Psychiatric services : a journal of the American Psychiatric Association
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This paper compares the prevalence of mental illnesses and alcohol and drug abuse and the residential histories of homeless individuals identified as having a mental illness and individuals who are not so identified. The cohort consisted of single persons applying for shelter over a 12-week period in Westchester County, a suburban county in New York State. ⋯ Not only is residential instability heightened among shelter users with mental illness, but over time public institutions play a critical role in their accommodations. For some homeless persons with mental illness, the circuit of shelters, rehabilitation programs, jails, and prisons may function as a makeshift alternative to inpatient care or supportive housing and may reinforce the marginalization of this population.
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In the early 1990s the National Institute of Mental Health sponsored projects in four cities that served a total of 896 homeless mentally ill adults. Each project tested the effectiveness of different housing, support, and rehabilitative services in reducing homelessness. Most homeless individuals resided in community housing after the intervention. ⋯ A 47.5 percent increase in community housing was found for those in active treatment conditions. At final follow-up, 78 percent of participants in community housing were stably housed. The findings indicate that effective strategies are available for serving homeless individuals with severe mental illness.
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Case Reports
Clinical implications of respect for autonomy in the psychiatric treatment of pregnant patients with depression.
Major depression, as well as depressive symptoms that do not meet the full diagnostic criteria for a diagnosis of depression, can chronically and variably affect a woman patient's decisions about the management of pregnancy, including the decision about whether to continue a pregnancy. Depression also has potential adverse consequences for the pregnant woman and her pregnancy. ⋯ The authors recommend strategies for assessing the decision-making abilities of pregnant patients with depression and for enhancing their autonomy. They suggest that nondirective counseling should generally be used with pregnant patients with depression when the fetus is previable and that directive counseling is ethically justifiable when the fetus is viable.