No Fixed Address version 2 (NFA v.2)

Discharge from hospital can result in living in homeless shelters or on the streets. In one year alone, Forchuk and colleagues (2006) found at least 194 individuals were directly discharged from London psychiatric in-patient programs to shelters or ‘No Fixed Address’. Although this issue is seldom discussed in the professional literature, information from shelters around the world and public press indicate it is a common problem (Forchuk et al., 2006). Research illustrates the impact of homelessness and financial crisis on recovery and long-term outcomes, including health issues of greater complexity and preventable use of costly healthcare services (Mikkonen& Raphael, 2010; Munn-Rivard, 2014). Hospitals must expend an additional $2,559 to care for an individual who is homeless (

One strategy developed by Forchuk and colleagues (2 streamlines housing and social support using on-site hospital access to resources. A pilot of the proposed strategy found that all seven participants randomly assigned to the intervention continued to be housed at three and six months’ follow-up, while individuals in usual care remained unhoused or had entered the sex trade (Forchuk et al., 2006). The next phase, called the No Fixed Address (NFA) project – for preventing discharge to ‘No Fixed Address’, used direct access to the Ontario Works database from hospital wards and access to a housing advocate and housing database (Forchuk et al., 2013). In this phase, only 3 of the 256 people accessing the service were discharged into homelessness. Despite NFA being effective, it was not sustained. Both hospital sites with psychiatric programs have physically moved, the Ontario Works database has changed, the Community Start-Up program has been discontinued and replaced by local initiatives, and the network of crises and homeless services has evolved.

With this changing context, the research team is implementing the No Fixed Address version 2 (NFAv.2) project to the effectiveness of a potential best practice for preventing discharge into homelessness.

The strategy brings in Housing Stability Workers from the Canadian Mental Health Association, caseworkers from Ontario Works, and Housing Stability Bank workers from the Salvation Army Centre of Hope, allowing clients to access their services by drop-in or appointment. Researchers will collect data from multiple administrative sources to determine the number of individuals who are homeless or at risk for homelessness, their service use, and demographics. Qualitative data will be obtained from participants and staff using interviews and focus groups to explore their experiences.

If successful the NFA strategy could be more widely implemented and offer policy alternatives for preventing homeless in individuals with mental health and housing challenges. Homelessness has a detrimental effect on recovery from mental illness and the impact of locating adequate housing for discharged psychiatric patients may have a positive impact on their treatment and rehabilitation and, ultimately, on the system as a whole.

References

Forchuk, C., Godin, M., Hoch, J. S., Kingston-MacClure, S., Jeng, M. S., Puddy, L., Vann, R., & Jensen, E. (2013). Preventing psychiatric discharge to homelessness. Canadian Journal of Community Mental Health, 32(3), 17-28. doi:10.7870/cjcmh-2013-028

Forchuk, C., MacClure, S. K., Van Beers, M., Smith, c., Csiernik, R., Hoch, J., & Jensen, E. (2008). Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and ‘no fixed address’. Journal of Psychiatric and Mental Health Nursing, 15(7), 569-575. doi:10.1111/j.1365-2850.2008.01266.x

Forchuk, C., Russel, G., Kingston-MacClure, S., Turner, K., & Dill, S. (2006). From psychiatric ward to the streets and shelters. Journal of Psychiatric and Mental Health Nursing, 13, 301–308. doi:10.1111/j.1365-2850.2006.00954.x

Hwang, S. W., Weaver, J., Aubry,T., & Hoch, J. S. (2011). Hospital costs and length of stay among homeless patients admitted to medical, surgical, and psychiatric services. Medical Care, 49(4), 350-354. doi:10.1097/MLR.0b013e318206c50d

Mikkonen, J., & Raphael, D. (2010). Social determinants of health: The Canadian facts. Toronto: York University School of Public Health and Management. Retrieved from http://www.thecanadianfacts.org/the_canadian_facts.pdf

Munn-Rivard, J. (2014). Current issues in mental health in Canada: Homelessness and access to housing. Retrieved from http://www.lop.parl.gc.ca/content/lop/ResearchPublications/2014-11-e.html

Press

Expanded No Fixed Address strategy houses half of those in danger of homelessness (Lawson Research, June 2019)
Research aims to prevent discharged patients from becoming homeless (CTV News London, June 2019)
Homelessness stemmed by transition 'helping hand' (Western University, June 2019)
Study points out need for housing worker embedded in hospital: Researcher (London Free Press, June 2019)
“Preventing homelessness after hospital discharge” (Inside, Fall 2019)

Team