Abstract
The objective of this paper is to critically review the methods used to study service use by homeless persons with mental illness, and discuss gaps in the evidence base and research implications. Searches were conducted of PsycINFO, MEDLINE, and PubMed to identify service use studies published between 2000 and 2014. Data were extracted on the types of services studied, quantification of service use, assessment tools, period of service use assessment, and analytic design. The review identified 27 studies described in 46 publications. The majority of the studies had observational designs that measured service use quantitatively as an outcome variable. Receipt or non-receipt and volume of use were the most common methods of quantifying service use. The types of services that have been examined primarily consist of formal mental health, primary health care, substance use, homelessness, and housing services. There is a considerable gap in the understanding of personal outcomes associated with use of services, as well as people’s experiences of using services. Specific to the homeless mentally ill population, there is an urgent need to better understand the role of service use in the attainment of stable housing and recovery from mental illness. In addition, less formal health and related services, such as peer support, have been largely excluded in service use research.
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References
*denotes an article included in the review
*Acosta, O., Toro, P.A.: Let’s ask the homeless people themselves: a needs assessment based on a probability sample of adults. Am. J. Commun. Psychol. 28, 343–366 (2000)
Aday, L.A., Andersen, R.: A framework for the study of access to medical care. Health Serv. Res. 9, 208–220 (1974)
Andersen, R.M.: Behavioral Model of Families’ Use of Health Services (Research Series No. 25). Centre for Health Administration Studies, University of Chicago, Chicago (1968)
Andersen, R.M.: Revisiting the behavioral model and access to medical care: does it matter? J. Health Soc. Behav. 36, 1–10 (1995)
Anthony, W.A.: Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosoc. Rehabil. J. 16, 11–23 (1993)
Baggett, T.P., O’Connell, J.J., Singer, D.E., Rigotti, N.A.: The unmet health care needs of homeless adults: a national study. Am. J. Public Health (2010). doi:10.2105/ajph.2009.180109
Biederman, D.J., Lindsey, E.W.: Promising research and methodological approaches for health behavior research with homeless persons. J. Soc. Distress Homel. (2014). doi:10.1179/1573658x14y.0000000008
Bhui, K., Shanahan, L., Harding, G.: Homelessness and mental illness: A literature review and a qualitative study of perceptions of the adequacy of care. Int. J. Soc. Psychiatr. (2006). doi:10.1177/0020764006062096
*Bonin, J.-P., Fournier, L., Blais, R.: Predictors of mental health service utilization by people using resources for homeless people in Canada. Psychiatr. Serv. 58, 936–941 (2007)
*Bonin, J.-P., Fournier, L., Blais, R.: A typology of mentally disordered users of resources for homeless people: towards better planning of mental health services. Adm. Policy Ment. Health (2009). doi:10.1007/s10488-009-0206-2
*Bonin, J.-P., Fournier, L., Blais, R., Perreault, M., White, N.D.: Health and mental health care utilization by clients of resources for homeless persons in Quebec City and Montreal, Canada: a 5-year follow-up study. J. Behav. Health Ser. R. 37, 95–110 (2010)
Bright, F.A.S., Kayes, N.M., Worrall, L., McPherson, K.M.: A conceptual review of engagement in healthcare and rehabilitation. Disabil. Rehabil. (2015). doi:10.3109/09638288.2014.933899
