Release from prison is a vulnerable period, especially for people with severe mental illness. Critical Time Intervention (CTI) can be effective in improving service access and reducing negative outcomes. Nested within a randomised controlled trial of CTI, qualitative interviews were conducted with trial participants in both intervention (CTI) and treatment as usual (TAU) arms, CTI managers delivering the intervention and associated professionals. Data were analysed using a framework approach. Four themes were identified: uncertainty about post-release plans; inadequate housing provision; support during transition; and continuity of care. Interviewees shared common concerns about transition into the community but CTI participants felt less anxious about release and reported receiving more support with housing, access to services and community reintegration than during previous periods of incarceration. Professionals raised concerns about the time-limited nature of CTI and the impact of austerity measures on the availability of support following CTI. Implications for service delivery will be discussed.

The purpose of this paper is to describe the development and initial accomplishments of a training program of young leaders in community mental health research as part of a Latin American initiative known as RedeAmericas. RedeAmericas was one of five regional 'Hubs' funded by the National Institute of Mental Health (NIMH) to improve community mental health care and build mental health research capacity in low- and middle-income countries. It included investigators in six Latin American cities - Santiago, Chile; Medellín, Colombia; Rio de Janeiro, Brazil; and Córdoba, Neuquén, and Buenos Aires in Argentina - working together with a team affiliated with the Global Mental Health program at Columbia University in New York City. One component of RedeAmericas was a capacity-building effort that included an Awardee program for early career researchers in the mental health field. We review the aims of this component, how it developed, and what was learned that would be useful for future capacity-building efforts, and also comment on future prospects for maintaining this type of effort.

We conducted a randomised clinical trial to test the efficacy of an enhanced version of an intervention previously shown to reduce HIV sexual risk behaviours among men with severe mental illness. One-hundred-and-forty-nine subjects aged 18-59 years were randomly assigned to the experimental or control conditions. Sexual risk behaviours were assessed every three months for 12-months. The primary analysis compared experimental and control groups with respect to sexual risk behaviours with casual partners as measured by the Vaginal Episodes Equivalent ( VEE) score. Additional analyses included comparison of VEE scores of those men sexually active in the three months prior to baseline and the proportion of condom-protected sexual acts with casual partners. There were no significant differences in sexual risk behaviours with casual partners between experimental and control subjects. Additional analyses demonstrated a trend toward sexual risk reduction at six months post-intervention ( p = 0.06) but not at 12 months. These results may reflect a lack of efficacy or a true reduction in risk that the trial was underpowered to detect at the 0.05-level. If there was a true reduction in risk, it was not maintained after the initial six months.

We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to assess the long-term course of schizophrenia in four key domains (symptoms, treatment, residence, and work) over two time periods (past two years, entire period of illness). The subjects were 27 consecutive admissions to a schizophrenia research unit. The LCS was filled out by pairs of raters, blinded to each others' ratings, using the same data (interview with subject and chart). Reliability was examined for 45 LCS ratings selected from all four domains and both time periods. Selected ratings pertained to the duration of specified experiences, the quality of these experiences, and the long-term time trend. The kappa statistic and the intra-class correlation coefficient (ICC) were used to determine inter-rater reliability for continuous and categorical ratings, respectively. LCS ratings proved reliable in all four key domains and both time periods. The reliability was fair to excellent for ratings of duration of experience (ICC ranged from 0.53 to 0.99), quality of experience (kappa ranged from 0.46 to 0.92) and long-term time trends (kappa ranged from 0.66 to 0.94). The LCS can be used to obtain reliable ratings of the long-term course of schizophrenia in multiple domains.

(1999). Using Local Resources in Patagonia. International Journal of Mental Health: Vol. 28, Mental Health Services in the Developing World: Perspectives on Evolution, Assessment, and Adaptation—2, pp. 17-24.

BACKGROUND:The spread of human immunodeficiency virus infection to impaired groups has intensified the challenge for its prevention; control of the epidemic now requires behavioral change among persons with limited ability to sustain attention and learn. In this randomized clinical trial, we tested an intervention to reduce sexual risk behaviors among homeless men with severe mental illness.METHODS:Men were recruited from a psychiatric program in a homeless shelter. Of 116 eligible men, 97 (83.6%) participated. Most were African American and had a chronic psychotic disorder and a comorbid substance use disorder. Participants were assigned to a 15-session experimental group intervention or to a 2-session control intervention and observed for 18 months. The 59 participants sexually active before the trial were the main target of the intervention. Sexual risk behavior was the primary outcome.RESULTS:Among the 59 sexually active men, follow-up data were obtained on 59 (100%) for the initial 6-month follow-up and on 56 (95%) for the remainder of the 18-month follow-up. The mean score on a sexual risk index for the experimental group was 3 times lower than for the control group (1.0 vs 3.1; P=.01) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up.CONCLUSIONS:This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.

