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We thank Drs. Rittenbach et al for their collaborative approach to the development of the Addiction and Mental Health Strategic Clinic Network, incorporating the voices of those with lived experiences.[1] As the network moves into this new decade, it would be truly heartening to see further emphasis on collaborative strategies to tackle the closely intertwined problem of homelessness. Mental illness appears to be both a cause and consequence of homelessness. In a 2012 study using a psychiatric screening tool (including substance use disorders) in an urban homeless population in Calgary, only 7% screened negative on all six modules, and 60% of the sample appeared to have mental illness but reported no history of psychiatric treatment.[2] These results highlighted the tremendous burden of psychiatric symptoms in this population.
A more recent study in 6 area shelters in Oklahoma City found that participants with mental health and substance use disorders were much more likely to use shelter services - encouragingly, these individuals had high odds of using mental health services and substance use counselling when such services were available.[3] With our province and country reeling from the opioid epidemic and economic pressures, creative strategies to tackle homelessness and psychiatric comorbidities in parallel are urgently needed.
References:
1. Rittenbach K, MacMaster FP, Mitchell N. Addiction and Mental Health Strategic Clinical Network. CMAJ 2019;191(Suppl):S7-S9.
2. Ganesh A, Campbell DJT, Hurley J, Patten S. High Positive Psychiatric Screening Rates in an Urban
Homeless Population. Can J Psychiatry 2013;58(6):353-360.
3. Daundasekara SS, Gallardo KR, Maria DS, et al. Shelter Service Utilization among Adults Experiencing Homelessness. Health Behavior and Policy Review 2019;6(2):128-139.