"Making a homeless person even more homeless … it's a necessary evil": The health and safety complexities of service restrictions as perceived by emergency shelter staff.

Service restrictions involve people experiencing homelessness being banned from an emergency shelter in response to a violation of program policies. Their use can be a pathway into unsheltered homelessness and reliance on other institutional services. However, the prevalence of service restriction use and the perspectives of shelter staff toward the practice are unknown.

Housing and Support Intervention and Mortality Among Homeless Adults With Mental Illnesses: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Homelessness is an important risk factor for premature death, with individuals experiencing homelessness having substantially higher mortality rates than the general population.

Objective: To assess the association of housing and support interventions with mortality among individuals experiencing homelessness and mental illnesses.

Design, Setting, And Participants: This secondary analysis of a randomized clinical trial included 2255 homeless adults with mental illnesses.

High support housing for people with serious mental illness in Canada: a scoping review.

Introduction: Mental health supportive housing aims to provide accommodation and support services to people with serious mental illness (SMI). Various supportive housing models have emerged in Canada post-deinstitutionalization, with heterogeneous and limited available information on congregate-based high support housing models (HSH) that provide 24/7 onsite supports. A registered scoping review was undertaken to identify the models and outcomes of HSH for people with SMI in Canada, including those exiting homelessness.

Strengthening the delivery of integrated physical health care for adults experiencing serious mental illness: a scoping review of interventions in mental health settings.

Individuals living with serious mental illness (SMI) face significant barriers to accessing appropriate physical health care, poorer associated health outcomes and premature mortality compared to the general population. This scoping review examines service delivery models and clinical practices supporting the integration of physical health care for adults with SMI within mental health settings, and their outcomes. Searches of four academic databases yielded 65 academic articles.

The opportunity to save a life: A qualitative study of a point-of-care overdose education and naloxone distribution intervention.

Canada's opioid crisis continues to escalate. Naloxone can effectively reverse the effects of opioid overdose. We planned a randomized trial on the effectiveness of a point-of-care overdose education and naloxone distribution (OEND) intervention on participants' performance in a simulated opioid overdose scenario.

Cultural influences on fidelity components in recovery colleges: a study across 28 countries and territories.

Background: Recovery colleges (RCs) support personal recovery through education, skill development and social support for people with mental health problems, carers and staff. Guided by co-production and adult learning principles, RCs represent a recent mental health innovation. Since the first RC opened in England in 2009, RCs have expanded to 28 countries and territories.

"Get Well Enough to Make the Right Decision for Themselves"-Experiences and Perspectives of Clinicians Working with People with Serious Mental Illness and Their Substitute Decision Makers.

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person's capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical-legal system in psychiatric care.

The Quadruple Aim and Homelessness: A Framework for Evaluating Program- and System-level Outcomes and Prioritizing Effective Interventions in Policy.

Homelessness rates are increasing in North America, and the service systems that support people experiencing homelessness have been transformed by the COVID-19 pandemic and overdose crisis. There is an urgent need to evaluate the program- and system-level outcomes of transformed service delivery approaches and emergent innovations for people experiencing homelessness using a multifaceted approach. We propose that the Quadruple Aim is well-positioned and highly relevant for optimizing service delivery to people experiencing homelessness.

Exploring the Landscape of Intensive Outreach Services for Older Adults With Serious Mental Illness: A Scoping Review.

Older adults living with mental illness, particularly those with serious mental illness (SMI), represent a vulnerable and underserved patient population. Deinstitutionalization laid the groundwork for intensive outreach services for this population, yet little attention was paid to the unique needs of older individuals with SMI. We conducted a scoping literature review to map the landscape of intensive outreach services developed for older adults living with SMI.

Strengthening the Delivery of Physical Healthcare for Adults Living With Serious Mental Illness - A Qualitative Description of Patient and Family Member Perspectives.

Background: Individuals with serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10-20 years earlier than the general population. This qualitative study aimed to explore the perspectives and experiences of adults living with SMI and family members with accessing physical healthcare within primary and mental health settings in Canada.

Methods: We conducted a qualitative descriptive study using semi-structured interviews with 20 adults living with SMI and five focus groups with 18 family members between July 2023 and April 2024.

Heat-Related Health Risks for People Experiencing Homelessness: A Rapid Review.

Extreme heat poses a significant public health threat for people experiencing homelessness (PEH), who face heightened risks due to prolonged outdoor exposure and limited access to resources. This rapid review synthesizes research from the past five years on the health impacts of extreme heat for PEH in high-income countries. A total of 11 studies were identified through a systematic search of multiple databases, focusing on publications from 2019 to 2024.

Cognitive Correlates of Resilience in Adults Experiencing Homelessness.

Objective: In adults who have experienced homelessness, greater psychological resilience is related to better quality of life, community functioning, and social cognition. Domain-specific cognitive functioning is positively associated with resilience in housed populations; however, these relationships have yet to be explored among adults experiencing homelessness. The aim of this study is to examine the relationships between domain-specific cognitive function and psychological resilience among adults experiencing homelessness.

Strengthening the delivery of integrated care for individuals experiencing serious mental illness within mental health settings: a qualitative description of health provider perspectives.

Background: Individuals experiencing serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10-20 years earlier than the general population. They encounter multiple barriers to accessing appropriate physical health care in many countries, including Canada, where policies and practices to promote integrated care delivery to this population remain scant. This qualitative study aimed to explore health provider perspectives and experiences with integrated physical and mental health care within mental health settings in Canada, in efforts to address the health needs of this population.

Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs.

Risk management is an important component of service delivery in supportive housing and Housing First programs. However, there is no evidence on the implementation of risk management approaches in these settings. This qualitative study examined what service providers working in supportive housing and Housing First programs in Canada identify as the programmatic and organizational factors that affect the prevention and management of high-risk behaviours and challenges (e.

"Like the Wild West": Health care provider perspectives on impacts of recreational cannabis legalization on patients and providers at a tertiary psychiatric hospital in Ontario, Canada.

Introduction: Legalization has increased cannabis availability in Canada. Research shows complex relationships between cannabis use and mental health, and a need for health care providers to engage with patients about cannabis use. Providers have noted gaps in knowledge and research on the medical effects of cannabis as barriers to service delivery.

Antecedents and Consequences of Violence in Homeless Shelters: Perspectives and Experiences of Service Users and Shelter Staff.

Violence is a critical issue in homeless shelters that affects service users and staff, yet there is limited evidence on how shelter-based violence occurs. The objective of this qualitative study was to investigate the antecedents and consequences of shelter-based violence from the perspectives of service users and staff. Purposive sampling was used to recruit individuals experiencing homelessness and shelter staff in a large metropolitan city in Ontario, Canada.

Capacity to Consent to Treatment of Substance Use Disorders at Ontario's Consent and Capacity Board: A Review of Past Reported Decisions.

An Ontario review of legal cases which have considered patients' ability to consent to substance use treatments.