A COVID-19 Intervention Aiding the Mentally Ill and Homeless

A search of 19 electronic databases yielded 1 study that described a strategy that met the eligibility criteria of researchers seeking interventions to support self-isolation and mandated COVID-19 quarantine for people with severe and persistent mental illness (SPMI). Their findings were published in Psychiatric Research & Clinical Practice.

The researchers considered all psychiatric disorder categories as SPMIs and any interventions designed to support self-isolation or mandatory quarantine for COVID-19, including comparisons of interventions.

They searched for peer-reviewed literature through PubMed, MEDLINE, PsychINFO, Cochrane, Embase, and they reviewed the websites of the following addictions and psychiatric institutions: the American Psychiatric Association, the Canadian Psychiatric Association, British Columbia Center for Substance Use, the American Society of Addiction Medicine, and the Canadian Society of Addiction Medicine. The investigators also searched reference lists of studies and reviews and unpublished, ongoing trials on the FDA website and the World Health Organization International Clinical Trial Registry.

Cochrane’s Covidence was used to remove duplicate citations (n=5582), screen records, extract data from reports, and find population‐intervention‐comparison‐outcome‐study design (PICOS) characteristics. The Cochrane Risk of Bias Tool was used to appraise study quality and identify individual risk of bias domains.

The 1 study that met the criteria retrospectively evaluated the utility of an isolation hotel for homeless individuals during the pandemic before vaccines were available. Of the 1,009 participants, (25% with a mental health disorder, 26% with a substance use disorder, 10% in jail in the past year), 81% completed the hotel stay. The study found that factors linked to early departure were unsheltered homelessness and requiring quarantine with close contact, but it had a serious risk of bias due to missing data (failure to note whether factors were consistent across individuals with SPMIs) and selection bias, as 48 patients had behavioral health needs surpassing the hotel capabilities. Strategies to improve retention and address needs not met are intervention priorities.

Shelter guidance documents indicated psychosocial supports and protocols, including

Alberta Health Services recommendations for providing designated bedrooms and bathrooms, limiting visitors, maintaining physical distance from ill individuals, avoiding sharing household items, frequent hand hygiene and sanitation, and self-monitoring for COVID-19 symptoms, along with psychosocial supports for concerns such as risk of becoming more acutely ill, unplanned detox, increased stress, and grief. It included procedures for accommodating individuals with a private hotel unit or designated isolation space and psychosocial and medical/pharmacy support for highly vulnerable clients. It described an outbreak team that helps units manage clients to prematurely leave the shelter without describing the supports or their effectiveness.

Limitations of the study included the fact the researchers limited the search to a time period during the COVID-19 pandemic.

A Royal Society of Canada policy briefing provided recommendations for shelter care for these individuals based on client feedback during the pandemic and noted hypothetical incentives for following isolation protocols that clients and support workers had advised, including snacks, drinks, cash-equivalent vouchers, cigarettes, cannabis, and alcohol. They urged hosting onsite programs supporting mental health and harm reduction.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.