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Psychiatr Prax 2017; 44(04): 194-205
DOI: 10.1055/s-0042-118594
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Wohninterventionen für Menschen mit schweren psychischen Störungen – Internationale Evidenz aus RCTs

Housing Interventions in Severe Mental Illness – International Evidence from RCTs
Uta Gühne
1   Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig
,
Janine Stein
1   Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig
,
Stefan Weinmann
2   Universitäre Psychiatrische Kliniken Basel/Schweiz
,
Thomas Becker   *
3   Klinik für Psychiatrie und Psychotherapie II der Universität Ulm, Bezirkskrankenhaus Günzburg
,
Steffi G. Riedel-Heller   *
1   Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig
› Author Affiliations
Further Information

Publication History

Publication Date:
26 January 2017 (online)

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Zusammenfassung

Hintergrund Im Rahmen psychosozialer Interventionen für psychisch kranke Menschen nehmen Wohnangebote eine Schlüsselposition ein. Welche Evidenz gibt es hinsichtlich deren Effektivität?

Methode Systematische Literaturrecherche nach randomisierten kontrollierten Studien (RCTs).

Ergebnisse Wenige RCTs, vornehmlich mit Wohnungslosen, wurden identifiziert. Wohninterventionen in Form unabhängigen Wohnens mit Unterstützung (Supported Housing) bei Wohnungslosen führen zu größerer Wohnstabilität. Aussagen zur Effektivität verschiedener Wohninterventionen im Vergleich lassen sich kaum treffen.

Schlussfolgerungen Mit dem Begriff des Supported Housing wurde ein Paradigmenwechsel eingeläutet. Es besteht erheblicher Forschungsbedarf, insbesondere für schwer psychisch Kranke, die nicht explizit von Wohnungslosigkeit bedroht sind.

Abstract

Objective Housing is important among psychosocial interventions for people with severe mental disorders. What do we know about the effectiveness of housing interventions?

Methods Systematic literature search for RCTs.

Results Few RCTs, almost exclusively with homeless individuals were conducted. Housing stability is one of the most direct indicators of the effectiveness of housing interventions among homeless people. There are weaker or inhomogeneous findings in other outcome areas. There are no clear results yet regarding the effectiveness of different housing interventions compared with each other.

Conclusions The variability in routine interventions complicates their comparison. Future studies should address the housing needs of people who are at risk of getting homeless and of people living in inadequate housing. Methodological challenges are discussed.

Schlüsselwörter

Versorgungsforschung - schwere psychische Störungen - Supported Housing - betreutes Wohnen - Evidenz

Keywords

health services research - severe mental disorders - supported housing - evidence

* geteilte Letztautorschaft


 

