Secondary objectives
Mental health is specifically assessed using the Modified Colorado Symptom Index (MCSI) [
41] and the Clinical Global Impression (CGI) [
42]. The MCSI contains 14 items which evaluate how often in the past month an individual has experienced a variety of mental health symptoms, including loneliness, depression, anxiety, and paranoia. Higher scores indicate a greater likelihood of mental health problems. The CGI rates the overall severity of any mental disorder, on a scale of the overall current severity of symptoms from 1 (healthy, not ill) to 7 (severely ill). The CGI is sensitive to change and correlates well with changes assessed with more complex scales [
43,
44].
Alcohol and substance use is assessed using sections K and L of the Mini International Neuropsychiatric Interview (MINI) [
36]. The MINI is an abbreviated, structured diagnostic interview that determines the presence or absence of diagnoses of dependence on and/or abuse of alcohol and/or the more frequently used or more problematic drugs, and whether the diagnosis is current (preceding 12 months) and/or a lifetime diagnosis (anytime in life - may or may not be current).
Adherence is assessed with the Medication Adherence Rating Scale (MARS) [
45], a 10-item, multidimensional, self-reporting instrument describing three dimensions: ‘medication adherence behavior’, ‘attitude toward taking medication’ and ‘negative side-effects and attitudes to psychotropic medication’. A high score correlates with a higher likelihood of medication adherence.
Global physical and mental health status is assessed using the 36-item Short Form Health Survey (SF-36) of the Medical Outcomes Study [
46]. The SF-36 is a self-administered questionnaire consisting of 36 items describing eight dimensions: physical functioning, social functioning, role-physical problems, role-emotional problems, mental health, vitality, bodily pain, and general health. Two composite scores can be calculated: the physical composite score and the mental composite score. Each dimension is scored within a range from 0 (poor health status) to 100 (good health status).
Quality of life is assessed using the S-QoL 18 [
47], which is a self-administered, multidimensional questionnaire developed and validated for the specific assessment of quality of life in patients with mental disorders [
47,
48]. The S-QoL 18 comprises 18 items describing eight dimensions: psychological well-being, self-esteem, family relationships, relationships with friends, resilience, physical well-being, autonomy, and sentimental life. It also generates a global score. Dimension and index scores range from 0, indicating the lowest quality of life, to 100, the highest quality of life.
Health status is assessed using the EuroQoL 5D [
49], a standardized instrument for use as a measure of health outcomes, providing a simple descriptive profile and a single index value. This self-administered questionnaire measures five dimensions: mobility, personal care, routine occupations, pain and discomfort, and anxiety and depression. Each dimension has three levels: no problems, some problems, and severe problems.
Recovery is assessed using the Recovery Assessment Scale (RAS) [
50], which measures various aspects of recovery from the perspective of the consumer, with a particular emphasis on hope and self-determination. This self-administered instrument comprises 24 items, exploring five domains: personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, and no domination by symptoms. A higher score indicates better recovery.
Social functioning is assessed using the Multnomah Community Integration Scale (MCAS) [
32,
33]. The MCAS is a 17-item instrument that measures the degree of functional ability of adult clients who have severe and persistent mental disorders and who live in the community. Items are grouped into four categories: 1) interference with functioning; 2) adjustment to living; 3) social skills; and 4) behavioral problems. Higher scores indicate more severe disability.
The following parameters are also recorded by research assistants using ad hoc questionnaires elaborated by the steering committee composed of economists, psychiatrists, psychologists, social workers and sociologists: gender, age, education level, social minimums and administrative situation, employment status, social network, health events, housing stability, contact with legal services, use of social services (for example., emergency shelters, transition shelters, stabilization shelters, supportive housing, and hostels) and experience of violence.
In the cost analysis, direct and indirect costs are measured during the 24-month follow-up period. Direct costs comprise the costs related to medical/health, legal, housing, and social services (that is, hospital days; emergency department visits; outpatient visits; use of substance abuse treatment centers; legal services, including days detained in jails and prisons; days in respite, shelter, and other housing; and case management) and indirect costs mainly related to loss of productivity [
51,
52]. Data are collected using national administrative, social and medical databases; medical records; structured interviews with research participants and the standardized Short Form-Health and Labor questionnaire (SF-H&L) [
53]. The SF-H&L inquires about productivity losses that are caused by health problems in general: absenteeism from paid work, production losses without absenteeism from paid work and hindrance in the performance of paid and unpaid work.