title: Missing link in community psychiatry: When a patient with schizophrenia was expelled from her home.
abstract: Treatment and disposition of homeless patients with schizophrenia represent a great challenge in clinical practice. We report a case of this special population, and discuss the development of homelessness, the difficulty in disposition, their utilization of health services, and possible applications of mandatory community treatment in this group of patients. A 51-year-old homeless female was brought to an emergency department for left femur fracture caused by an assault. She was diagnosed with schizophrenia about 20 years ago but received little help from mental health services over the decades. During hospitalization, her psychotic symptoms were only partially responsive to treatment. Her family refused to handle caretaking duties. The social welfare system was mobilized for long-term disposition. Homeless patients with schizophrenia are characterized by family disruption, poor adherence to health care, and multiple emergency visits and hospitalization. We hope this article can provide information about the current mental health policy to medical personnel. It is possible that earlier intervention and better outcome can be achieved by utilizing mandatory community treatment in the future, as well as preventing patients with schizophrenia from losing shelters.
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Kevin Chien-Chang
authors.initials: KC
authors.lastname: Wu
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: ylchien@hotmail.com.
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Chien
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan.
authors.forename: Sung-Tai
authors.initials: ST
authors.lastname: Lee
mesh_terms: D003158:Community Psychiatry / Q000592:standards*; D004636:Emergency Service, Hospital; D005260:Female; D005265:Femoral Neck Fractures / Q000175:diagnosis; D006703:Ill-Housed Persons / Q000523:psychology*; D006760:Hospitalization; D006798:Housing; D006801:Humans; D037141:Mandatory Programs / Q000331:legislation & jurisprudence; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012559:Schizophrenia / Q000628:therapy*; D012946:Social Welfare / Q000331:legislation & jurisprudence*; D013624:Taiwan
keywords: homeless; mandatory community treatment; risk factor; schizophrenia; utilization