  • Literatur

  • 1 Maslow A. Motivation and Personality. New York: Harper; 1954
    Google Scholar
  • 2 Kyle T, Dunn JR. Effects of housing circumstances on health, quality of life and healthcare use for people with severe mental illness: a review. Health Soc Care Community 2008; 16: 1-15
    CrossrefPubMedGoogle Scholar
  • 3 Gühne U, Becker T, Salize H. et al. Wie viele Menschen sind in Deutschland schwer psychisch krank?. Psychiat Prax 2015; 42: 415-423
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Finzen A. Auf dem Wege zur Reform – die Psychiatrie-Enquete wird 40. Psychiat Prax 2015; 42: 392-396
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 DGPPN. S3-Leitlinie Psychosoziale Therapien bei schweren psychischen Erkrankungen. S3-Praxisleitlinien in Psychiatrie und Psychotherapie. Berlin: Springer; 2013
    Google Scholar
  • 6 BAGüS. Kennzahlenvergleich der überörtlichen Träger der Sozialhilfe 2014. Im Internet: www.bagues.de (Stand: 16.02.2016)
    Google Scholar
  • 7 AOLG/AG Psychiatrie. Weiterentwicklung der psychiatrischen Versorgungsstrukturen in Deutschland – Bestandsaufnahme und Perspektiven. Beschluss der Gesundheitsministerkonferenz der Länder vom 28. Juni 2012. Im Internet: http://www.masgf.brandenburg.de/cms/detail.php/bb1.c.348046.de (Stand: 28.09.2016)
    Google Scholar
  • 8 DGSP. Eingliederungshilfe auf dem Weg zur Inklusion. Positionspapier des DGSP-Fachausschusses Menschen in Heimen. Im Internet: www.psychiatrie.de/dgsp (Stand: 26.01.2016)
    Google Scholar
  • 9 Völlm B, Becker H, Kunstmann W. Psychiatrische Morbidität bei allein stehenden wohnungslosen Männern. Psychiat Prax 2004; 31: 236-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Torchella I, Anbrecht F, Buchkrämer G. et al. Wohnungslose Frauen mit psychischer Erkrankung – eine Feldstudie. Psychiat Prax 2004; 31: 228-235
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 BAGW. Zahl der Wohnungslosen in Deutschland auf neuem Höchststand. Pressemitteilung (05.10.2015). Im Internet: www.bagw.de/de/themen/zahl_der_wohnungslosen/index.html (Stand: 11.02.2016)
    Google Scholar
  • 12 Salize HJ, Dillmann-Lange C, Kentner-Figura B. et al. Drohende Wohnungslosigkeit und psychische Gefährdung – Prävalenz und Einflussfaktoren bei Risikopopulationen. Nervenarzt 2006; 77: 1345-1354
    CrossrefPubMedGoogle Scholar
  • 13 Tsemberis S, Assmussen S. From streets to homes: The pathways to housing consumer preference supported housing model. Alcoh Treat Q 1999; 17: 113-131
    PubMedGoogle Scholar
  • 14 Leff HS, Chow CM, Pepin R. et al. Does one size fit all? What we can and can’t learn from a meta-analysis of housing models for persons with mental illness. Psychiatr Serv 2009; 60: 473-482
    CrossrefPubMedGoogle Scholar
  • 15 Mueser KT, Deavers F, Penn DL. et al. Psychosocial Treatments for Schizophrenia. Annu Rev Clin Psychol 2013; 9: 465-497
    CrossrefPubMedGoogle Scholar
  • 16 Rosemann M, Konrad M. Handbuch Betreutes Wohnen. Von der Heimversorgung zur ambulanten Unterstützung. Bonn: Psychiatrie-Verlag; 2011
    Google Scholar
  • 17 Siskind D, Harris M, Pirkis J. et al. A domains-based taxonomy of supported accommodation for people with severe and persistent mental illness. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 875-894
    CrossrefPubMedGoogle Scholar
  • 18 Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Chapter 8: Assessing risk of bias in included studies. (updated March 2011). Im Internet: www.cochrane-handbook.org (Stand: 10.02.1016)
    Google Scholar
  • 19 Bitter D, Entenfellner A, Matschnig T. Da-Heim im Heim!? Bedeutet Ent-Hospitalisierung auch Ent-Institutionalisierung?. Psychiat Prax 2009; 36: 261-269
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Ruggeri M, Leese M, Thornicroft G. et al. Definition and prevalence of severe and persistent mental illness. Br J Psychiatry 2000; 177: 149-155
    CrossrefPubMedGoogle Scholar
  • 21 Benston EA. Housing Programs for Homeless Individuals With Mental Illness: Effects on Housing and Mental Health Outcomes. Psychiatr Serv 2015; 66: 806-816
    CrossrefPubMedGoogle Scholar
