How to Help Young People with Early Psychosis avoid Homlessness?

Abstract

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.