Examining Health Literacy Levels in Homeless Persons and Vulnerably Housed Persons with Mental Health Disorders.

Health care use is high in persons who are homeless and vulnerably housed, but their health literacy (ability to read and understand health information) is often not known. The purpose of this study was to determine health literacy rates in a Canadian population of homeless and vulnerably housed individuals with mental health disorders. Higher levels of health literacy were associated with being housed, higher levels of education, non-psychotic mental health diagnoses and lower levels of drug use. This suggests that health literacy may be a potential barrier for accessing and utilizing health services and information for vulnerable populations.

Transitions from Assertive Community Treatment Among Urban and Rural Teams: Identifying Barriers, Service Options, and Strategies.

An emerging focus of Assertive Community Treatment (ACT) teams is the transition of clients to less intensive services, which creates space for individuals in need of ACT and is consistent with a recovery orientation of treatment. However, there is limited research on team transition rates, post-ACT services, and strategies to overcome transition barriers. In addition, few studies have examined differences in these factors among urban and rural ACT teams. To address these knowledge gaps, we interviewed eight ACT teams in urban and rural areas of eastern Ontario regarding their transition rates, processes of transitioning ACT clients to less intensive services, transition barriers, and solutions to overcoming these barriers. On average, teams transitioned about 6% of their clients over our 3-year study period. Urban and rural teams described both similar and distinct clinical and systemic barriers, such as client reluctance to transition and finding psychiatric follow-up outside of ACT. Implications for ACT practice and policy are discussed.

Bespoke Drug Discovery Training for Low-Middle Income Countries.

Working in drug discovery is difficult for many institutions due to the need for resources, funding, and in-country expertise. The Wellcome Centre for Anti-Infective Research (WCAIR) is responding to the unmet training needs for individuals/institutions working in drug discovery in low-middle income countries. Through their training program, individuals can undertake a practical placement, either online or at the center, with access to a dedicated trainer from their field of research. Practical placements are tailored to the needs of the individual/institute to enable capability building on return to their home institute. In addition to training placements, the center is focused on building partnerships by supporting institutes to work in drug discovery. Here we highlight WCAIR's training program and the partnerships that have developed from this.

Correction to "Bespoke Drug Discovery Training for Low-Middle Income Countries".

[This corrects the article DOI: 10.1021/acsmedchemlett.3c00215.].

Community treatment orders: beyond hospital utilization rates examining the association of community treatment orders with community engagement and supportive housing.

The purpose of this paper is to examine the association of community treatment orders (CTO) with community engagement and housing arrangements for one population of psychiatric patients in Ontario, Canada. Socio demographic characteristics and health service utilization information were collected for each patient placed on a CTO during a 3 year period. Information was collected for each of the 84 patients when a CTO was first issued and then updated to reflect both the patient's ongoing involvement with the legislation and related clinical outcomes. A significant increase in the number of community services and a shift to supportive housing arrangements was found for patients following issuance of a CTO.

An international comparison of legal frameworks for supported and substitute decision-making in mental health services.

There have been important recent developments in law, research, policy and practice relating to supporting people with decision-making impairments, in particular when a person's wishes and preferences are unclear or inaccessible. A driver in this respect is the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the implications of the CRPD for policy and professional practices are currently debated. This article reviews and compares four legal frameworks for supported and substitute decision-making for people whose decision-making ability is impaired. In particular, it explores how these frameworks may apply to people with mental health problems. The four jurisdictions are: Ontario, Canada; Victoria, Australia; England and Wales, United Kingdom (UK); and Northern Ireland, UK. Comparisons and contrasts are made in the key areas of: the legal framework for supported and substitute decision-making; the criteria for intervention; the assessment process; the safeguards; and issues in practice. Thus Ontario has developed a relatively comprehensive, progressive and influential legal framework over the past 30 years but there remain concerns about the standardisation of decision-making ability assessments and how the laws work together. In Australia, the Victorian Law Reform Commission (2012) has recommended that the six different types of substitute decision-making under the three laws in that jurisdiction, need to be simplified, and integrated into a spectrum that includes supported decision-making. In England and Wales the Mental Capacity Act 2005 has a complex interface with mental health law. In Northern Ireland it is proposed to introduce a new Mental Capacity (Health, Welfare and Finance) Bill that will provide a unified structure for all substitute decision-making. The discussion will consider the key strengths and limitations of the approaches in each jurisdiction and identify possible ways that further progress can be made in law, policy and practice.

Community treatment orders: profile of a Canadian experience.

OBJECTIVE: This study reports the first published Canadian profile of a sample of psychiatric patients from the Royal Ottawa Hospital in Ottawa, Ontario, who were issued community treatment orders (CTOs). METHOD: We undertook a population study of sociodemographic and health care use patterns from January 2001 to September 2003, using a standardized information collection tool. RESULTS: The issuance of CTOs was associated with a statistically significant reduction in the number and length of hospital admissions and increased use of supportive community-based services and supportive housing. CONCLUSION: CTOs are effective tools for allowing patients to live in the least restrictive setting possible while they receive diverse services. They also effectively reduce rates and lengths of readmission to hospital.

Taking it to the street: a psychiatric outreach service in Canada.

This paper describes a model of flexible psychiatric outreach service in Canada designed to meet the needs of persons who are homeless or marginally housed and have mental illness. The activities of the Psychiatric Outreach Team of the Royal Ottawa Hospital for individual clients and the community agencies who serve them are profiled, followed by a demographic and mental and physical health profile of the clients seen in the past year. The differences from other models of service and the benefits and limitations of this unique multidisciplinary team are discussed, with implications for future service development for this vulnerable population.