Public health is paying increasing attention to elusive urban populations such as the homeless, street drug users, and illegal immigrants. Yet, valid data on the health of these populations remain scarce; longitudinal research, in particular, has been hampered by poor follow-up rates. This paper reports on the follow-up methods used in two randomized clinical trials among one such population, namely, homeless men with mental illness. Each of the two trials achieved virtually complete follow-up over 18 months. The authors describe the ethnographic approach to follow-up used in these trials and elaborate its application to four components of the follow-up: training interviewers, tracking participants, administering the research office, and conducting assessments. The ethnographic follow-up method is adaptable to other studies and other settings, and may provide a replicable model for achieving high follow-up rates in urban epidemiologic studies.

OBJECTIVES: This study examined a strategy to prevent homelessness among individuals with severe mental illness by providing a bridge between institutional and community care. METHODS: Ninety-six men with severe mental illness who were entering community housing from a shelter institution were randomized to receive 9 months of a "critical time" intervention plus usual services or usual services only. The primary analysis compared the mean number of homeless nights for the two groups during the 18-month follow-up period. To elucidate time trends, survival curves were used. RESULTS: Over the 18-month follow-up period, the average number of homeless nights was 30 for the critical time intervention group and 91 for the usual services group. Survival curves showed that after the 9-month period of active intervention, the difference between the two groups did not diminish. CONCLUSIONS: Strategies that focus on a critical time of transition may contribute to the prevention of recurrent homelessness among individuals with mental illness, even after the period of active intervention.

OBJECTIVE The high seroprevalence of HIV that has been reported among homeless individuals with mental illness indicates an urgent need to examine HIV risk behavior in this population. METHOD Injection drug use and sexual behavior were assessed in comprehensive interviews with 218 homeless mentally ill men in a New York City shelter. First, the proportion of men who had injected drugs was established. Then, among those who had injected drugs, the injection drug use behaviors associated with HIV transmission (i.e., whether they had ever engaged in high-risk behaviors and had ever engaged in risk-reduction behaviors) and their current sexual risk behaviors were examined. RESULTS Fifty (23%) of the 218 men had injected drugs. Among these 50, the great majority had engaged in high-risk behaviors, including sharing needles (66%) and using shooting galleries (64%). Few had engaged in risk-reduction behaviors, such as cleaning needles with bleach (22%) and using a needle exchange program (2%). In the past 6 months alone, the majority of the injection drug users had had unprotected sex with women (48%) or with men (10%). CONCLUSIONS This study documents a high lifetime prevalence of injection drug use in a group of homeless men with mental illness. The men who had injected drugs reported injection drug use and sexual behaviors with high risk of HIV transmission and gave scant evidence of risk-reduction behaviors. These individuals may fall between service systems and may be difficult to reach but, nonetheless, must be included in efforts to prevent transmission of HIV infection.

In this paper, we describe an intervention to reduce sexual risk behaviours for HIV transmission among homeless men with mental illness. In some urban areas of North America, 10± 20% of homeless mentally ill men are infected with HIV1,2. Yet, HIV prevention has been neglected in this population. There have been only limited attempts to offer HIV prevention in the settings where these men reside; and research in this ® eld has been minimal. Available data indicate that sexual behaviours Ð as well as drug use behaviours Ð contribute to the contraction and transmission of HIV in this population. Our previous studies found that both were important factors in HIV contraction3,4. Because more men currently practice unsafe sex than inject drugs, unsafe sexual behaviour may be the most important factor leading to further HIV transmission. While the need for sexual risk reduction in this population is clear, it presents a daunting challenge. Little is known about the sexual lives of homeless mentally ill men. Methods for changing behaviour (of any kind) among the chronic mentally ill have yet to be fully developed and tested. Finally, virtually no research has been conducted on behaviour change among destitute mentally ill people who also drink and use drugs. The present intervention drew on available theories of behaviour change from the ® eld of HIV prevention and psychiatric rehabilitation5± 15. In addition, we relied heavily on our clinical experience14± 18. Thus, application of these theories was considerably adapted for homeless mentally ill men. Below we describe, ® rst, the setting in which the intervention was developed. Second, we provide an overview of the philosophy and approaches that guided the intervention. Third, we discuss some of our ongoing work in this ® eld. THE SETTING

Tuberculosis and HIV among mentally ill men in a New York City shelter. H Saez, E Valencia, S Conover, and E SusserCopyRight https://doi.org/10.2105/AJPH.86.9.1318 Published Online: October 07, 2011