Busch-Geertsema, V., Edgar, W., O’Sullivan, E., Pleace, N.: Homelessness and homeless policies in Europe: lessons from research. Paper presented at the European Consensus Conference on Homelessness, Brussels, Belgium (2010, December)
Canavan, R., Barry, M.M., Matanov, A., Barros, H., Gabor, E., Greacen, T., Holcnerová, P., Kluge, U., Nicaise, P., Moskalewicz, J., Díaz-Olalla, J.M., Straßmayr, C., Schene, A.H., Soares, J.J.F., Gaddini, A., Priebe, S.: Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities. BMC Health Serv. Res. (2012). doi:10.1186/1472-6963-12-222
Chinman, M., George, P., Dougherty, R.H., Daniels, A.S., Ghosa, S.S., Swift, A., Delphin-Rittmon, M.E.: Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatr. Serv. 65, 429–441 (2014)
*Currie, L.B., Patterson, M.L., Moniruzzaman, A., McCandless, L.C., Somers, J.M.: Examining the relationship between health-related need and the receipt of care by participants experiencing homelessness and mental illness. BMC Health Serv. Res. (2014). doi:10.1186/1472-6963-14-404
Davidson, L., Chinman, M., Sells, D., Rowe, M.: Peer support among adults with serious mental illness: a report from the field. Schizophr. Bull. (2006). doi:10.1093/schbul/sbj043
Davidson, L., O’Connell, M.J., Tondora, J., Lawless, M., Evans, A.C.: Recovery in serious mental illness: a new wine or just a new bottle? Prof. Psychol. Res. Pract. (2005). doi:10.1037/0735-7028.36.5.480
Fazel, S., Khosla, V., Doll, H., Geddes, J.: The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med. (2008). doi:10.1371/journal.pmed.0050225
Folsom, D.P., Hawthorne, W., Lindamer, L., Gilmer, T., Bailey, A., Golshan, S., Garcia, P., Unützer, J., Hough, R., Jeste, D.V.: Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. Am. J. Psychiatry (2005). doi:10.1176/appi.ajp.162.2.370
*Forchuk, C., Brown, S.A., Schofield, R., Jensen, E.: Perceptions of health and health service utilization among homeless and housed psychiatric consumer/survivors. J. Psychiatr. Ment. Health 15, 399–407 (2008)
*Gelberg, L., Andersen, R.M., Leake, B.D.: The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Serv. Res. 34, 1273–1302 (2000)
Geller, J.L.: The first step in health reform for those with serious mental illness: integrating the dis-integrated mental health system. J. Nerv. Ment. Dis. (2015). doi:10.1097/nmd.0000000000000396
*Gilmer, T.P., Manning, W.G., Ettner, S.L.: A cost analysis of San Diego county’s REACH program for homeless persons. Psychiatr. Serv. 60, 445–450 (2009)
*Gilmer, T.P., Stefancic, A., Ettner, S.L., Manning, W.G., Tsemberis, S.: Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Arch. Gen. Psychiatry 67, 645–652 (2010)
Goering, P.N., Streiner, D.L., Adair, C., Aubry, T., Barker, J., Distasio, J., Hwang, S.W., Komaroff, J., Latimer, E., Somers, J., Zabkiewicz, D.M.: The at home/chez soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a housing first intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open (2011). doi:10.1136/bmjopen-2011-000323
Goldman, H.H., Thelander, S., Westrin, C.-G.: Organizing mental health services: an evidence-based approach. J. Ment. Health Policy 3, 69–75 (2000)
*Gonzalez, G., Rosenheck, R.A.: Outcomes and service use among homeless persons with serious mental illness and substance abuse. Psychiatr. Serv. 53, 437–446 (2002)
Greenwood, R.M., Stefancic, A., Tsemberis, A., Busch-Geertsema, V.: Implementation of housing first in Europe: successes and challenges in maintaining model fidelity. Am. J. Psychiatr. Rehabil. (2013). doi:10.1080/15487768.2013.847764
