Skip to main content

Psychiatric Care for People Experiencing Homelessness

  • Chapter
  • First Online:
Textbook of Community Psychiatry

Abstract

Homelessness is persistent as a major social problem, and addressing behavioral health challenges for people experiencing homelessness has become a classic domain of modern community psychiatry. This chapter discusses the current epidemiology and causes of homelessness as they relate to behavioral health and outlines the resultant overall landscape of services and interventions for affected adult populations. It details challenges in care and covers clinical technique, both psychosocial and biological, while also describing a comprehensive and systematic model to guide the use of all interventions to support transition from the street to home.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Advisory: Behavioral Health Services for People Who Are Homeless. (March 2021) Publication ID PEP20-06-04-003. Substance Abuse and Mental Health Services Administration. Accessed from: https://store.samhsa.gov/product/advisory-behavioral-health-services-people-who-are-homeless/

  • Aron A, Aron EN, Smollan D (1992). Inclusion of other in the self scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63(4), 596-612.

    Article  Google Scholar 

  • Aubry T, Nelson G, Tsemberis S (2015). Housing first for people with severe mental illness who are Homeless: A review of the research and findings from the at Home—Chez soi demonstration project. The Canadian Journal of Psychiatry, 60(11), 467-474.

    Article  PubMed  Google Scholar 

  • Backer, TE Howard EA, Moran GE. (2007). The role of effective discharge planning in preventing homelessness. The Journal of Primary Prevention, 28(3-4), 229-243.

    Article  PubMed  Google Scholar 

  • Castellow J, Kloos B, Townley G (2015). Previous homelessness as a risk factor for recovery from serious mental illnesses. Community Mental Health Journal, 51(6), 674-684.

    Article  PubMed  Google Scholar 

  • Collins S, Duncan MH, Saxon AJ, Taylor EM, Mayberry N, et al. (2021). Combining behavioral harm-reduction treatment And Extended-release Naltrexone for people experiencing homelessness and alcohol use disorder in the USA: a randomised clinical trial. The Lancet Psychiatry, 8(4), 287-300.

    Article  PubMed  Google Scholar 

  • Corporation for Supported Housing (2021). Racial disparities and disproportionality index. Available at https://www.csh.org/supportive-housing-101/data/#RDDI. (Retrieved 3/20/2021).

  • Critical Time Intervention. Training & Consultation. (n.d.). Retrieved March 29, 2021, from http://www.criticaltime.org/training/

  • Culhane DP, Dejowski EF, Ibañez, J, Needham E, Macchia, I. (1994). Public shelter admission rates in Philadelphia and New York city: The implications of turnover for sheltered population counts. Housing Policy Debate, 5(2), 107-140.

    Article  Google Scholar 

  • Culhane, DP, Lee, C, Wachter SM. (1996). Where the homeless come from: a study of the prior address distribution of families admitted to public shelters in New York City and Philadelphia. Housing Policy Debate, 7(2), 327-365.

    Article  Google Scholar 

  • Desai RA, Harpaz-Rotem I, Najavits LM, Rosenheck, RA. (2008). Impact of the seeking safety program on clinical outcomes among homeless female veterans with psychiatric disorders. Psychiatric Services, 59(9), 996-1003.

    Article  PubMed  Google Scholar 

  • Dixon L, Hackman A, Lehman A (1997). Administration and Policy in Mental Health, 25(2), 199-208.

    Article  PubMed  Google Scholar 

  • Fazel S, Khosla V, Doll H, Geddes J (2008) The prevalence of mental disorders among the homeless in Western countries: systematic review and meta-regression analysis. PLoS Medicine (www.plosmedicine.org) 5: 0001-0012.

  • Fenton WS, Blyler CR, Heinssen RK (1997). Determinants of medication compliance in schizophrenia: Empirical and clinical findings. Schizophrenia Bulletin, 23(4), 637-651.

    Article  PubMed  Google Scholar 

  • Forney JC, Lombardo S, Toro PA (2007). Diagnostic and other correlates of HIV risk behaviors in a probability sample of homeless adults. Psychiatric Services, 58(1), 92-99.

    Article  PubMed  Google Scholar 

  • Foster S, LeFauve C, Kresky-Wolff M, Rickards LD (2009). Services and supports for individuals with co-occurring disorders and long-term homelessness. The Journal of Behavioral Health Services & Research, 37(2), 239-251.

    Article  Google Scholar 

  • Hackman A, Dixon L. Assertive community treatment. In Clinical Guide to the Treatment of the Mentally Ill Homeless Person. (2006). Eds. Gillig PM, McQuistion HL. American Psychiatric Press, Inc., Washington, DC

    Google Scholar 

  • Hayes M, Zonneville M, Bassuk E. (2010) The SHIFT Study: Services and Housing Interventions for Families in Transition. American Institutes for Research.

