[Utilization of medical and psychosocial services by mentally ill homeless persons. Results of an epidemiological study]. / Die Inanspruchnahme medizinischer und psychosozialer Dienste durch psychisch erkrankte Obdachlose. Ergebnisse einer epidemiologischen Studie.

The aim of this study was to ascertain to what extent homeless, mentally ill subjects in Munich take advantage of available psychosocial services. To obtain a representative picture of the situation, the first step was to ascertain how many people in Munich are actually homeless. The next step was to ascertain what proportion of them are in need of psychotherapy. Using the standardized Diagnostic Interview Schedule (DIS), 146 men and 32 women were interviewed. The results according to the DSM-III demonstrated high lifelong and 6-month prevalence of psychic disturbances. Medical and social services were often enjoyed, but mostly over a short period of time in particularly critical situations. Continued treatment rarely followed. Women were treated more often than men. Elements such as age and level of education hardly influenced patients' seeking help. Despite a high prevalence of addictive disease, alcohol and drug clinics were rarely consulted. The increase in the number of diagnoses was paralleled by an increase in the number of patients seeking help. Most treatments involved schizophrenia and anxiety. By means of logistic regression models, predictors of the extent to which these services were used were analysed. We conclude that new clinical models are needed and that the aversion to the present care system is too great. Continued treatment occurs only rarely.

[Mental illness in homeless men and women in Munich]. / Psychische Erkrankung bei obdachlosen Männern und Frauen in München.

PURPOSE: Mental illness appears to be overrepresented among homeless individuals. The purpose of this study was the standardised assessment of mental illness in a representative sample of homeless men and of homeless women in the city of Munich, Germany. METHODS: In order to get a very good estimate of the population of homeless individuals in Munich, a pre-sampling survey was conducted. On the basis of this pre-sampling survey the size and relevant characteristics of the total population of homeless individuals in Munich were defined. Individuals of the sample were randomly selected from the population. 146 men and 32 women were interviewed using the Diagnostic Interview Schedule (DIS). RESULTS: Homeless men were on the average 43 years of age; most of them unmarried or divorced, had a relatively low degree of school education and a relatively long duration of homelessness. The prevalence of mental illness (lifetime) was very high: 91.8% had a substance abuse disorder (82.9% alcohol dependence), 41.8% had an affective disorder, 22.6% had an anxiety disorder and 12.4% suffered from schizophrenia. Of the homeless men in Munich 94.5% had at least one DIS/DSM-III axis I diagnosis 6-month prevalence data is also presented. CONCLUSIONS: The results confirm the findings of other studies in other countries of high rates of mental illness among homeless individuals. In comparison to a study in Los Angeles using the same methodology, prevalence rates were even higher in Munich. Implications for health care planning are discussed.

Mental illness in homeless women: an epidemiological study in Munich, Germany.

In an epidemiological survey of the prevalence of mental illness in homeless individuals in Munich, Germany, a probability sample of 32 homeless women were interviewed using a standardized diagnostic instrument (Diagnostic Interview Schedule for DSM-III diagnoses). Results point to very high prevalence rates of mental disorders among homeless women. The most frequent diagnostic groups were alcohol and drug abuse (lifetime prevalence rate 90.6%), affective disorders (50.0%), anxiety disorders (43.8%) and schizophrenia (21.9%). Prevalence rates are compared with a female household sample (Epidemiological Catchment Area Study in New Haven, Connecticut). All disorders tended to be more frequent in homeless women as compared with the household sample. Our results show the urgent need to provide medical and other assistance to homeless women. There is a need for adequate psychiatric care, supply with food and housing and the development of concepts for personal and vocational rehabilitation considering the specific needs of women.

Alcoholism among homeless men in Munich, Germany.

