Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis.

BACKGROUND: Homeless and marginally housed persons who use alcohol and/or illicit drugs often have end-of-life care needs that go unmet due to barriers that they face to accessing end-of-life care services. Many homeless and marginally housed persons who use these substances must therefore rely upon alternate sources of end-of-life care and support. This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/or illicit drugs. METHODS: A qualitative case study design was used to explore end-of-life care services delivery to homeless and marginally housed persons in six Canadian cities. A key objective was to explore the role of harm reduction services. 54 health and social services professionals participated in semi-structured qualitative interviews. All participants reported that they provided care and support to this population at end-of-life. RESULTS: Harm reduction services (e.g., syringe exchange programs, managed alcohol programs, etc.) were identified as a critical point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs. Where possible, harm reduction services facilitated referrals to end-of-life care services for this population. Harm reduction services also provided end-of-life care and support when members of this population were unable or unwilling to access end-of-life care services, thereby improving quality-of-life and increasing self-determination regarding place-of-death. CONCLUSIONS: While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population.

Improving access to acute mental health services in a general hospital.

BACKGROUND: There is a paucity of service research on the effectiveness of short-term mental health clinics. AIMS: To outline the development of the Urgent Consultation Clinic (UCC), an inter-professional, short-term, mental health program in a general hospital, and to evaluate the effectiveness of the UCC from a quality improvement perspective. METHOD: Participants (n = 143) completed a battery of validated measures assessing psychological and physical symptoms, quality of life, life satisfaction, and satisfaction with services at three time-points. Inter-professional team members rated participants' overall functioning and severity of mental health problems at intake and termination. RESULTS: The median time from referral to initial UCC visit was 12 days. A significant decline in the severity of mental health symptoms was observed, with 87% of participants reporting clinically elevated symptoms at intake compared to 71% at termination. Significant improvements were observed in life satisfaction, overall functioning, and mental quality of life. Sixty-nine percent of participants rated the quality of services as good or excellent. CONCLUSIONS: The UCC model of care contributed to improved access to psychiatric evaluation and short-term treatment. This inter-professional model could be applied to other health care settings to meet the needs of patients requiring acute psychiatric services.

Identifying the core competencies of community support providers working with people with psychiatric disabilities.

The study was intended to identify core competencies for community support providers working with people with psychiatric disabilities. Using multiple methods developed from previous research in the field of developmental disabilities, 18 consumers receiving services and 16 staff members from two mental health community support programs identified a list of 68 competencies that included personal attributes, knowledge, and skills. Based on a card sort task, 34 consumers receiving services and 34 support workers from six mental health community support programs rated 59 of the 68 competencies as being either absolutely necessary or desirable. Results of a second card sort task found that a majority of competencies identified as being needed pre-employment were personal attributes consistent with adopting a person-centered approach. Competencies categorized as to be learned on the job involved special knowledge and skills specific to working with people with psychiatric disabilities. The range of personal attributes, knowledge, skills represented in the identified competencies reflects the complexity of contemporary mental health community support. Findings are indicative of the need for specialized training and supervision that has not been typically available in the community mental health sector.