OBJECTIVE:The authors investigated sexual behaviors related to HIV transmission among homeless mentally ill men in a New York City shelter. A previous study of a similar population found HIV prevalence to be 19%.METHODS:In standardized interviews with 122 men, data on sexual behaviors for the previous 6 months were collected. The frequency and nature of sexual episodes that may facilitate HIV transmission were examined. In addition, sexual risk behaviors among broadly defined diagnostic groups were compared.RESULTS:Of the 122 men, 65 (53%) had sex, 56 with women and 20 with men (11 who had sex with both women and men are counted in each group). The sexually active men, in most cases, had only occasional sex (once per month or less). The majority of sexually active men--29 (52%) of those who had sex with women and 12 (60%) of those who had sex with men--had sex without a condom and with nonmonogamous partners. Comorbid cocaine abuse or dependence was significantly associated with high-risk sexual behaviors.CONCLUSIONS:The majority of these men had sex occasionally or not at all. Nonetheless, because many of them had unprotected sex with nonmonogamous partners, the few sexual episodes may have carried an appreciable risk of HIV transmission. Moreover, men with a comorbid cocaine dependence may represent a group with an especially high risk for sexual HIV transmission. The authors propose that in this population, preventive interventions could modify the nature, if not the frequency, of sexual episodes.

BackgroundWe examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders.MethodWe studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia, we examined the distribution of duration of the episode. With respect to separation from affective disorders, we assessed the frequency of affective symptoms.ResultsDuration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes.ConclusionsAcute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification as proposed in the ICD–10.

We report on the prevalence of human immunodeficiency virus (HIV) infection among psychiatric patients in a New York City shelter for homeless men. We reviewed the records of all 90 men discharged from the shelter psychiatry program to community housing over a 2-year period. HIV serostatus was recorded for 62 of the 90 men. Of these 62, 12 (19.4%) were positive. There were 28 men whose serostatus was not recorded. Data on the HIV risk behaviors of these 28 men suggested that seroprevalence could have been similarly high among them. The results indicate an urgent need to develop and apply preventive interventions for HIV in this population.

We assessed psychiatric states in 223 men at first entry to New York, NY, municipal men's shelters, overall and differentiated by prior experience of homelessness. Instruments included a diagnostic interview (Structured Clinical Interview for DSM-III-R: Psychotic Disorders), the Short Michigan Alcoholism Screening Test, and the Center for Epidemiologic Studies of Depression Scale. The use of a "first timer" sample, and of a clinical diagnostic interview, had not, to our knowledge, been previously attempted in studies of psychiatric problems in the homeless. The majority of men had a history of mental disorder or of heavy substance use. On diagnostic interview, 17% of the men had a definite or probable history of psychosis, and another 8% had a possible history of psychosis. A confident diagnosis of schizophrenia was made in 8%. A history of alcohol or other drug abuse was evident in 58%. Cocaine was already (in 1985) the drug of choice; 27% of the study sample had used it more than 50 times. One third of the men were in extreme distress, much of it apparently acute and associated with the transition to the shelter, and 7% reported suicidal thoughts at the time of the interview. The newly homeless, compared with those who had been homeless for much of the 5 years prior to shelter entry, were younger and had fewer psychiatric problems.

In the last decade the reappearance in the United States of widespread homelessness has been coupled with a high visibility of mentally ill homeless persons in urban centres. This apparent association between homelessness and mental illness has stimulated an intense and ongoing debate on the contribution of mental illness to homelessness. Although mentally ill persons were noticeable among the homeless in prior historical periods (Deutsch 1937; Grob 1973; Rothman 1971), the relationship between the two rarely generated public discourse of a similar scale or intensity. Perhaps a historical precedent can be found in the campaign for asylums in the nineteenth century, when many mentally ill persons were housed in jails. That controversy, however, centred on the deplorable treatment of the mentally ill rather than on the causes of homelessness.

Because the problem of homelessness has generated such attention and controversy, findings from studies of homeless populations are often received eagerly without appreciation of the significant biases inherent in surveys. Drawing on surveys of the homeless made in the 1980s, the authors review problems in sampling and in measurement of mental disorder. They suggest that within any one study researchers employ alternative sampling strategies and measures of mental disorder to facilitate comparison of results within and across studies.

The authors interviewed homeless men in New York City shelters about their childhood experiences. Childhood placement away from the family was frequent, especially among former psychiatric patients. Childhood problem behaviors were also frequent.

Temperature–(water vapor) Pressure‐Sintering (TPS) diagrams were established to control the microstructure evolution and densification during sintering of silicon. Experiments were performed under controlled humidified atmospheres and corroborated diagram predictions.