Community Mental Health Journal

, Volume 50, Issue 7, pp 831–840 | Cite as

Homelessness, Behavioral Health Disorders and Intimate Partner Violence: Barriers to Services for Women

  • Allison N. PonceEmail author
  • Martha Staeheli Lawless
  • Michael Rowe
Original Paper


Homeless women comprise a significant portion of the homeless population and may encounter multiple life stressors including mental illness, substance abuse, and trauma. Women who are homeless may experience difficulty gaining access to resources such as shelter and health care. In addition, the interaction of behavioral health problems with intimate partner violence (IPV) may create extraordinary barriers to their engagement in services. This paper explores the co-occurrence of homelessness, behavioral health problems, and IPV and lessons learned through a gender-specific homeless services program designed to reach women who are unengaged in traditional services. Recommendations for providing gender-responsive services are discussed.


Homeless women Intimate partner violence Gender-responsive services Homeless services 


  1. Becker, M. A., & Gatz, M. (2005). Introduction to the impact of co-occurring disorders and violence on women: Findings from the SAMHSA Women, Co-occurring Disorders and Violence study. Journal of Behavioral Health Services & Research, 32, 1111–1112. doi: 10.1097/00075484-200504000-00001.CrossRefGoogle Scholar
  2. Bradley, R., Schwartz, A. C., & Kaslow, N. J. (2005). Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: Self-esteem, social support, and religious coping. Journal of Traumatic Stress, 18, 685–696. doi: 10.1002/jts.20077.PubMedCrossRefGoogle Scholar
  3. Breakey, W. R., Fischer, P. J., Kramer, M., Nestadt, G., Romanoski, A. J., Ross, A., et al. (1989). Health and mental health problems of homeless men and women in Baltimore. Journal of the American Medical Association, 262, 1352–1357. doi: 10.1001/jama.262.10.1352.PubMedCrossRefGoogle Scholar
  4. Browne, A. (1993). Family violence and homelessness: The relevance of trauma histories in the lives of homeless women. American Journal of Orthopsychiatry, 63, 370–384. doi: 10.1037/h0079444.PubMedCrossRefGoogle Scholar
  5. Browne, A., & Bassuk, S. (1997). Interpersonal violence in the lives of homeless and poor housed women: Prevalence and patterns in an ethnically diverse sample. American Journal of Orthopsychiatry, 67, 261–278. Retrieved from
  6. Buckner, J. C., Bassuk, E. L., & Zima, B. T. (1993). Mental health issues affecting homeless women: Implications for intervention. American Journal of Orthopsychiatry, 63(3), 385–389.PubMedCrossRefGoogle Scholar
  7. Campbell, J. C. (2002). Health consequences of intimate partner violence. The Lancet, 359, 1331–1336. doi: 10.1016/S0140-6736(02)08336-8.CrossRefGoogle Scholar
  8. Carlson, B. E., McNutt, L., Choi, D. Y., & Rose, I. M. (2002). Intimate partner abuse and mental health: The role of social support and other protective factors. Violence Against Women, 8(6), 720–745. doi: 10.1177/10778010222183251.CrossRefGoogle Scholar
  9. Christensen, R. C., Hodgkins, C. C., Garces, L., Estlund, K. L., Miller, M. D., & Touchton, R. (2005). Homeless, mentally ill and addicted: The need for abuse and trauma services. Journal of Health Care for the Poor and Underserved, 16(4), 615–622.PubMedCrossRefGoogle Scholar
  10. Coker, A. L., Smith, P. H., Thompson, M. P., McKeown, R. E., Bethea, L., & Davis, K. E. (2002). Social support protects against the negative effects of partner violence on mental health. Journal of Women’s Health & Gender-Based Medicine, 11(5), 465–476. doi: 10.1089/15246090260137644.CrossRefGoogle Scholar
  11. Dutton, M. A., Green, B. L., Kaltman, S. I., Roesch, D. M., Zeffiro, T. A., & Krause, E. D. (2006). Intimate partner violence, PTSD, and adverse health outcomes. Journal of Interpersonal Violence, 21, 955–968. doi: 10.1177/0886260506289178.PubMedCrossRefGoogle Scholar
