Contemporary health promotion emphasises the concepts of lifestyle, risk, and preventive health b... more Contemporary health promotion emphasises the concepts of lifestyle, risk, and preventive health behaviour alongside the broader societal concerns of the environment, public policy, and culture. 1 The recent green paper Our Healthier Nation stresses a more coordinated approach to health promotion for people who are socially excluded, emphasising behavioural change through targeted interventions at the level of the community. 2 There have been extensive reviews of homelessness and health, 3 4 along with calls for urgent action, 5-7 but little attention has been paid to the health promotion needs of homeless people, and there is no firm evidence base for practice. One challenge for health promotion is to develop and deliver appropriate initiatives to a heterogeneous population that is not always easy to categorise but has a wide range of needs. The healthcare priorities of a young man sleeping on the streets differ from those of a single mother in temporary accommodation. To be homeless means more than just the absence of secure accommodation. Homelessness has as much to do with social exclusion as with bricks and mortar, and demands a range of health promotion strategies.
SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance... more SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance misuse, and personality disorder. However, psychiatric services in the UK have only recently engaged actively with homeless people. This article provides some background information about homelessness and mental illness and describes the elements of inclusion health and some of the models of service for homeless people that have been established over the past 30 years.
Specialist mental health services for homeless people have developed since the 1980s, in response... more Specialist mental health services for homeless people have developed since the 1980s, in response to the increased awareness of the numbers of homeless people with mental health problems on the street. They have employed many of the principles of assertive outreach but have engaged, not with people who are already, to some extent, engaged with mental health services, but with those homeless people who have become completely disengaged from medical and mental health services. They have pioneered ways of working in non-clinical settings, such as the street, day centres, and hostels for the homeless. They have developed models for closer collaboration with voluntary sector services and non-medical housing and social services. In the last few years, they have developed more sophisticated outreach models. These use psychological notions of complex trauma to facilitate engagement with people who have a history of rejecting help—and to enable the subsequent provision of effective services ...
Homelessness is often discussed as if it were a crisis—an interruption in the usual, civilized wa... more Homelessness is often discussed as if it were a crisis—an interruption in the usual, civilized way of organizing society. However, the history of homeless people is a poorly documented but unbroken thread through the last 600 years of our history. Moreover, the literature suggests that severe mental illness has been a prominent feature of homeless populations from the age of monastic provision, through the ages of the bridewell and the asylum, and into the current era of community care. Although direct accounts are sparse, we can gain some sense of what happened to homeless people with mental illness through specific pieces of legislation, and the documented history of the institutions and services established to deal with the problem. A theme persisting through the centuries has been the tension between punishment and rehabilitation.
SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance... more SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance misuse, and personality disorder. However, psychiatric services in the UK have only recently engaged actively with homeless people. This article provides some background information about homelessness and mental illness and describes the elements of inclusion health and some of the models of service for homeless people that have been established over the past 30 years.
Clinical psychiatry, for all its emphasis on scientific rigour, is mediated mainly by words rathe... more Clinical psychiatry, for all its emphasis on scientific rigour, is mediated mainly by words rather than by numbers. As with other professional areas, it has developed its own set of jargon words and phrases. Many of these are not the technical terms traditionally seen as jargon, but standard English words and phrases used in an idiosyncratic way. They therefore go unnoticed as jargon, while enfeebling our communications. I have used the template of Ambrose Bierce's The Devil's Dictionary to highlight some examples, with the aim of helping us all to talk, write and, perhaps, think more clearly.
Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic ant... more Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic antipsychotics. They are said to have treatment-resistant schizophrenia (TRS). Clozapine is still the only effective treatment for TRS, although it is underused in clinical practice. Initial use is delayed, it can be hard for patients to tolerate, and clinicians can be uncertain as to when to use it. What if, at the start of treatment, we could identify those patients likely to respond to clozapine - and those likely to suffer adverse effects? It is likely that clinicians would feel less inhibited about using it, allowing clozapine to be used earlier and more appropriately. Genetic testing holds out the tantalizing possibility of being able to do just this, and hence the vital importance of pharmacogenomic studies. These can potentially identify genetic markers for both tolerance of and vulnerability to clozapine. We aim to summarize progress so far, possible clinical applications, limitati...
Background: The impact of mental disorders among homeless people is likely to be substantial in l... more Background: The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia. Methods: A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule. Results: We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness. Conclusion: Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.
Aims and method A service evaluation was undertaken to examine outcomes in patients who were stre... more Aims and method A service evaluation was undertaken to examine outcomes in patients who were street homeless (‘rough sleepers’) and who were compulsorily admitted to hospital under the Mental Health Act 1983. The data were collected from the patients' case notes. Results At 1-year follow-up, patients had positive outcomes in areas such as accommodation status, registration with a general practitioner and engagement with the clinical team. Clinical implications The study shows that the intervention of a Mental Health Act assessment and compulsory hospital admission in homeless people on the street is associated with positive outcomes at 1 year.
Introduced by Spitzer and studied by Liggett [14] the Long Range Exclusion Process (LREP ) is an ... more Introduced by Spitzer and studied by Liggett [14] the Long Range Exclusion Process (LREP ) is an interacting particle system with truly long range interaction. Informally speaking: each particle on a lattice hops at independent random times following instantaneously a random dynamic on the lattice until finding a vacant site (if any). These instantaneous, potentially long jumps prevent the process to have the Feller property. In this paper we review the main results about the LREP including recent developments obtained in and . New results on Feller approximations and about the regularity set of the LREP are also provided. Finally we briefly discuss some connections of the LREP with the discrete Hammersley process introduced in [8] and the sandpile process in infinite volume developed in [18] and [17].
