Skip to main content
Log in

Copenhagen Community Psychiatric Project (CCPP): characteristics and treatment of homeless patients in the psychiatric services after introduction of community mental health centres

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

The main purpose of the study was to describe the characteristics of homeless psychiatric patients, and to compare the treatment they are offered to that offered to domiciled patients by the psychiatric services. Another purpose was to analyse the prevalence of homelessness among psychiatric patients before and after the introduction of community mental health centres in Copenhagen. Cross-sectional studies were conducted in two intervention and two control districts before and after introduction of the new treatment modalities. In 1991, 80 of 1008 patients (8%) were homeless. Male sex, young age, living on general welfare, schizophrenia and alcohol or substance abuse were the factors that most markedly differentiated homeless from domiciled patients. Compared with the treatment of domiciled patients, the homeless were more likely to be offered no further treatment after consultation in a psychiatric emergency and, if admitted, they were more likely to be placed in locked wards, given compulsory medication, and medicated with depot neuroleptics. The homeless were also less likely to be offered psychotherapy and consultation with a social worker. Schizophrenia and alcohol or substance abuse characterised the majority of the patients discharged homeless. In the intervention districts, the number of homeless patients in contact with the psychiatric services was found to increase at the same rate as the number of all patients in contact with the psychiatric services. In the control districts, no changes in prevalence of homeless patients or other patients in contact with the psychiatric services occurred. It is concluded that homeless psychiatric patients comprise a difficult patient group, with problems of schizophrenia, substance abuse and lack of motivation for treatment. It is recommended that special efforts be made to create housing facilities that fit the needs of different types of homeless patients, and that the homeless mentally ill are assisted in obtaining and maintaining an acceptable housing situation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alstrom CH, Lindelius R, Salum I (1975) Mortality among homeless men. Br J Addict 70: 245–252

    Google Scholar 

  • Appleby L, Desai PN (1985) Documenting the relationship between homelessness and psychiatric hospitalization. Hosp Community Psychiatry 36: 732–737

    Google Scholar 

  • Appleby L, Slagg N, Desai PN (1982) The urban nomad: a psychiatric problem? Curr Psychiatr Ther 21: 253–262

    Google Scholar 

  • Baxter E, Hopper K (1982) The new mendicancy: homeless in New York City. Am J Orthopsychiatry 52: 393–408

    Google Scholar 

  • Brandt P (1987) Homelessness and mental illness. Changes in the clientèle at an institution for the homeless during the last 25 years (in Danish). Nord J Psychiatry 41: 295–301

    Google Scholar 

  • Brandt P (1992) Young homeless in Copenhagen (in Danish). Thesis, FADL, Copenhagen, Aarhus Odense

    Google Scholar 

  • Breakey WR, Fischer PJ, Kramer M, Nestadt G, Romanoski AJ, Ross A, Royall RM, Stine OC (1989) Health and mental health problems of homeless men and women in Baltimore. J Am Med Assoc 262: 1352–1357

    Google Scholar 

  • Copenhagen Statistical Bureau (1989) Social districts of Copenhagen. Numbers. Copenhagen Statistical Bureau, Copenhagen

    Google Scholar 

  • Copenhagen Statistical Bureau (1991) Social districts of Copenhagen. Numbers. Copenhagen Statistical Bureau, Copenhagen

    Google Scholar 

  • Garety P, Toms RM (1990) Collected and neglected: are Oxford hostels for the homeless filling up with disabled psychiatric patients? Br J Psychiatry 157: 269–272

    Google Scholar 

  • Gelberg L, Linn LS, Leake BD (1988) Mental health, alcohol and drug use, and criminal history among homeless adults. Am J Psychiatry 145: 191–196

    Google Scholar 

  • Herrman H, McGorry P, Bennett P, van Riel R, Singh B (1989) Prevalence of severe mental disorders in disaffiliated and homeless people in inner Melbourne. Am J Psychiatry 146: 1179–1184

    Google Scholar 

  • Herzberg JL (1987) No fixed abode. A comparison of men and women admitted to an east London psychiatric hospital. Br J Psychiatry 150: 621–627

    Google Scholar 

  • Hopper K, Baxter E (1981) Private lives/public spaces. Community Service Society, New York

    Google Scholar 

  • Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York Chichester Brisbane

    Google Scholar 

  • Institute of Psychiatric Demography (1991) Annual reports from the psychiatric case register 1987–1991. Institute of Psychiatric Demography, Aarhus

    Google Scholar 

  • Järvinen M (1993) The new homeless. Women, poverty and violence (in Danish). Socpol Copenhagen