  12. Frencher, S. K., Benedicto, C. M. B., Kendig, T. D., Herman, D., Barlow, B., & Pressley, J. C. (2010). A comparative analysis of serious injury and illness among homeless and housed low income residents of New York City. Journal of Trauma-Injury Infection & Critical Care, 69, S191–S199. doi: 10.1097/TA.0b013e3181fld31e.CrossRefGoogle Scholar
  13. Gelberg, L. (1996). Homeless persons. In R. M. Andersen, T. H. Rice, & G. F. Kominski (Eds.), Changing the US health care system: Key issues in health services, policy and management (pp. 273–301). San Francisco: Jossey-Bass.Google Scholar
  14. Gelberg, L, Browner, C. H., Lejano, E., & Arangua, L. (2004). Access to women’s health care: A qualitative study of barriers perceived by homeless women. Women and Health, 40, 87–100. Retrieved from
  15. Lawless, M., Rowe, M., & Miller, R. (2009). New visions of me: Finding joy in recovery with women who are homeless. Journal of Dual Diagnosis, 5, 305–322. doi: 10.1080/15504260903371747.CrossRefGoogle Scholar
  16. Lipsky, S., & Caetano, R. (2007). Impact of intimate partner violence on unmet need for mental health care: Results from the NSDUH. Psychiatric Services, 58, 822–829. doi: 10.1176/ Scholar
  17. Luhrmann, T. M. (2008). “The Street Will Drive You Crazy”: Why homeless psychotic women in the institutional circuit in the United States often say no to offers of help. American Journal of Psychiatry, 165, 15–20. Retrieved from
  18. Nyamathi, A. M., Leake, B., & Gelberg, L. (2000). Sheltered versus nonsheltered homeless women: Differences in health, behavior, victimization, and utilization of care. Journal of General Internal Medicine, 15, 565–572. doi: 10.1046/j.1525-1497.2000.07007.x.PubMedCrossRefPubMedCentralGoogle Scholar
  19. Nyamathi, A., Lewis, C., Leake, B., Flaskerud, J., & Bennet, C. (1995). Barriers to condom use and needle cleaning among impoverished minority female injection drug users and partners of injection drug users. Public Health Reports, 100, 166–172. Retrieved from
  20. Olivet, J., Bassuk, E., Elstad, E., Kenney, R., & Shapiro, L. (2007). Bridging the gap: Assessing the evidence of outreach and engagement in homeless services. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.Google Scholar
  21. Padgett, D. K., Hawkins, R. L., Abrams, C., & Davis, A. (2006). In their own words: Trauma and substance abuse in the lives of formerly homeless women with serious mental illness. American Journal of Orthopsychiatry, 76, 461–467. doi: 10.1037/1040-3590.76.4.461.PubMedCrossRefGoogle Scholar
  22. Pranjape, A., Heron, S., & Kaslow, N. J. (2006). Utilization of services by abused, low-income African-American women. Journal of General Internal Medicine, 21, 189–192. doi: 10.1111/j.1525-1497.2005.00314.x.CrossRefGoogle Scholar
  23. Randolph, F., Blasinsky, M., Leginski, W., Parker, L. B., & Goldman, H. H. (1997). Creating integrated service systems for homeless persons with mental illness: the ACCESS program. Access to community care and effective services and supports. Psychiatric Services, 48(3), 369–373.PubMedGoogle Scholar
  24. Rayburn, N. R., Wenzel, S. L., Elliott, M. N., Hambarsoomians, K., Marshall, G. N., & Tucker, J. S. (2005). Trauma, depression, coping, and mental health service seeking among impoverished women. Journal of Consulting and Clinical Psychology, 73, 667–677. doi: 10.1037/0022-006X.73.4.667.PubMedCrossRefGoogle Scholar
  25. Rowe, M. (1999). Crossing the border: Encounters between homeless people and outreach workers. Berkeley: University of California Press.Google Scholar
  26. Rowe, M., Frey, J., Bailey, M., Fisk, D., & Davidson, L. (2001). Clinical responsibility and client autonomy: Dilemmas in mental health work at the margins. American Journal of Orthopsychiatry, 71, 400–407.PubMedCrossRefGoogle Scholar
