Involuntary Admission to Hospital of Homeless People with Schizophrenia From the Street – 1 Year Outcomes

A retrospective case-note study of the 1 year outcomes of 37 people admitted under the Mental Health Act from street assessments in South London carried out by the START team, an assertive outreach team for homeless people. Introduction Hospital staff not infrequently question the effectiveness of treating individuals with long DUPs (duration of untreated psychosis). A street assessment is complex to arrange, involves several different agencies, is expensive and often distressing for the individual concerned. We need to be reasonably sure that we are doing more good than harm in admitting someone to hospital in this way. There is little in the published literature regarding this aspect of psychiatric practice. Method We selected a consecutive group of street Mental Health Act Assessments by examining the paper records held by our AMPH (Approved Mental Health Professional) service and cross-referencing these with our electronic case records. We looked at several psycho-social outcome measures one year following discharge from hospital. Results Although the number is small, the outcomes are overwhelmingly positive, in spite of notions about long DUP being predictive of poor response to treatment. Most of the subjects were in housing and remained in contact with a mental health team. Implications The assertive treatment of people rough sleeping with psychosis, even with long DUPs and long histories of street sleeping, can be highly effective.