    Google Scholar 

  • Herman DB, Susser, ES, Struening EL, Link BL (1997). Adverse childhood experiences: Are they risk factors for adult homelessness? American Journal of Public Health, 87(2), 249-255.

    Article  PubMed  PubMed Central  Google Scholar 

  • Herman D, Opler L, Felix A, Valencia E, Wyatt RJ, Susser E (2000). A critical time intervention with mentally iii homeless men. The Journal of Nervous and Mental Disease, 188(3), 135-140.

    Article  PubMed  Google Scholar 

  • Hopper EK, Bassuk EL, Olivet J (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(2), 80-100.

    Article  Google Scholar 

  • Intensive Mobile Treatment Team Concept Paper. (June 2017) NYC Department of Health and Mental Hygiene https://www1.nyc.gov/assets/doh/downloads/pdf/acco/2017/intensive-mobile-treatment-concept-paper.pdf

  • Jones K, Colson PW, Holter MC, Lin, S, Valencia, E, et al. (2003). Cost-effectiveness of critical time intervention to reduce homelessness among persons with mental illness. Psychiatric Services, 54(6), 884-890.

    Article  PubMed  Google Scholar 

  • Joseph H, Langrod JG. (2004). The homeless Substance abuse: A Comprehensive Text- Book (4th ed.; pp. 1141–1168). Eds. Lowinson JH, Ruiz P, Millman RB, Langrod JG. Lippincott, Williams, & Wilkins, Philadelphia.

    Google Scholar 

  • Khouri, A (2020, July 19) Amid the coronavirus pandemic, a Black housing crisis gets worse. Los Angeles Times. https://www.latimes.com/homeless-housing/story/2020-07-19/amid-coronavirus-pandemic-black-housing-crisis-gets-worse

  • Larimer ME (2009). Health care and public service use and costs before and After provision of housing for chronically homeless persons with severe alcohol problems. JAMA, 301(13), 1349.

    Article  PubMed  Google Scholar 

  • Lee, M. A., Mather, M. (2008). US labor force trends, Population Bulletin 63:1-16.

    Google Scholar 

  • Magwood O, Leki VY, Kpade V, Saad A, Alkhateeb Q, et al (2019). Common trust and personal safety issues: A systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness. PLOS ONE, 14(12).

    Google Scholar 

  • McQuistion HL (2007, October 12). Services for mentally ill homeless people: The quest for best practices. (Symposium presentation) APA Institute for Psychiatric Services, New Orleans, LA.

    Google Scholar 

  • McQuistion HL, Felix A, Samuels, J (2008). Serving people who have mental illness and homelessness. Tasman A, Lieberman J, Kay J (eds), Psychiatry, 3rd Ed. John Wiley & Sons, London.

    Google Scholar 

  • McQuistion HL, Gillig PM. (2006). Introduction: Mental illness, homelessness, and clinical practice. In Gillig PM, McQuistion HL (eds), The American Association of Community Psychiatrists Clinical Manual in Treating Mentally Ill Homeless People. American Psychiatric Press, Washington, DC.

    Google Scholar 

  • McQuistion HL, Gorroochurn P, Hsu E, Caton CL (2013). Risk factors associated with recurrent homelessness after a first homeless episode. Community Mental Health Journal, 50(5), 505-513.

    Article  PubMed  Google Scholar 

  • Morse GA, York MM, Dell N, Blanco J, Birchmier C. (2017). Improving outcomes for homeless people with alcohol disorders: A multi-program community-based approach. Journal of mental health, 6, 684-691.

    Google Scholar 

  • National Coalition for the Homeless (2006). McKinney-Vento Act. Available at http://www.nationalhomeless.org/publications/facts/McKinney.pdf. Accessed July 21, 2022.

  • North, C. S., Eyrich, K. M., Pollio, D. E., & Spitznagel, E.L. (2004). Are rates of psychiatric disorders in the homeless population changing? American Journal of Public Health, 94, 103–108

    Article  PubMed  PubMed Central  Google Scholar 

  • O'Connell JJ, Oppenheimer SC, Judge CM, Taube RL, Blanchfield BB, et al (2010). The Boston health care for the Homeless program: a public health framework. American Journal of Public Health, 100(8), 1400-1408.

    Article  PubMed  PubMed Central  Google Scholar 

  • Osher FC (2001). Co-occurring addictive and mental disorders. In RW Manderscheid & MJ Henderson (Eds.). Center for Mental Health Services, Mental Health, United States 2000. DHHS Pub No (SMA))1-3537. Washington, DC: Superintendant of Doscuments, US Government Printing Office, 91–98.

    Google Scholar 

  • Philips SD, Burns BJ, Edgar ER, Mueser KT, Linkins KW, et al (2001). Moving assertive community treatment into standard practice. Psychiatric Services, 52 (6): 771-779.