Contemporary health promotion emphasises the concepts of lifestyle, risk, and preventive health b... more Contemporary health promotion emphasises the concepts of lifestyle, risk, and preventive health behaviour alongside the broader societal concerns of the environment, public policy, and culture. 1 The recent green paper Our Healthier Nation stresses a more coordinated approach to health promotion for people who are socially excluded, emphasising behavioural change through targeted interventions at the level of the community. 2 There have been extensive reviews of homelessness and health, 3 4 along with calls for urgent action, 5-7 but little attention has been paid to the health promotion needs of homeless people, and there is no firm evidence base for practice. One challenge for health promotion is to develop and deliver appropriate initiatives to a heterogeneous population that is not always easy to categorise but has a wide range of needs. The healthcare priorities of a young man sleeping on the streets differ from those of a single mother in temporary accommodation. To be homeless means more than just the absence of secure accommodation. Homelessness has as much to do with social exclusion as with bricks and mortar, and demands a range of health promotion strategies.
SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance... more SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance misuse, and personality disorder. However, psychiatric services in the UK have only recently engaged actively with homeless people. This article provides some background information about homelessness and mental illness and describes the elements of inclusion health and some of the models of service for homeless people that have been established over the past 30 years.
Specialist mental health services for homeless people have developed since the 1980s, in response... more Specialist mental health services for homeless people have developed since the 1980s, in response to the increased awareness of the numbers of homeless people with mental health problems on the street. They have employed many of the principles of assertive outreach but have engaged, not with people who are already, to some extent, engaged with mental health services, but with those homeless people who have become completely disengaged from medical and mental health services. They have pioneered ways of working in non-clinical settings, such as the street, day centres, and hostels for the homeless. They have developed models for closer collaboration with voluntary sector services and non-medical housing and social services. In the last few years, they have developed more sophisticated outreach models. These use psychological notions of complex trauma to facilitate engagement with people who have a history of rejecting help—and to enable the subsequent provision of effective services ...
Homelessness is often discussed as if it were a crisis—an interruption in the usual, civilized wa... more Homelessness is often discussed as if it were a crisis—an interruption in the usual, civilized way of organizing society. However, the history of homeless people is a poorly documented but unbroken thread through the last 600 years of our history. Moreover, the literature suggests that severe mental illness has been a prominent feature of homeless populations from the age of monastic provision, through the ages of the bridewell and the asylum, and into the current era of community care. Although direct accounts are sparse, we can gain some sense of what happened to homeless people with mental illness through specific pieces of legislation, and the documented history of the institutions and services established to deal with the problem. A theme persisting through the centuries has been the tension between punishment and rehabilitation.
SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance... more SUMMARY Homelessness has long been associated with high rates of psychosis, alcohol and substance misuse, and personality disorder. However, psychiatric services in the UK have only recently engaged actively with homeless people. This article provides some background information about homelessness and mental illness and describes the elements of inclusion health and some of the models of service for homeless people that have been established over the past 30 years.
Clinical psychiatry, for all its emphasis on scientific rigour, is mediated mainly by words rathe... more Clinical psychiatry, for all its emphasis on scientific rigour, is mediated mainly by words rather than by numbers. As with other professional areas, it has developed its own set of jargon words and phrases. Many of these are not the technical terms traditionally seen as jargon, but standard English words and phrases used in an idiosyncratic way. They therefore go unnoticed as jargon, while enfeebling our communications. I have used the template of Ambrose Bierce's The Devil's Dictionary to highlight some examples, with the aim of helping us all to talk, write and, perhaps, think more clearly.
Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic ant... more Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic antipsychotics. They are said to have treatment-resistant schizophrenia (TRS). Clozapine is still the only effective treatment for TRS, although it is underused in clinical practice. Initial use is delayed, it can be hard for patients to tolerate, and clinicians can be uncertain as to when to use it. What if, at the start of treatment, we could identify those patients likely to respond to clozapine - and those likely to suffer adverse effects? It is likely that clinicians would feel less inhibited about using it, allowing clozapine to be used earlier and more appropriately. Genetic testing holds out the tantalizing possibility of being able to do just this, and hence the vital importance of pharmacogenomic studies. These can potentially identify genetic markers for both tolerance of and vulnerability to clozapine. We aim to summarize progress so far, possible clinical applications, limitati...
Background: The impact of mental disorders among homeless people is likely to be substantial in l... more Background: The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia. Methods: A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule. Results: We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness. Conclusion: Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.
Aims and method A service evaluation was undertaken to examine outcomes in patients who were stre... more Aims and method A service evaluation was undertaken to examine outcomes in patients who were street homeless (‘rough sleepers’) and who were compulsorily admitted to hospital under the Mental Health Act 1983. The data were collected from the patients' case notes. Results At 1-year follow-up, patients had positive outcomes in areas such as accommodation status, registration with a general practitioner and engagement with the clinical team. Clinical implications The study shows that the intervention of a Mental Health Act assessment and compulsory hospital admission in homeless people on the street is associated with positive outcomes at 1 year.
Introduced by Spitzer and studied by Liggett [14] the Long Range Exclusion Process (LREP ) is an ... more Introduced by Spitzer and studied by Liggett [14] the Long Range Exclusion Process (LREP ) is an interacting particle system with truly long range interaction. Informally speaking: each particle on a lattice hops at independent random times following instantaneously a random dynamic on the lattice until finding a vacant site (if any). These instantaneous, potentially long jumps prevent the process to have the Feller property. In this paper we review the main results about the LREP including recent developments obtained in and . New results on Feller approximations and about the regularity set of the LREP are also provided. Finally we briefly discuss some connections of the LREP with the discrete Hammersley process introduced in [8] and the sandpile process in infinite volume developed in [18] and [17].
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Papers by Philip Timms