  • 22 Aubry T, Nelson G, Tsemberis S. Housing First for People with Severe Mental Illness who are Homeless: A Review of the Research and Findings From the At Home-Chez soi Demonstration Project. Can J Psychiatry 2015; 60: 467-474
    CrossrefPubMedGoogle Scholar
  • 23 Ly A, Latimer E. Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature. Can J Psychiatry 2015; 60: 475-487
    CrossrefPubMedGoogle Scholar
  • 24 Rog DJ, Marshall T, Dougherty RH. et al. Permanent supportive housing: assessing the evidence. Psychiatr Serv 2014; 65: 287-294
    CrossrefPubMedGoogle Scholar
  • 25 Sun AP. Helping homeless individuals with co-occurring disorders: the four components. Soc Work 2012; 57: 23-37
    CrossrefPubMedGoogle Scholar
  • 26 Tabol C, Drebing C, Rosenheck R. Studies of “supported” and “supportive” housing: A comprehensive review of model descriptions and measurement. Eval Program Plann 2010; 33: 446-456
    CrossrefPubMedGoogle Scholar
  • 27 O’Campo P, Kirst M, Schaefer-McDaniel N. et al. Community-based services for homeless adults experiencing concurrent mental health and substance use disorders: a realist approach to synthesizing evidence. J Urban Health 2009; 86: 965-989
    CrossrefPubMedGoogle Scholar
  • 28 Macpherson R, Edwards TR, Chilvers R. et al. Twenty-four hour care for schizophrenia. Cochrane Database Syst Rev 2009 (02): CD004409
    PubMedGoogle Scholar
  • 29 Taylor TL, Killaspy H, Wright C. et al. A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems. BMC Psychiatry 2009; 9: 55
    CrossrefPubMedGoogle Scholar
  • 30 Nelson G, Aubry T, Lafrance A. A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. Am J Orthopsychiatry 2007; 77: 350-361
    CrossrefPubMedGoogle Scholar
  • 31 Chilvers R, Macdonald GM, Hayes AA. Supported housing for people with severe mental disorders. Cochrane Database Syst Rev 2006 (04): CD000453
    PubMedGoogle Scholar
  • 32 Stergiopoulos V, Hwang SW, Gozdzik A. et al. Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness. A Randomized Trial. JAMA 2015; 313: 905-915
    CrossrefPubMedGoogle Scholar
  • 33 Aubry T, Goering P, Veldhuizen S. et al. A multiple-City RCT of Housing First with Assertive Community Treatment for homeless Canadiens with severe mental illness. Psychiatric Serv 2016; 67: 275-281
    CrossrefPubMedGoogle Scholar
  • 34 Goldfinger SM, Schutt RK, Tolomiczenko GS. et al. Housing placement and subsequent days homeless among formerly homeless adults with mental illness. Psychiatr Serv 1999; 50: 674-679
    CrossrefPubMedGoogle Scholar
  • 35 Seidman LJ, Schutt RK, Caplan B. et al. The effect of housing interventions on neuropsychological functioning among homeless persons with mental illness. Psychiatr Serv 2003; 54: 905-908
    CrossrefPubMedGoogle Scholar
  • 36 Tsemberis S, Gulcur L, Nakae M. Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health 2004; 94: 651-656
    CrossrefPubMedGoogle Scholar
  • 37 Gulcur L, Stefancic A, Shinn M. et al. Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and Housing First programmes. J Community Appl Soc Psychol 2003; 13: 171-186
    CrossrefPubMedGoogle Scholar
  • 38 Herman D, Conover S, Gorroochurn P. et al. A randomized trial of critical time intervention to prevent homelessness in persons with severe mental illness following institutional discharge. Psychiatr Serv 2011; 62: 713-719
    CrossrefPubMedGoogle Scholar
  • 39 Tomita A, Herman DB. The Impact of Critical Time Intervention in Reducing Psychiatric Re-Hospitalization Following Hospital Discharge. Psychiatr Serv 2012; 63: 935-937
    CrossrefPubMedGoogle Scholar
  • 40 McHugo GJ, Bebout RR, Harris M. et al. A randomized controlled trial of integrated versus parallel housing services for homeless adults with severe mental illness. Schizophr Bull 2004; 30: 969-982
    CrossrefPubMedGoogle Scholar
  • 41 Bastian H, Bender R, Ernst AS. et al. Methoden. Im Internet: https://www.iqwig.de/download/Methoden_IQWiG_Entwurf_V-2-0.pdf (Stand: 23.09.2016)
    Google Scholar
  • 42 Veldhuizen S, Adair CE, Methot C. et al. Patterns and predictors of attrition in a trial of a housing intervention for homeless people with mental illness. Soc Psychiatry Epidmiol 2015; 50: 195-202
    PubMedGoogle Scholar
