Trajectories of Incarceration Over Six Years Among People with Mental Illness and Experiences of Homelessness: Predictive Factors Among Participants in a Randomized Trial of Housing First: Trajectoires d’incarcération sur six ans chez les personnes atteintes de maladie mentale et ayant connu l’itinérance–Facteurs prédictifs chez les participants à un essai à répartition aléatoire en marge du programme «Logement d’abord»

ObjectiveTo identify long-term trajectories of incarceration, impact of Housing First intervention, and associated predictor factors among people with mental illness and experiences of homelessness who participated in a randomized trial of Housing First in Toronto, Canada.MethodsParticipants in the Toronto site of the At Home/Chez Soi study (n = 559) were followed from 2009 to 2017. The primary outcome of interest was incarceration trajectories, analyzed using group-based trajectory modelling. Multinomial logistic regression was used to examine the association between Housing First intervention, baseline socio-demographic and health characteristics, and trajectories of incarceration.ResultsThree group-based incarceration trajectories were identified: Low (66.3%), decreasing (23.1%), and high (10.6%). Younger age, early onset of homelessness, longer duration of homelessness, male gender, drug and alcohol dependence or abuse disorders, and history of traumatic brain injury were significant predictors of high and decreasing incarceration trajectories compared to low trajectory. Receiving Housing First was not significantly associated with incarceration trajectory group.ConclusionsA small subgroup of individuals with mental illness and experiences of homelessness demonstrated a persistently high and long-term incarceration trajectory. Multi-disciplinary collaborations with mental health, housing and the criminal justice systems are needed, especially for individuals at increased risk of future incarceration.The trial is registered in the ISRCTN registry (ISRCTN42520374).