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BACKGROUND Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. AIMS To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course(More)
OBJECTIVE The study evaluated the effectiveness of a three-year outpatient commitment pilot program established in 1994 at Bellevue Hospital in New York City. METHODS A total of 142 participants were randomly assigned; 78 received court-ordered treatment, which included enhanced services, and 64 received the enhanced-service package only. Between 57 and(More)
OBJECTIVE Research on homelessness among persons with severe mental illness tends to focus on aspects of demand, such as risk factors or structural and economic forces. The authors address the complementary role of supply factors, arguing that "solutions" to residential instability-typically, a series of institutional placements alternating with shelter(More)
OBJECTIVE Despite decades of deinstitutionalization, individuals with psychiatric disabilities living outside the hospital may be described as in the community, but not of it. To effectively address the persisting problem of social exclusion of persons with psychiatric disabilities, new conceptual tools are needed. To address this need, a new definition of(More)
BACKGROUND Data on the two-year pattern of course of illness have been collected in the WHO study of the Determinants of Outcomes of Severe Mental Disorder (DOSMD). These data are reanalysed using recursive partitioning, a method not yet applied to psychiatric data to test the hypothesis that subjects from participating centres in developing countries had(More)
BACKGROUND Established legal mandates and high expectations for psychiatric advance directives are not matched by empirical evidence documenting their actual implementation. AIMS To explore the interests, concerns and planning activities of informed mental health service users contemplating such directives. METHOD Standard qualitative research(More)
OBJECTIVE Quality of life, once a priority in caring for people with severe mental illness, has since been eclipsed by other concerns. This article returns attention to quality of life by offering a theory of social integration (as quality of life) for persons disabled by severe mental illness. METHODS Data collection for this qualitative study consisted(More)
OBJECTIVE This paper compares the prevalence of mental illnesses and alcohol and drug abuse and the residential histories of homeless individuals identified as having a mental illness and individuals who are not so identified. The cohort consisted of single persons applying for shelter over a 12-week period in Westchester County, a suburban county in New(More)
An ethnographic study of the homeless poor in New York City suggests that significant changes have taken place in the size and composition of that population during the past 15 years. Among the disenfranchised, the mentally disabled figure prominently, many of them casualties of state deinstitutionalization and restricted admission policies. This paper(More)
OBJECTIVE This study examined whether outcomes in housing, clinical status, and well-being of persons with severe mental illness and a history of homelessness differ between those in supported housing and those in community residences, two housing arrangements that substantially differ in the level of independence that is offered to its tenants. METHODS A(More)