  • 43 Patterson M, Moniruzzaman A, Palepu A. et al. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 1245-1259
    CrossrefPubMedGoogle Scholar
  • 44 Stergiopoulos V, Gozdzik A, Misir V. et al. Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial. PLoS One 2015; 10: e0130281
    CrossrefPubMedGoogle Scholar
  • 45 Kirst M, Zerger S, Misir V. et al. The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug Alcohol Depend 2015; 146: 24-29
    CrossrefPubMedGoogle Scholar
  • 46 Palepu A, Patterson ML, Moniruzzaman A. et al. Housing First Improves Residential Stability in Homeless Adults with concurrent substance dependence and mental disorders. Am J Public Health 2013; 103 (Suppl. 02) e30-36
    PubMedGoogle Scholar
  • 47 Patterson ML, Moniruzzaman A, Somers JM. Community Participation and Belonging Among Formerly Homeless Adults with Mental Illness After 12 months of Housing First in Vancouver, British Columbia: A Randomized Controlled Trial. Community Ment Health J 2014; 50: 604-611
    CrossrefPubMedGoogle Scholar
  • 48 Somers JM, Rezansoff SN, Moniruzzaman A. et al. Housing First Reduces Re-offending among Formerly Homeless Adults with Mental Disorders: Results of a Randomized Controlled Trial. PLoS One 2013; 8: e72946
    CrossrefPubMedGoogle Scholar
  • 49 Woodhall-Melnik J, Misir V, Kaufman-Shriqui V. et al. The Impact of a 24 Month Housing First Intervention on Participants’ Body Mass Index and Waist Circumference: Results from the At Home/Chez Soi Toronto Site Randomized Controlled Trial. PLoS One 2015; 10: e0137069
    CrossrefPubMedGoogle Scholar
  • 50 Gulcur L, Tsemberis S, Stefancic A. et al. Community integration of adults with psychiatric disabilities and histories of homelessness. Community Ment Health J 2007; 43: 211-228
    CrossrefPubMedGoogle Scholar
  • 51 Hurlburt MS, Hough RL, Wood PA. Effects of substance abuse on housing stability of homeless mentally Ill persons in supported housing. Psychiatr Serv 1996; 47: 731-736
    CrossrefPubMedGoogle Scholar
  • 52 Dickey B, Gonzalez O, Latimer E. et al. Use of mental health services by formerly homeless adults residing in group and independent housing. Psychiatr Serv 1996; 47: 152-158
    CrossrefPubMedGoogle Scholar
  • 53 Greenwood RM, Schaefer-McDaniel NJ, Winkel G. et al. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. Am J Community Psychol 2005; 36: 223-238
    CrossrefPubMedGoogle Scholar
  • 54 Schutt RK, Goldfinger SM, Penk WE. Satisfaction with residence and with life: When homeless mentally ill persons are housed. Eval Program Plann 1997; 20: 185-194
    CrossrefPubMedGoogle Scholar
  • 55 Lipton FR, Nutt S, Sabatini A. Housing the homeless mentally ill: a longitudinal study of a treatment approach. Hosp Community Psychiatry 1988; 39: 40-45
    PubMedGoogle Scholar
  • 56 Hyde C, Bridges K, Goldberg D. et al. The evaluation of a hostel. A controlled study using modified cost-benefit analysis. Br J Psychiatry 1987; 151: 805-812
    CrossrefPubMedGoogle Scholar
  • 57 Dickey B, Latimer E, Powers K. et al. Housing costs for adults who are mentally ill and formerly homeless. J Ment Health Adm 1997; 24: 291-305
    CrossrefPubMedGoogle Scholar
  • 58 de Vet R, van Luijtelaar MJ, Brilleslijper-Kater SN. et al. Effectiveness of Case Management for Homeless Persons: A Systematic Review. Am J Public Health 2013; 103: e13-e26
    PubMedGoogle Scholar
  • 59 Tomita A, Herman DB. The role of a critical time intervention on the experience of continuity of care among persons with severe mental illness following hospital discharge. J Nerv Ment Dis 2015; 203: 65-70
    CrossrefPubMedGoogle Scholar
  • 60 Tomita A, Lukens EP, Herman DB. Mediation analysis of critical time intervention for persons living with serious mental illnesses: Assessing the role of family relations in reducing psychiatric re-hospitalization. Psychiatr Rehabil J 2014; 37: 4-10
    CrossrefPubMedGoogle Scholar
  • 61 Susser E, Valencia E, Conover S. et al. Preventing recurrent homelessness among mentally ill men: A “critical time” intervention after discharge from a shelter. Am J Public Health 1997; 87: 256-262
    CrossrefPubMedGoogle Scholar