Hamilton, A.B., Chinman, M., Cohen, A.N., Oberman, R.S., Young, A.S.: Implementation of consumer providers into mental health intensive case management teams. J. Behav. Health Ser. Res. (2015). doi:10.1007/s11414-013-9365-8
*Herrman, H., Evert, H., Harvey, C., Gureje, O., Pinzone, T., Gordon, I.: Disability and service use among homeless people living with psychotic disorders. Aust. N. Z. J. Psychiatry 38, 965–974 (2004)
*Horvitz-Lennon, M., Frank, R.G., Thompson, W., Baik, S.H., Alegría, M., Rosenheck, R.A., Normand, S.-L.T.: Investigation of racial and ethnic disparities in service utilization among homeless adults with severe mental illnesses. Psychiatr. Serv. 60, 1032–1038 (2009)
*Horvitz-Lennon, M., Zhou, D., Normand, S.-L.T., Alegría, M., Thompson, W.K.: Racial and ethnic service use disparities among homeless adults with severe mental illnesses receiving ACT. Psychiatr. Serv. 62, 598–604 (2011)
Hwang, S.W., Aubry, T., Palepi, A., Farrell, S., Nisenbaum, R., Hubley, A.M., Klodawsky, F., Gogosis, E., Hay, E., Pidlubny, S., Dowbor, T., Chambers, C.: The health and housing in transition study: a longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities. Int. J. Public Health. (2011). doi:10.1007/s00038-011-0283-3
Hwang, S.W., Tolomiczenko, G., Kouyoumdjian, F.G., Garner, R.E.: Interventions to improve the health of the homeless: a systematic review. Am. J. Prev. Med. (2005). doi:10.1016/j.amepre.2005.06.017
Kerman, N., Curwood, S.E., Sirohi, R., Trainor, J.: What’s in the basket of services? Support preferences of mental health consumers and family members. Can. J. Commun. Ment. Health (2013). doi:10.7870/cjcmh-2013-018
Kidd, S.A., McKenzie, K.J., Virdee, G.: Mental health reform at a systems level: widening the lens on recovery-oriented care. Can. J. Psychiatry 59, 243–249 (2014)
*Kuno, E., Rothbard, A.B., Averyt, J., Culhane, D.: Homelessness among persons with serious mental illness in an enhanced community-based mental health system. Psychiatr. Serv. 51, 1012–1016 (2000)
*Lam, J.A., Rosenheck, R.A.: Correlates of improvement in quality of life among homeless persons with serious mental illness. Psychiatr. Serv. 51, 116–118 (2000)
Lamb, H.R., Bachrach, L.L.: Some perspectives on deinstitutionalization. Psychiatr. Serv. 52, 1039–1045 (2001)
Landis, J.R., Koch, G.G.: The measurement of observer agreement for categorical data. Biometrics (1977). doi:10.2307/2529310
*Lee, S., de Castella, A., Freidin, J., Kennedy, A., Kroschel, J., Humphrey, C., Kerr, R., Hollows, A., Wilkins, S., Kulkarni, J.: Mental health care on the streets: an integrated approach. Aust. N. Z. J. Psychiatry 44, 505–512 (2010)
*Lemming, M.R., Calsyn, R.J.: Utility of the behavioral model in predicting service utilization by individuals suffering from severe mental illness and homelessness. Community Ment. Health J. 40, 347–364 (2004)
*Lemming, M.R., Calsyn, R.J.: Ability of the behavioral model to predict utilization of five services by individuals suffering from severe mental illness and homelessness. J. Soc. Serv. Res. (2006). doi:10.1300/j079v32n03_09
Levinson, D., Ross, M.: Homelessness Handbook. Berkshire Publishing Group, Great Barrington (2007)
*Lindamer, L.A., Liu, L., Sommerfeld, D.H., Folsom, D.P., Hawthorne, W., Garcia, P., Aarons, G.A., Jeste, D.V.: Predisposing, enabling, and need factors associated with high service use in a public mental health system. Adm. Policy Ment. Health (2012). doi:10.1007/s10488-011-0350-3
*Linton, K.F., Shafer, M.S.: Factors associated with the health service utilization of unsheltered, chronically homeless adults. Soc. Work Publ. Health (2014). doi:10.1080/19371918.2011.619934
Markowitz, F.E.: Psychiatric hospital capacity, homelessness, and crime and arrest rates. Criminology (2006). doi:10.1111/j.1745-9125.2006.00042.x
