In his correspondence, Dr. Podschus discusses important results of our meta-analysis (1). In the first point, Dr. Podschus states the basic requirements for care, with which we can only agree.

We would like to add the following to his other points. Despite the nationwide social security systems installed in Germany, the number of homeless people is increasing. In other Western countries with less well-developed security systems, such as North America, targeted assistance—and especially outreach concepts, such as Assertive Community Treatment (ACT) and Intensive Case Management (ICM)—and Housing First concepts (for which homeless people do not need to qualify by abstinence, for instance from alcohol) have been developed and scientifically evaluated in recent years (2, 3). These have been shown to have a good effectiveness in terms of rehousing and improving mental and physical health.

Many aspects of these concepts that have been specially developed for care are already part of German support systems, for example the psychiatric integration support (Eingliederungshilfe). It would be conceivable to:

  • Compare the internationally proven concepts, such as those mentioned, with the existing support structures in Germany, and to modify the latter if necessary;
  • Reduce any interface problems and unify structures;
  • Focus on outreach support.

Moreover, with a pooled 1-month prevalence rate of 77.4% (95% confidence interval: [71.3; 82.9]) for Axis 1 disorders among homeless people in Germany (1), the question is indeed whether having separate care providers for psychiatric integration support and social housing assistance—as currently is the case—is necessary. As this often leads to questions about responsibility and results in interface problems, it ultimately provides suboptimal care for homeless people in many cases.

DOI: 10.3238/arztebl.2018.0068b

Dr. med. Stefanie Schreiter
Charité – Universitätsmedizin Berlin, Germany
Department of Psychiatry and Psychotherapy
Charité Campus Mitte
stefanie.schreiter@charite.de

Dr. med. Stefan Gutwinski

PD Dr. med. Meryam Schouler-Ocak

Prof. Dr. med. Felix Bermpohl

Prof. Dr. med. Michael Krausz
Department of Psychiatry,
University of British Columbia (UBC) Vancouver, Canada

Prof. Dr. med. Stefan Leucht
Technische Universität München,Germany
Klinikum rechts der Isar,
Klinik für Psychiatrie und Psychotherapie

Prof. Dr. med. Wulf Rössler
Universität Zürich,Switzerland
Klinik für Psychiatrie und Psychotherapie,
Psychiatrische Universitätsklinik

Conflict of interest statement

The authors declare that no conflict of interest exists.

1.
Schreiter S, Bermpohl F, Krausz M, Leucht S, Rössler W, Schouler-Ocak M, Gutwinski S: The prevalence of mental illness in homeless people in Germany—a systematic review and meta-analysis. Dtsch Arztebl Int 2017; 114: 665–72 VOLLTEXT
2.
Nelson G, Aubry T, Lafrance A: A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. Am J Orthopsychiatry 2007; 77: 350–61 CrossRef MEDLINE
3.
Patterson M, Moniruzzaman A, Palepu A, et al.: Housing first improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 1245–59 CrossRef MEDLINE
1.Schreiter S, Bermpohl F, Krausz M, Leucht S, Rössler W, Schouler-Ocak M, Gutwinski S: The prevalence of mental illness in homeless people in Germany—a systematic review and meta-analysis. Dtsch Arztebl Int 2017; 114: 665–72 VOLLTEXT
2.Nelson G, Aubry T, Lafrance A: A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. Am J Orthopsychiatry 2007; 77: 350–61 CrossRef MEDLINE
3.Patterson M, Moniruzzaman A, Palepu A, et al.: Housing first improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 1245–59 CrossRef MEDLINE

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