  • 62 Herman D, Opler L, Felix A. et al. A critical time intervention with mentally ill homeless men: impact on psychiatric symptoms. J Nerv Ment Dis 2000; 188: 135-140
    CrossrefPubMedGoogle Scholar
  • 63 Jones K, Colson PW, Holter MC. et al. Cost-effectiveness of critical time intervention to reduce homelessness among persons with mental illness. Psychiatr Serv 2003; 54: 884-890
    CrossrefPubMedGoogle Scholar
  • 64 Goering P, Veldhuizen S, Watson A, Adair C, Kopp B, Latimer E, Nelson G, MacNaughton E, Streiner D, Aubry T. National At Home/Chez Soi Final Report. Im Internet: http://www.mentalhealthcommission.ca (Stand: 22.01.2016)
    Google Scholar
  • 65 Tsai J, Bond GR, Salyers MP. et al. Housing preferences and choices among adults with mental illness and substance use disorders: a qualitative study. Community Ment Health J 2010; 46: 381-388
    CrossrefPubMedGoogle Scholar
  • 66 Piat M, Lesage A, Boyer R. et al. Housing for persons with serious mental illness: consumer and service provider preferences. Psychiatr Serv 2008; 59: 1011-1017
    CrossrefPubMedGoogle Scholar
  • 67 Schutt RK, Goldfinger SM. Housing preferences and perceptions of health and functioning among homeless mentally ill persons. Psychiatr Serv 1996; 47: 381-386
    CrossrefPubMedGoogle Scholar
  • 68 Tanzman B. An overview of surveys of mental health consumers’ preferences for housing and support services. Hosp Community Psychiatry 1993; 44: 450-455
    PubMedGoogle Scholar
  • 69 Zelen M. A New Design for Randomized Clinical Trials. The New England Journal of Medicine 1979; 300: 1242-1245
    CrossrefPubMedGoogle Scholar
  • 70 Torgerson DJ, Sibbald B. What is a patient preference trial?. BMJ 1998; 316: 360
    CrossrefPubMedGoogle Scholar
  • 71 Relton C, Torgerson D, O’Cathain A. et al. Rethinking pragmatic randomised controlled trials: introducing the “cohort multiple randomised controlled trial” design. BMJ 2010; 340: c1066
    CrossrefPubMedGoogle Scholar
  • 72 Goering P, Veldhuizen S, Nelson GB. et al. Further Validation of the Pathways Housing First Fidelity Scale. Psychiatr Serv 2016; 67: 111-114
    CrossrefPubMedGoogle Scholar
  • 73 Walther C. Betreutes Wohnen psychisch kranker Menschen. Wirksamkeitsstudien in Deutschland. Soziale Arbeit 2014; 63: 54-62
    PubMedGoogle Scholar
  • 74 Quadflieg N, Fichter MM. Ist die Zuweisung dauerhaften Wohnraums an Obdachlose eine effektive Maßnahme? Eine prospektive Studie über drei Jahre zum Verlauf psychischer Beschwerden. Psychiat Prax 2007; 34: 276-282
    Article in Thieme ConnectPubMedGoogle Scholar
  • 75 Salize HJ, Arnold M, Uber E. et al. Verbesserung der psychiatrischen Behandlungsprävalenz bei Risikopersonen vor dem Abrutschen in die Wohnungslosigkeit. Psychiat Prax 2015; DOI: 10.1055/s-0035-1552764.
    PubMedGoogle Scholar
  • 76 Schutt RK, Seidman LJ, Caplan B. et al. The role of neurocognition and social context in predicting community functioning among formerly homeless seriously mentally ill persons. Schizophr Bull 2007; 33: 1388-1396
    PubMedGoogle Scholar
  • 77 Shern DL, Felton CJ, Hough RL. Housing outcomes for homeless adults with mental illness: results from the second-round McKinney Program. Psychiatr Serv 1997; 48: 239-241
    CrossrefPubMedGoogle Scholar
  • 78 Schutt RK, Hough RL, Goldfinger SM. et al. Lessening Homelessness Among Persons with Mental Illness: A Comparison of Five Randomized Treatment Trials. Asian J Psychiatr 2009; 2: 100-102
    CrossrefPubMedGoogle Scholar
  • 79 Padgett DK, Gulcur L, Tsemberis S. Housing First Services for People Who Are Homeless With Co-Occurring Serious Mental Illness and Substance Abuse. Res Soc Work Pract 2006; 16: 74-83
    CrossrefPubMedGoogle Scholar
  • 80 Somers JM, Patterson ML, Moniruzzaman A. et al. Vancouver At Home: pragmatic randomized trials investigating Housing First for homeless and mentally ill adults. Trials 2013; 14: 365
    CrossrefPubMedGoogle Scholar
  • 81 Hwang SW, Stergiopoulos V, O’Campo P. et al. Ending homelessness among people with mental illness: the At Home/Chez Soi randomized trial of a Housing First intervention in Toronto. BMC Public Health 2012; 12: 787
    CrossrefPubMedGoogle Scholar