*McLaughlin, T.C.: Using common themes: cost-effectiveness of permanent supported housing for people with mental illness. Res. Soc. Work Pract. (2011). doi:10.1177/1049731510387307
*McNiel, D.E., Binder, R.L.: Psychiatric emergency service use and homelessness, mental disorder, and violence. Psychiatr. Serv. 56, 699–704 (2005)
*Min, S.-Y., Wong, Y.L.I., Rothbard, A.B.: Outcomes of shelter use among homeless persons with serious mental illness. Psychiatr. Serv. 55, 284–289 (2004)
*Nakonezny, P.A., Ojeda, M.: Health services utilization between older and younger homeless adults. Gerontologist 45, 249–254 (2005)
Newman, S.J.: Housing attributes and serious mental illness: implications for research and practice. Psychiatr. Serv. 52, 1309–1317 (2001)
*Odell, S.M., Commander, M.J.: Risk factors for homelessness among people with psychotic disorders. Soc. Psychiatry Psychiatr. Epidemiol. 35, 396–401 (2000)
*Ortega, A.N., Rosenheck, R.: Hispanic client-case manager matching: differences in outcomes and service use in a program for homeless persons with severe mental illness. J. Nerv. Ment. Dis. (2002). doi:10.1097/01.nmd.0000016257.61846.de
*Padgett, D.K., Henwood, B., Abrams, C., Davis, A.: Engagement and retention in services among formerly homeless adults with co-occurring mental illness and substance abuse: voices from the margins. Psychiatr. Rehab. J. (2008). doi:10.2975/31.3.2008.226.233
*Patterson, M.L., Moniruzzaman, A., Frankish, C.J., Somers, J.M.: Missed opportunities: childhood learning disabilities as early indicators of risk among homeless adults with mental illness in Vancouver, British Columbia. BMJ Open (2012a). doi:10.1136/bmjopen-2012-001586
*Patterson, M.L., Somers, J.M., Moniruzzaman, A.: Prolonged and persistent homelessness: multivariable analyses in a cohort experiencing current homelessness and mental illness in Vancouver, British Columbia. Ment. Health Subst. Use (2012b). doi:10.1080/17523281.2011.618143
Pescosolido, B.A., Gardner, C.B., Lubell, K.M.: How people get into mental health services: stories of choice, coercion and “muddling through” from “first-timers”. Soc. Sci. Med. 46, 275–286 (1998)
Pistrang, N., Barker, C., Humphreys, K.: The contributions of mutual help groups for mental health problems to psychological well-being: a systematic review. In: Brown, L.D., Wituk, S. (eds.) Mental Health Self-Help, pp. 61–85. Springer, New York (2010)
*Pollio, D.E., Spitznagel, E.L., North, C.S., Thompson, S., Foster, D.A.: Service use over time and achievement of stable housing in a mentally ill homeless population. Psychiatr. Serv. 51, 1536–1543 (2000)
*Pollio, D.E., North, C.S., Eyrich, K.M., Foster, D.A., Spitznagel, E.: Modeling service access in a homeless population. J. Psychoact. Drugs 35, 487–495 (2003)
*Pollio, D.E., North, C.S., Eyrich, K.M., Foster, D.A., Spitznagel, E.L.: A comparison of agency-based and self-report methods of measuring services across an urban environment by a drug-abusing homeless population. Int. J. Methods Psychiatr. Res. (2006). doi:10.1002/mpr.28
*Poulin, S.R., Maguire, M., Metraux, S., Culhane, D.P.: Service use and costs for persons experiencing chronic homelessness in Philadelphia: population-based study. Psychiatr. Serv. 61, 1093–1098 (2010)
*Rhoades, H., Wenzel, S.L., Golinelli, D., Tucker, J.S., Kennedy, D.P., Ewing, B.: Predisposing, enabling and need correlates of mental health treatment utilization among homeless men. Community Ment. Health J. (2014). doi:10.1007/s10597-014-9718-7
*Rosenheck, R.A., Dennis, D.: Time-limited assertive community treatment for homeless persons with severe mental illness. Arch. Gen. Psychiatry 58, 1073–1080 (2001)
