A SFU researcher hopes his work with homeless people in Vancouver can be used to inform municipal decision-makers.
This week, health sciences professor Julian Somers of SFU’s Somers Research Group talked about a study that shows a link between homelessness and poor adherence to antipsychotic medication. It was published by researcher Stefanie Rezansoff and is the first study to investigate how this population adheres to the medicine they need for mental health.
Rezansoff found that only 12 per cent of the 290 individuals studied took their prescriptions at the level needed to be effective, despite having full drug coverage and high access to pharmacies.
“Treatment protocols recommend that patients receive these medications continuously once they’re initiated. But this can be difficult to ensure when people are precariously housed,” said Rezansoff. “There’s a strong link between low adherence and long-term homelessness.”
The subjects of the study had been diagnosed with serious mental illnesses and prescribed antipsychotic medication, said Somers.
Schizophrenia is one of the more serious and persistent forms of mental illness, and medication is the mainstay of treatment. It is also overrepresented among homeless people.
Somers said his group undertook the research because of the increasing number of homeless people who suffer with both substance dependence and mental illness.
“The course of homelessness tends to be much longer and more problematic,” he said.
When symptoms are not effectively managed, individuals are at a higher risk of hospitalization, arrest, victimization and suicide.
Three key recommendations come out of the study.
Firstly, that an ongoing relationship with a medical caregiver leads to greater adherence to medication for this population, in much the same way as individuals benefit from having a family doctor instead of using drop-in clinics.
Secondly, that long-acting injectable medication is the best way to administer to this population.
And thirdly, that the lowest levels of adherence are associated with long periods of homelessness.
“House people – give people appropriate housing and support,” said Somers.
He said the individuals involved in the study consented to having their pharmacy records studied, and researchers found the Pharmanet offers “very complete” records.
He and other researchers interviewed the subjects. Somers described them as having “a life marked by repeated experiences of – the term we used was ‘adversity.’”
Somers is collaborating with provincial officials and members of the justice system on this work, and said everyone in the field agrees that mental illness on the street is at worrisome levels.
He said supportive housing is the key, and that the Housing First model has been proven effective in New York City.
“At the end of the day, the action takes place at the health authorities and at the municipal level.”