  • Knudsen HC, Jessen-Petersen B, Klitgaard V, Krasnik A, Nordentoft M, S≸lan H (1992) Patients in long-term contact with the psychiatric services. In: Community mental health centres in Copenhagen. An evaluation of the first two years (in Danish). Institute for Social Medicine, Copenhagen, pp 262–309

    Google Scholar 

  • Knudsen HC, Krasnik A, Nordentoft M, Jessen-Petersen B, S≸lan H (1996) The Copenhagen Community Project (CCPP). In: Knudsen HC, Thornicroft G (eds) Mental health service evaluation. Cambridge University Press, Cambridge New York Melbourne, pp 57–81

    Google Scholar 

  • Koegel P, Burnam MA, Farr RK (1988) The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Arch Gen Psychiatry 45: 1085–1092

    Google Scholar 

  • Lamb HR (1984) The homeless mentally ill. A task force report of the American Psychiatric Association, 2nd edn. American Psychiatric Association, Washington, D.C.

    Google Scholar 

  • Lamb HR, Talbott JA (1986) The homeless mentally ill. The perspective of the American Psychiatric Association. J Am Med Assoc 256: 498–501

    Google Scholar 

  • Linn LS, Gelberg L, Leake B (1990) Substance abuse and mental health status of homeless and domiciled low-income users of a medical clinic. Hosp Community Psychiatry 41: 306–310

    Google Scholar 

  • Lipton AA, Weinstein AS (1981) Implementing DSM-III in New York State mental health facilities. Hosp Community Psychiatry 32: 616–620

    Google Scholar 

  • Lipton FR, Nutt S, Sabatini A (1988) Housing the homeless mentally ill: a longitudinal study of a treatment approach. Hosp Community Psychiatry 39: 40–45

    Google Scholar 

  • The Municipality of Copenhagen (1992) Statistical ten-year review 1992. Copenhagen Statistical Bureau, Copenhagen

    Google Scholar 

  • Nordentoft M (1994) Homelessness, social integration and quality of life among psychiatric patients in Copenhagen (in Danish). Thesis, FADL, Copenhagen

    Google Scholar 

  • Nordentoft M, Knudsen HC, Schulsinger F (1992) Housing conditions and residential needs of psychiatric patients in Copenhagen. Acta Psychiatr Scand 85: 385–389

    Google Scholar 

  • Nordentoft M, Knudsen HC, Jessen-Petersen B, Krasnik A, S≸lan H, Welcher B, Treufeldt P (1996) CCPP Copenhagen Community Psychiatric Project. Implementation of community mental health services in Copenhagen: effect on service utilization, quality of life, social integration and positive and negative symptoms. Soc Psychiatry Psychiatr Epidemiol 31: 336–344

    Google Scholar 

  • Rossi PH, Wright JD, Fisher GA, Willis G (1987) The urban homeless: estimating composition and size. Science 235: 1336–1341

    Google Scholar 

  • Roth D, Bean GJ (1986) New perspectives on homelessness: findings from a statewide epidemiological study. Hosp Community Psychiatry 37: 712–719

    Google Scholar 

  • Sclar ED (1990) Homelessness and housing policy: a game of musical chairs. Am J Public Health 80: 1039–1040

    Google Scholar 

  • Scott J (1993) Homelessness and mental illness. Br J Psychiatry 162: 314–324

    Google Scholar 

  • Smith EM, North CS, Spitznagel EL (1992) A systematic study of mental illness, substance abuse, and treatment in 600 homeless men. Ann Clin Psychiatry 4: 111–120

    Google Scholar 

  • SPSS (1992) SPSS Windows, advanced statistics release 5.0. SPSS, Chicago

    Google Scholar 

  • Susser E, Struening EL, Conover S (1989) Psychiatric problems in homeless men. Lifetime psychosis, substance use, and current distress in new arrivals at New York City shelters. Arch Gen Psychiatry 46: 845–850

    Google Scholar 

  • Susser ES, Lin SP, Conover SA (1991) Risk factors for homelessness among patients admitted to a state mental hospital. Am J Psychiatry 148: 1659–1664

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nordentoft, M., Knudsen, H.C., Jessen-Petersen, B. et al. Copenhagen Community Psychiatric Project (CCPP): characteristics and treatment of homeless patients in the psychiatric services after introduction of community mental health centres. Soc Psychiatry Psychiatr Epidemiol 32, 369–378 (1997). https://doi.org/10.1007/BF00788176

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00788176

Keywords

Navigation