Fostering Accessibility to Mental Health Services for Youth Experiencing Homelessness in Montreal, Canada: A Historical Cohort Comparison Study.

IF 2.7 4区医学 Q2 PSYCHIATRY

International Journal of Social Psychiatry Pub Date : 2026-09-01 Epub Date: 2026-05-13 DOI:10.1177/00207640261446109

Amal Abdel-Baki, Giuseppe D'Andrea, Charles Tessier, Diane Aubin, Nora Morrison, Marie-Eve Dupont, Camille Arbaud, Pasquale Bauco, Jai L Shah, Ashok Malla, Srividya N Iyer

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引用次数: 0

Abstract

Background: Youth experiencing homelessness face significant barriers to mental healthcare. To address this gap, the Réseau d'Intervention de Proximité Auprès des Jeunes de la rue (RIPAJ) was established in Montréal in 2003 through collaboration between community and governmental health organizations. In 2016, RIPAJ joined the national Adolescent/Young Adult Connections to Community-driven Early Strengths-based Stigma-free services-Open Minds (ACCESS-OM) initiative, aiming to enhance mental healthcare accessibility for youth experiencing homelessness.

Aims: This study evaluates the impact of this integrated approach on referral trends and wait times before and during ACCESS-OM RIPAJ implementation.

Method: Monthly referrals and wait times for first appointment were recorded for a historical cohort (2014-2015) and the ACCESS-OM RIPAJ period (2016-2020). We used Poisson and Cox regression models to analyze trends in referral rates and wait times, with 2014 as reference period. Seasonality was controlled by incorporating calendar month in the models. Additional Cox regressions examined individual-level sociodemographic and clinical factors associated with post-implementation wait times.

Results: We analyzed 158 referrals for 2014 to 2015 and 681 for 2016 to 2020. Monthly referrals increased significantly, peaking at 2.5 times the 2014 level. Wait times remained stable, with 73.5% evaluated within 72 hr. The hazard ratio for wait times during the peak period was 0.87 (95% CI [0.63, 1.20]) indicating no significant change despite the surge in referrals. Older age and self-referral were associated with reduced wait times.

Conclusions: This collaborative model successfully increased mental healthcare utilization among youth experiencing homelessness, providing valuable insights for addressing the unmet needs of this vulnerable population and potentially reducing homelessness perpetuation.

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促进加拿大蒙特利尔无家可归青年获得心理健康服务：一项历史队列比较研究。

背景：无家可归的青年在心理保健方面面临重大障碍。为了弥补这一差距，2003年，通过社区和政府卫生组织之间的合作，在蒙特兰萨达尔建立了“近距离儿童健康干预计划”（RIPAJ）。2016年，RIPAJ加入了全国青少年/年轻人与社区驱动的早期优势无耻辱服务-开放思想（ACCESS-OM）倡议的联系，旨在提高无家可归青年的心理保健可及性。目的：本研究评估了这种综合方法在ACCESS-OM RIPAJ实施之前和期间对转诊趋势和等待时间的影响。方法：记录历史队列（2014-2015年）和ACCESS-OM RIPAJ期间（2016-2020年）的每月转诊和首次预约等待时间。我们使用泊松和考克斯回归模型分析转诊率和等待时间的趋势，以2014年为参照期。通过在模型中加入自然月份来控制季节性。另外的Cox回归检查了与实施后等待时间相关的个人层面的社会人口学和临床因素。结果：我们分析了2014年至2015年的158例转诊病例和2016年至2020年的681例转诊病例。每月转诊人数显著增加，达到2014年水平的2.5倍。等待时间保持稳定，73.5%的患者在72小时内接受了评估。高峰期间等待时间的风险比为0.87 (95% CI[0.63, 1.20])，表明尽管转诊人数激增，但没有显著变化。年龄越大和自我推荐与等待时间缩短有关。结论：这种合作模式成功地增加了无家可归青年的心理保健利用，为解决这一弱势群体未满足的需求提供了有价值的见解，并有可能减少无家可归的长期存在。

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来源期刊

International Journal of Social Psychiatry PSYCHIATRY-

CiteScore

12.30

自引率

1.30%

发文量

120

期刊介绍： The International Journal of Social Psychiatry, established in 1954, is a leading publication dedicated to the field of social psychiatry. It serves as a platform for the exchange of research findings and discussions on the influence of social, environmental, and cultural factors on mental health and well-being. The journal is particularly relevant to psychiatrists and multidisciplinary professionals globally who are interested in understanding the broader context of psychiatric disorders and their impact on individuals and communities. Social psychiatry, as a discipline, focuses on the origins and outcomes of mental health issues within a social framework, recognizing the interplay between societal structures and individual mental health. The journal draws connections with related fields such as social anthropology, cultural psychiatry, and sociology, and is influenced by the latest developments in these areas. The journal also places a special emphasis on fast-track publication for brief communications, ensuring that timely and significant research can be disseminated quickly. Additionally, it strives to reflect its international readership by publishing state-of-the-art reviews from various regions around the world, showcasing the diverse practices and perspectives within the psychiatric disciplines. This approach not only contributes to the scientific understanding of social psychiatry but also supports the global exchange of knowledge and best practices in mental health care.