Rosenheck, R., Morrissey, J., Lam, J., Calloway, M., Stolar, M., Johnsen, M., Randolph, F., Blasinsky, M., Goldman, H.: Service delivery and community: social capital, service systems integration, and outcomes among homeless persons with severe mental illness. Health Serv. Res. 36, 691–710 (2001)
*Rosenheck, R.A., Resnick, S.G., Morrissey, J.P.: Closing service system gaps for homeless clients with a dual diagnosis: integrated teams and interagency cooperation. J. Ment. Health Policy 6, 77–87 (2003)
*Rothbard, A.B., Min, S.-Y., Kuno, E., Wong, Y.-L.I.: Long-term effectiveness of the ACCESS program in linking community mental health services to homeless persons with serious mental illness. J. Behav. Health Ser. Res. 31, 441–449 (2004)
Rowe, M.: Citizenship and Mental Health. Oxford University Press, New York (2015)
Rowe, M., Styron, T., David, D.H.: Mental health outreach to persons who are homeless: implications for practice from a statewide study. Community Mental Health J. (2016). doi:10.1007/s10597-015-9963-4
Salize, H.J., Werner, A., Jacke, C.O.: Service provision for mentally disordered homeless people. Curr. Opin. Psychiatr. (2013). doi:10.1097/yco.0b013e328361e596
*Stein, J.A., Andersen, R.M., Koegel, P., Gelberg, L.: Predicting health services utilization among homeless adults: a prospective analysis. J. Health Care Poor U. 11, 212–230 (2000)
Stergiopoulos, V., Dewa, C., Durbin, J., Chau, N., Svoboda, T.: Assessing the mental health service needs of the homeless: a level-of-care approach. J. Health Care Poor Underserved (2010). doi:10.1353/hpu.0.0334
*Stergiopoulos, V., Gozdzik, A., O’Campo, P., Holtby, A.R., Jeyaratnam, J., Tsemberis, S.: Housing first: exploring participants’ early support needs. BMC Health Serv. Res. 14, 167–182 (2014)
*Tam, T.W., Zlotnick, C., Bradley, K.: The link between homeless women’s mental health and service system use. Psychiatr. Serv. 59, 1004–1010 (2008)
Trainor, J., Pomeroy, E., Pape, B.: A Framework for Support, 3rd edn. Canadian Mental Health Association, Toronto (2004)
*Unick, G.J., Kessell, E., Woodard, E.K., Leary, M., Dilley, J.W., Shumway, M.: Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service. Gen. Hosp. Psychiatry (2011). doi:10.1016/j.genhosppsych.2011.06.004
*Voronka, J., Harris, D.W., Grant, J., Komaroff, J., Boyle, D., Kennedy, A.: Un/helpful help and its discontents: peer researchers paying attention to street life narratives to inform social work policy and practice. Soc. Work Ment. Health (2014). doi:10.1080/15332985.2013.875504
*Wong, Y.-L.I., Nath, S.B., Solomon, P.L.: Group and organizational involvement among persons with psychiatric disabilities in supported housing. J. Behav. Health Ser. Res. 34, 151–167 (2007)
*Wong, Y.-L.I., Poulin, S.R., Lee, S., Davis, M.R., Hadley, T.R.: Tracking residential outcomes of supported independent living programs for persons with serious mental illness. Eval. Program Plan. (2008). doi:10.1016/j.evalprogplan.2008.07.001
*Young, A.S., Chinman, M.J., Cradock-O’Leary, J.A., Sullivan, G., Murata, D., Mintz, J., Koegel, P.: Characteristics of individuals with severe mental illness who use emergency services. Community Ment. Health J. (2005). doi:10.1007/s10597-005-2650-0
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Kerman, N., Sylvestre, J. & Polillo, A. The study of service use among homeless persons with mental illness: a methodological review. Health Serv Outcomes Res Method 16, 41–57 (2016). https://doi.org/10.1007/s10742-016-0147-7
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DOI: https://doi.org/10.1007/s10742-016-0147-7