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

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
• 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
• 3 Gühne U, Becker T, Salize H. et al. Wie viele Menschen sind in Deutschland schwer psychisch krank?. Psychiat Prax 2015; 42: 415-423
• 4 Finzen A. Auf dem Wege zur Reform – die Psychiatrie-Enquete wird 40. Psychiat Prax 2015; 42: 392-396
• 5 DGPPN. S3-Leitlinie Psychosoziale Therapien bei schweren psychischen Erkrankungen. S3-Praxisleitlinien in Psychiatrie und Psychotherapie. Berlin: Springer; 2013
• 6 BAGüS. Kennzahlenvergleich der überörtlichen Träger der Sozialhilfe 2014. Im Internet: www.bagues.de (Stand: 16.02.2016)
• 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)
• 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)
• 9 Völlm B, Becker H, Kunstmann W. Psychiatrische Morbidität bei allein stehenden wohnungslosen Männern. Psychiat Prax 2004; 31: 236-240
• 10 Torchella I, Anbrecht F, Buchkrämer G. et al. Wohnungslose Frauen mit psychischer Erkrankung – eine Feldstudie. Psychiat Prax 2004; 31: 228-235
• 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)
• 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
• 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
• 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
• 15 Mueser KT, Deavers F, Penn DL. et al. Psychosocial Treatments for Schizophrenia. Annu Rev Clin Psychol 2013; 9: 465-497
• 16 Rosemann M, Konrad M. Handbuch Betreutes Wohnen. Von der Heimversorgung zur ambulanten Unterstützung. Bonn: Psychiatrie-Verlag; 2011
• 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
• 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)
• 19 Bitter D, Entenfellner A, Matschnig T. Da-Heim im Heim!? Bedeutet Ent-Hospitalisierung auch Ent-Institutionalisierung?. Psychiat Prax 2009; 36: 261-269
• 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
• 21 Benston EA. Housing Programs for Homeless Individuals With Mental Illness: Effects on Housing and Mental Health Outcomes. Psychiatr Serv 2015; 66: 806-816
• 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
• 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
• 24 Rog DJ, Marshall T, Dougherty RH. et al. Permanent supportive housing: assessing the evidence. Psychiatr Serv 2014; 65: 287-294
• 25 Sun AP. Helping homeless individuals with co-occurring disorders: the four components. Soc Work 2012; 57: 23-37
• 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
• 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
• 28 Macpherson R, Edwards TR, Chilvers R. et al. Twenty-four hour care for schizophrenia. Cochrane Database Syst Rev 2009 (02): CD004409
• 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
• 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
• 31 Chilvers R, Macdonald GM, Hayes AA. Supported housing for people with severe mental disorders. Cochrane Database Syst Rev 2006 (04): CD000453
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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)
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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)
• 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
• 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
• 67 Schutt RK, Goldfinger SM. Housing preferences and perceptions of health and functioning among homeless mentally ill persons. Psychiatr Serv 1996; 47: 381-386
• 68 Tanzman B. An overview of surveys of mental health consumers’ preferences for housing and support services. Hosp Community Psychiatry 1993; 44: 450-455
• 69 Zelen M. A New Design for Randomized Clinical Trials. The New England Journal of Medicine 1979; 300: 1242-1245
• 70 Torgerson DJ, Sibbald B. What is a patient preference trial?. BMJ 1998; 316: 360
• 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
• 72 Goering P, Veldhuizen S, Nelson GB. et al. Further Validation of the Pathways Housing First Fidelity Scale. Psychiatr Serv 2016; 67: 111-114
• 73 Walther C. Betreutes Wohnen psychisch kranker Menschen. Wirksamkeitsstudien in Deutschland. Soziale Arbeit 2014; 63: 54-62
• 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
• 75 Salize HJ, Arnold M, Uber E. et al. Verbesserung der psychiatrischen Behandlungsprävalenz bei Risikopersonen vor dem Abrutschen in die Wohnungslosigkeit. Psychiat Prax 2015;
• 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
• 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
• 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
• 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
• 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
• 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