    Article  Google Scholar 

  • Pringle J, Grasso K, Lederer L (2017). Integrating the Integrated: Merging integrated Dual Diagnosis Treatment (IDDT) with Housing First. Community Mental Health Journal, 53(6), 672-678.

    Article  PubMed  Google Scholar 

  • Prochaska JO, DiClemente CC, Norcross JC (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.

    Article  PubMed  Google Scholar 

  • Ray N. (2006). Lesbian, gay, bisexual and transgender youth: An epidemic of homelessness. New York: National Gay and Lesbian Task Force Policy Institute and the National Coalition for the Homeless.

    Google Scholar 

  • Rog D J (2004). The evidence on Supported Housing. Psychiatric Rehabilitation Journal, 27(4), 334-344.

    Article  PubMed  Google Scholar 

  • Roth D, Bean J (1986). The Ohio study: A comprehensive look at homelessness. Psychosocial Rehabilitation Journal, 9(4), 31-38.

    Article  Google Scholar 

  • Rotter M, McQuistion HL, Broner N, Steinbacher M (2005). Best practices: The impact of the "incarceration culture" on reentry for adults with mental illness: A training and group treatment model. Psychiatric Services, 56(3), 265-267.

    Article  PubMed  Google Scholar 

  • Rowe M, Styron T, David DH (2015). Mental health outreach to persons who are homeless: implications for practice from a Statewide Study. Community Mental Health Journal, 52(1), 56-65.

    Article  PubMed  Google Scholar 

  • Sacks S, DeLeon G, Sacks JY, et al.: TC-oriented supported housing for homeless MICAs. J Psychoactive Drugs 35: 355-366, 2003

    Article  PubMed  Google Scholar 

  • Sacks S, Banks S, McKendrick K, Sacks JY (2008). Modified therapeutic community for co-occurring disorders: A summary of four studies. Journal of Substance Abuse Treatment, 34(1), 112-122.

    Article  PubMed  Google Scholar 

  • Sajatovic M, Levin J, Ramirez LF, Hahn DY, Tatsuoka C, et al (2013). Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. The Journal of Clinical Psychiatry, 74(12), 1249-1255.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sullivan BJ, Burke J (2013). Single-Room occupancy housing in New York city: The origins and dimensions of a crisis. CUNY Law Review, 17(01), 113.

    Article  Google Scholar 

  • Sullivan, G, Burnam A, Koegel P (2000). Pathways to homelessness among the mentally ill. Social Psychiatry and Psychiatric Epidemiology, 35(10), 444-450.

    Article  PubMed  Google Scholar 

  • Susser, E, Struening EL, Conover S, Lin SP (1991). Childhood antecedents of homelessness in psychiatric patients. American Journal of Psychiatry, 148(8), 1026-1030.

    Article  PubMed  Google Scholar 

  • Susser E, Valencia E, Conover S, Felix A, Tsai WY, Wyatt, RJ (1997). Preventing recurrent homelessness among mentally ill men: A "critical time" intervention after discharge from a shelter. American Journal of Public Health, 87(2), 256-262.

    Article  PubMed  PubMed Central  Google Scholar 

  • The COVID Tracking Project at The Atlantic. (2021, March 20) https://covidtracking.com/race

  • Townsend W, Boyd S, Griffin G. (2000). Emerging Best Practices in Mental Health Recovery. Columbus, Ohio: Ohio Department of Mental Health, Office of Consumer Services.

    Google Scholar 

  • Tsemberis S, Eisenberg RF (2000). Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services, 51(4), 487-493.

    Article  PubMed  Google Scholar 

  • U.S. Department of Housing and Urban Development (2021). 2020 AHAR: Part 1 - PIT Estimates of Homelessness in the U.S. https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf

  • U.S. Government Accountability Office. July 2020 Homelessness. More HUD oversight of data collection would improve the estimates of homeless population. https://www.gao.gov/assets/gao-20-433.pdf

  • U.S. Interagency Council on Homelessness (2018) https://www.usich.gov/resources/uploads/asset_library/Homelessness-in-America-Focus-on-chronic.pdf.

  • Valencia E, Susser ES, McQuistion HL (1996). Critical time points in the clinical care of homeless mentally ill individuals. J. Vaccaro, G. Clark (Eds.), Practicing psychiatry in the community: A manual (pp. 259–276). American Psychiatric Press, Washington, DC.

    Google Scholar 

  • Zlotnick C, Kronstadt D, Klee L (1998). Foster care children and family homelessness. American Journal of Public Health, 88(9), 1368-1370.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Carino, T., McQuistion, H.L. (2022). Psychiatric Care for People Experiencing Homelessness. In: Sowers, W.E., McQuistion, H.L., Ranz, J.M., Feldman, J.M., Runnels, P.S. (eds) Textbook of Community Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-031-10239-4_42

Download citation

Publish with us

Policies and ethics