City expands health programs for chronically homeless in shelters

Recurring episodes of paranoia got Jacques kicked of every apartment he rented.

For Marco, it was untreated schizophrenia. He lost his job, his wife and access to his children. He lived on the street and in shelters.

For both men, it’s been a life of housing instability for nearly two decades. But thanks to a re-integration program at the Welcome Hall Mission that aims to improve the mental health of those on the street, these men, now in their 50s, have moved to into an independent-living apartment.

They’re part of the Programme réaffiliation itinérance et santé mentale (PRISM) that deals with homeless people suffering from a mental illness by bringing the care to their doorstep — at a shelter — via a team that includes a doctor, nurse, psychiatrist and social worker.

The PRISM program is a partnership between a hospital and a shelter. “Neither one of us would have been able to do this alone,” explained Dr. Karl Looper, chief psychiatrist at the Jewish General Hospital of the PRISM program that brings together the westcentral health department, the CIUSSS West-Central Montreal and the Mission.

“We’re struck by how often people show up at the emergency room, brought in by police ... but rarely get follow-up care because you can’t reach them, there’s no phone number to call,” Looper said, or they live in and out of homeless shelters that are not equipped to provide the health care that they need.

The Mission has set aside eight beds for a program that has already seen 19 clients since November, and seven clients have been placed in their own apartments. They get a bed with a locker, access to a communal living room, and daily consultations with health staff. Many who don’t have a family doctor are assigned one, others require help to settle legal issues.

On average, it takes about three months of intense, daily care from mental health experts to move a chronically homeless person to a kind of independent living, explained CIUSSS West-Central psychiatrist Vincent Laliberté, who heads the program at the Mission.

The program is effective and gets results fast, Laliberté said. Those who move into independent living are not left alone but are assigned an outreach health team whose members looks in on them daily.

The PRISM method was developed by Dr. Oliver Farmer five years ago, and is now in use at three other Montreal shelters. Farmer was looking for a better way to treat mentally ill patients after two people were fatally shot by Montreal police, Mario Hamel in 2012, and Farshad Mohammadi in 2013.

An estimated 3,000 to 4,000 homeless live in Montreal.

The old cliché is that a homeless person is some drunk in the ditch, said Samuel Watts, executive-director of the Welcome Hall Mission. But more often, a multitude of factors spiral someone toward homelessness — for example, a breakdown in the family and overwhelming stress, he said.