  27. Rowe, M., Hoge, M., & Fisk, D. (1996). Critical issues in serving people who are homeless and mentally ill. Administration and Policy in Mental Health, 23, 555–565. doi: 10.1007/BF02108691.CrossRefGoogle Scholar
  28. Rowe, M., Hoge, M. A., & Fisk, D. (1998). Services for mentally ill homeless persons: Street-level integration. American Journal of Orthopsychiatry, 68(3), 490–496.PubMedCrossRefGoogle Scholar
  29. Sacks, J. Y., McKendrick, K., & Banks, S. (2008). The impact of early trauma and abuse on residential substance abuse treatment outcomes for women. Journal of Substance Abuse Treatment, 43, 90–100. doi: 10.1016/j.jsat.2007.01.010.CrossRefGoogle Scholar
  30. Segal, S., & Baumohl, J. (1985). The community living room. Social Casework, 66, 111–116.Google Scholar
  31. Sells, D., Black, R., Davidson, L., & Rowe, M. (2008). Beyond generic support: The incidence and impact of invalidation within peer-based and traditional treatment for clients with severe mental illness. Psychiatric Services, 59, 1322–1327. Retrieved from
  32. Sells, D., Davidson, L., Jewell, C., Falzer, P., & Rowe, M. (2006). The treatment relationship in peer-based and regular case management services for clients with severe mental illness. Psychiatric Services, 57, 1179–1184. Retrieved from
  33. Stein, J. A., Leslie, M. B., & Nyamathi, A. (2002). Relative contributions of parent substance use and childhood maltreatment to chronic homelessness, depression, and substance abuse problems among homeless women: Mediating roles of self-esteem and abuse in adulthood. Child Abuse and Neglect, 26(10), 1011–1027. doi: 10.1016/S0145-2134(02)00382-4.PubMedCrossRefGoogle Scholar
  34. Teruya, C., Longshore, D., Andersen, R. M., Aragua, L., Nyamathi, A., Leaker, B., et al. (2010). Health and health care disparities among homeless women. Women and Health, 50, 719–736. doi: 10.1080/03630242.2010.532754.PubMedCrossRefPubMedCentralGoogle Scholar
  35. Thompson, M. P., Kaslow, N. J., Kingree, J. B., Rashid, A., Puett, R., Jacobs, D., et al. (2000). Partner violence, social support, and distress among inner-city African American women. American Journal of Community Psychology, 28, 127–143. doi: 10.1023/A:1005198514704.PubMedCrossRefGoogle Scholar
  36. US Conference of Mayors (2009). Hunger and Homelessness Survey: A status report on hunger and homelessness in America’s cities. Washington, DC: Author. Retrieved from
  37. US Department of Housing and Urban Development. (2012). The 2011 annual homeless assessment report to congress. Retrieved from
  38. Weinreb, L., Perloff, J., Goldberg, R., Lessard, D., & Hosmer, D. W. (2006). Factors associated with health service utilization patterns in low-income women. Journal of Health Care for the Poor and Underserved, 17, 180–199. doi: 10.1353/hpu. 2006.0036.PubMedCrossRefGoogle Scholar
  39. Yeater, E. A., Austin, J. L., Green, M. J., & Smith, J. (2010). Coping mediates the relationship between posttraumatic stress disorder (PTSD) symptoms and alcohol use in homeless, ethnically diverse women: A preliminary study. Psychological Trauma: Theory, Research, Practice, and Policy, 2(4), 307–310. doi: 10.1037/a0021779.CrossRefGoogle Scholar
  40. Zlotnick, C., & Zerger, S. (2008). Survey findings on characteristics and health status of clients treated by federally funded (US) Health Care for the Homeless Programs. Health and Social Care in the Community, 17, 18–26. doi: 10.1111/j.1365-2524.2008.00793.x.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Allison N. Ponce
    • 1
    Email author
  • Martha Staeheli Lawless
    • 2
  • Michael Rowe
    • 3
  1. 1.Department of PsychiatryYale School of MedicineNew HavenUSA
  2. 2.Center for Public Health and Health PolicyUniversity of Connecticut Health CenterEast HartfordUSA
  3. 3.Program for Recovery and Community Health, Department of PsychiatryYale School of MedicineNew HavenUSA

Personalised recommendations