COPENHAGEN COMMUNITY PSYCHIATRIC PROJECT (CCPP) - CHARACTERISTICS ANDTREATMENT OF HOMELESS PATIENTS IN THE PSYCHIATRIC-SERVICES AFTER INTRODUCTION OF COMMUNITY-MENTAL-HEALTH-CENTERS

The main purpose of the study was to describe the characteristics of h omeless psychiatric patients, and to compare the treatment they are of fered to that offered to domiciled patients by the psychiatric service s. Another purpose was to analyse the prevalence of homelessness among psychiatric patients before and after the introduction of community m ental health centres in Copenhagen. Cross-sectional studies were condu cted in two intervention and two control districts before and after in troduction of the new treatment modalities. In 1991, 80 of 1008 patien ts (8%) were homeless. Male sex, young age, living on general welfare, schizophrenia and alcohol or substance abuse were the factors that mo st markedly differentiated homeless from domiciled patients. Compared with the treatment of domiciled patients, the homeless were more likel y to be offered no further treatment after consultation in a psychiatr ic emergency and, if admitted, they were more likely to be placed in l ocked wards, given compulsory medication, and medicated with depot neu roleptics. The homeless were also less likely to be offered psychother apy and consultation with a social worker. Schizophrenia and alcohol o r substance abuse characterised the majority of the patients discharge d homeless. In the intervention districts, the number of homeless pati ents in contact with the psychiatric services was found to increase at the same rate as the number of all patients in contact with the psych iatric services. In the control districts, no changes in prevalence of homeless patients or other patients in contact with the psychiatric s ervices occurred. It is concluded that homeless psychiatric patients c omprise a difficult patient group, with problems of schizophrenia, sub stance abuse and lack of motivation for treatment. It is recommended t hat special efforts be made to create housing facilities that fit the needs of different types of homeless patients, and that the homeless m entally ill are assisted in obtaining and maintaining an acceptable ho using situation.