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Independent Housing and Support for individuals with severe mental illness: Randomized controlled trial vs. observational study

English title Independent Housing and Support for individuals with severe mental illness: Randomized controlled trial vs. observational study
Applicant Richter Dirk
Number 179451
Funding scheme Project funding (Div. I-III)
Research institution Universitäre Psychiatrische Dienste Bern
Institution of higher education University of Berne - BE
Main discipline Psychology
Start/End 01.05.2019 - 30.04.2023
Approved amount 477'209.00
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All Disciplines (3)

Discipline
Psychology
Neurology, Psychiatry
Rehabilitation

Keywords (6)

Social Psychiatry; Observational Study; Psychiatry; Randomized Controlled Trial; Psychiatric Rehabilitation; Supported Housing

Lay Summary (German)

Lead
Menschen mit schweren psychischen Erkrankungen mussen oftmals während oder nach der Behandlung in speziellen Wonformen betreut werden. Die Forschung zur Wohnrehabilitation steht aktuell vor erheblichen Veränderungen und Herausforderungen. In der Schweiz - wie auch in anderen Ländern - etablieren sich zunehmend ambulante Alternativen zu traditionellen Wohnheimen. Die ambulante Wohnversorgung wird von den Nutzenden gegenüber Wohnheimen deutlich präferiert. Welche Auswirkungen dies für die betroffenen Personen hat, darüber ist relativ wenig bekannt. Die vorliegenden Studien mit hoher Qualität beziehen sich ausschliesslich auf Menschen in Obdachlosigkeit. Bis anhin ist weltweit keine randomisierte und kontrollierte Studie für Menschen mit psychischen Erkrankungen durchgeführt worden, die auf die hiesigen Verhältnisse und Problemlagen anwendbar ist.
Lay summary
Die Studie hat zwei Ziele: Zum einen sollen die Auswirkungen unterschiedlicher Formen der Wohnversorgung (ambulantes Wohncoaching und Wohnheime) über einen Zeitraum von zwei Jahren verglichen werden. Die Auswirkungen werden in erster Linie anhand von sozialen Indikatoren gemessen. Hierzu wird am Standort Zürich eine randomisierte kontrollierte Studie durchgeführt, in der Nutzende per Zufallsprinzip auf eine der beiden Wohnformen zugeteilt werden. Parallel wird am Standort Bern eine sogenannte Beobachtungsstudie durgeführt, wo Nutzende über den gleichen Zeitraum in den Wohnformen, für die sie sich entschieden haben, ebenfalls begleitet werden. Da davon auszugehen ist, dass die Wohnformen in Bern teilweise von unterschiedlichen Personen in Anspruch genommen werden, soll anschliessend über ein statistisches Verfahren (Propensity Scoring) versucht werden, Personen mit ähnlichen Voraussetzungen und Eigenschaften hinsichtlich des Erfolgs der Rehabilitation zu vergleichen.

Auf diesem Weg kann das zweite Ziel der Studie erreicht werden, nämlich ein Vergleich der methodischen Ansätze (randomisierte kontrollierte Studie versus Beobachtungsstudie). Hiermit soll herausgefunden werden, ob es tatsächlich immer randomisierte Studien braucht, um Wohnformen mit einer qualitativ hochstehenden Methodik zu vergleichen. Randomisierte Studien in diesem Bereich sind mit grossen ethischen und logistischen Herausforderungen verbunden. Diese Herausforderungen sind vermutlich die Gründe, weshalb bis anhin noch keine solche Studie ausserhalb des Personenkreises der Menschen in Obdachlosigkeit durchgeführt worden ist.
Direct link to Lay Summary Last update: 10.12.2018

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Abstract

Background: Adequate and stable housing conditions are fundamental for the psychiatric rehabilitation of individuals with severe mental illness (SMI). A common approach in psychiatric rehabilitation relies on a continuum of residential services that aims at enabling the person with SMI to live eventually independently. Current state of research, however, shows clearly that most persons in question remain in residential care settings (RCS). The Independent Housing and Support (IHS) scheme is a new model that aims at direct placement in an independent accommodation in the community. Support is provided according to individual needs in a permanent housing situation without time limit. Up to now, randomized controlled trials (RCTs) to evaluate the effectiveness of IHS have only been conducted with homeless populations in North America. The purpose of the present study is to evaluate IHS compared to traditional RCS for non-homeless persons with severe mental illness. With this study, we aim at demonstrating that IHS is not inferior to RCS. The rationale for utilizing a non-inferiority approach is based on the current state of research and on research that has shown strong preferences for IHS against RCS by people with SMI. Methods: As the preference issue makes RCTs in housing research difficult we will use a specific time window in Zurich that allows conducting a RCT due to a scarcity of IHS settings and will combine the RCT with a comparative observational study in Berne where IHS is already well-established. At the Zurich site, a RCT compares the effects of living with IHS against living in residential care. At the Berne site, an observational study design (OSD) will be applied in connection with the same types of housing as in Zurich. Propensity scoring will be utilized to minimize the risk of bias in the OSD. A number of N=56 eligible subjects in Zurich and N=112 subjects (due to specific requirements for propensity scoring) in Berne complying with the inclusion criteria will be recruited and allocated to intervention and control groups according to the site-specific study designs. Recruitment period will last 18 months. All participants will be assessed by independent researchers at baseline (T0), after 6 months (T1), 12 months (T2), 18 months (T3) using a standardized set of measures.Expected value of the proposed project: There is a considerable lack of research on housing services in the context of mental health. To our knowledge, the proposed research project would be the first partially randomized controlled trial with a non-homeless population that focusses on housing for individuals with severe mental illness. Hence, it would be of scientific value by enlarging mental health service research by a trial on an understudied topic at the border of medical and social sciences. Additionally, the comparison and, if possible, combination of RCT and OSD is supposed to allow methodological insights that make effectiveness research in the field of housing for people with SMI easier. Furthermore, this project is of considerable practical value. Along with the “Housing First” model for homeless people, IHS is the first intervention that directly addresses the primary aim of rehabilitative housing services, the attainment of an independent accommodation, even if the individual is in need of specialized psychiatric or psychosocial care. It would enable a useful and needs-oriented subsidiary service with an extended spectrum of eligibility (in particular individuals who do not receive disability funds but are in need of support on housing issues, e.g. after a first episode of psychosis). Moreover, it provides an alternative option for those who do not comply with traditional housing facilities due to experienced confinement of their autonomy. These individuals frequently face homelessness and wander between shelters and psychiatric institutions. Given that housing remains a major social and political problem in particular for people with mental disorders the results of this project might provide a valuable scientific basis for political decision makers and administrations.
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