damage. Many clues suggest that the organization of care and the current constraints of the law concerning the mentally ill help lay the wandering urban vulnerable people (Fischer, 2006).

Discussion

The Department of Health and Human Services estimates that the number of homeless at between 500,000 and 600,000 thousand people. About a third of them are considered, to suffer from serious mental illness. In general, schizophrenia, bipolar disorder or major depression and the numbers keep growing. People with mental illnesses have a higher rate of homelessness, with all the problems ...