Probably in association with changes in the economic structure and high unemployment rates in western industrialized countries, homelessness is becoming more apparent publicly and receiving increased media attention. More studies on the issue of mental illness and homelessness have been performed in recent years in North America while hardly any representative and reliable data exists concerning Germany and some other European countries. The aim of our study was 1) to assess alcohol abuse and dependency as well as other mental disorders in a representative sample of homeless men in Munich using reliable methods of case identification (Diagnostic Interview Schedule [DIS and DIS/DSM-III diagnoses); 2) to compare homeless alcoholics with homeless non-alcoholics in our sample on relevant variables and issues and 3) to compare our data from the sample of homeless men in Munich with data obtained by others using the same case identification procedure (DIS/DSM-III diagnoses). According to our results, the lifetime prevalence of any DIS/DSM-III Axis I diagnoses was 94.5% and the lifetime prevalence of substance use disorder was 91.8%. The single most prevalent diagnosis among homeless males in Munich was alcohol dependency (lifetime 82.9%), while alcohol abuse (lifetime 8.2%) and drug abuse/dependency were considerably lower (lifetime 17.8%). Data show that alcoholism and its consequences were more severe in the Munich as compared to the Los Angeles homeless sample. Homeless alcoholics showed a high comorbidity with other mental disorders (lifetime) such as affective disorders (44.4%), anxiety disorders (22.6%), drug abuse/dependence (18.8%) and schizophrenia (12.0%); 64% of those with alcoholism at some time during their life had at least one other lifetime mental disorder. Alcohol-related patterns of living and symptoms as well as social or role functioning are described for homeless alcoholics in Munich and compared with data from other relevant studies. Considering the extremely high prevalence of alcohol dependence frequently in combination with other mental disorders, the use of alcohol rehabilitation and other services as well as self-help groups was minimum among Munich homeless alcoholics. New concepts to deal with these problems are needed and if they exist, they need to be implemented.

[Psychiatric homelessness research. From "psychopathology of the vagrant" to "homeless mentally ill"]. / Psychiatrische Obdachlosenforschung. Von der"Psychopathologie des Landstreichers" zu den" Homeless Mentally Ill".

German psychiatrists around 1900 reported that dementia praecox and other mental disorders were common among homeless individuals. On the basis of the concept of psychopathy, homelessness in the 1920s was viewed as an "inferiority of character". The combination of psychiatric diagnosis and social prejudice was used as a justification for the "elimination of abnormal personalities" during the Third Reich. Growing numbers of homeless individuals in the last two decades stimulated a new interest in psychiatric research on the homeless. Larger epidemiological studies show high prevalence rates for severe mental disorders (schizophrenia, affective disorders, substance abuse). This points to the urgent need to develop sophisticated and sensible concepts to deal effectively with the complex problems associated with homelessness.

Mental illness in a representative sample of homeless men in Munich, Germany.

The aim of the study was to reliably assess the 6-month and lifetime prevalence of mental illness according to DSM-III criteria in a representative sample of homeless individuals in the city of Munich, Germany. Because the characteristics of the homeless population were unknown, we first conducted a pre-sampling survey to determine a proportionate allocation of the main interviews in three nested sampling strata. For the pre-sampling we approached 300 males, who appeared to be homeless, for a brief interview; of these, 271 were homeless according to our definition and were allocated to one of three sectors ("shelter", "meal services", "outdoor"). Thereafter, we randomly sampled homeless males in these three strata until the indicated allocations were met. The Diagnostic Interview Schedule (DIS) was used for diagnostic classification according to DSM-III in the main interview. Results from this representative urban sample show that the mean age of the homeless males was 43 years; most were unmarried or divorced, had a relatively low level of school education and a long duration of homelessness. Based on the main interviews with 146 homeless males the following lifetime prevalence rates were obtained: 91.8% for substance use disorder (82.9% alcohol dependence), 41.8% for affective disorders, 22.6% for anxiety disorders and 12.4% for schizophrenia. Of the homeless males in Munich, 94.5% had at least one DIS/DSM-III axis I diagnosis. Six-month prevalence data is also presented. Results are compared with those of a very similar study on homeless individuals in Los Angeles, which also used DIS/DSM-III diagnoses. In comparison with representative community samples in the United States and in Germany, mental illness was much more frequent among homeless individuals in Munich as well as in Los Angeles. Implications for health care planning are discussed.

[Group work with relatives of Alzheimer patients--a systemic approach]. / Gruppenarbeit mit Angehörigen von Alzheimer-Kranken--ein systemischer Ansatz.

Dementia does not only infringe the patient's but also his caregivers' lives. The social system surrounding the patient is facing a heavy burden. The care is negatively affected by two components: lack of support from outside and problems within the relationship of patient and caregiver. In a support group for caregivers of Alzheimer patients we therefore adapted a combined approach of psycho-education and system therapy. We centered on the adverse patterns of behavior between patient and caregiver and the broadening of the support system. Techniques from systemic family therapy were used. Two cases illustrate the possibilities of this new approach to group therapy with caregivers of Alzheimer patients.