Skip to main content
Log in

A systematic study of mental health services utilization by homeless men and women

  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Summary

Psychiatric illness is overrepresented among the homeless, but mental health services are underutilized in this population in proportion to their needs. The current study was concerned with 900 homeless men and women randomly sampled and systematically interviewed with the Diagnostic Interview Schedule; it focuses on psychiatric and substance abuse rehabilitation service patterns and stated needs of this population in relation to specific psychiatric disorders. Although rates of lifetime treatment utilization were fairly high in comparison with general population utilization patterns, rates of treatment in the current year were low. In particular, outpatient services have been neglected for reliance upon inpatient services. Although the major reason cited for not obtaining treatment by homeless persons with mental illness was lack of insurance and inability to pay for it, having health insurance was not associated with mental health services utilization, nor were other important predictors apparent. Mental health professionals serving mentally ill homeless populations would best serve them by focusing on creative and innovative ways to improve the availability and attractiveness of ambulatory care services.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Arce AA, Tadlock M, Vergare MJ, Shapiro SH (1983) A psychiatric profile of street people admitted to an emergency shelter. Hosp Commun Psychiatry 34:812–817

    Google Scholar 

  • Bassuk EL, Rosenberg L (1988) Why does family homelessness occur? A case-control study. Am J Public Health 78:783–788

    PubMed  Google Scholar 

  • Bassuk EL, Rubin L, Lauriat A (1984) Is homelessness a mental health problem? Am J Psychiatry 141:1546–1550

    PubMed  Google Scholar 

  • Bassuk EL, Rubin L, Lauriat AS (1986) Characteristics of sheltered homeless families. Am J Public Health 76:1097–1101

    PubMed  Google Scholar 

  • Baxter E, Hooper K (1982) The new mendicancy: homeless in New York City. Am J Orthopsychiatry 52:393–408

    PubMed  Google Scholar 

  • Breakey WR, Fischer PJ, Kramer M, Nestadt G, Romanoski AJ, Ross A, Royall RM, Stine OC (1989) Health and mental health problems of homeless men and women in Baltimore. JAMA 262: 1352–1357

    Article  PubMed  Google Scholar 

  • Cohen CI, Thompson KS (1992) Homeless mentally ill or mentally ill homeless? Am J Psychiatry 149:816–823

    PubMed  Google Scholar 

  • Drake RE, Osher FC, Wallach MA (1991) Homelessness and dual diagnosis. Am Psychol 46:1149–1158

    PubMed  Google Scholar 

  • Fischer PJ, Breakey WR (1986) Homelessness and mental healthian overview. Int J Ment Health 14:6–41

    Google Scholar 

  • Fischer PJ, Shapiro S, Breakey WR, Anthony JC, Kramer M (1986) Mental health and social characteristics of the homeless: a survey of mission users. Am J Public Health 76:519–524

    PubMed  Google Scholar 

  • Gelberg L, Linn LS, Leake BD (1988) Mental health, alcohol and drug use, and criminal history among homeless adults. Am J Psychiatry 145:191–196

    PubMed  Google Scholar 

  • Koegel P, Burnam A, Farr RK (1988) The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Arch Gen Psychiatry 45:1085–1092

    PubMed  Google Scholar 

  • Padgett D, Struening EL, Andrews H (1990) Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Med Care 28:805–821

    PubMed  Google Scholar 

  • Reich R, Siegel L (1978) The emergence of the bowery as a psychiatric dumping ground. Psychiatr Q 50:191–201

    PubMed  Google Scholar 

  • Robertson MJ (1986) Mental disorder among homeless persons in the United States: an overview of recent empirical literature. Admin Ment Health 14:14–27

    Google Scholar 

  • Robins LN, Helzer JE, Croughan J, Williams JBW, Spitzer RL (1981) NIMH Diagnostic Interview Schedule: Version III (May 1981). National Institute of Mental Health, Washington, D.C.

    Google Scholar 

  • Robins LN, Locke BZ, Regier DA (1991) Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. In: Robins LN, Regier DA (eds) An overview of psychiatric disorders in America. The Free Press, New York

    Google Scholar 

  • Smith EM, North CS, Spitznagel EL (1991) Are hard-to-interview street dwellers needed in assessing psychiatric disorders in homeless men? Int J Methods Psychiatr Res 1:69–78

    Google Scholar 

  • Smith EM, North CS, Spitznagel EL (1992a) A systematic study of mental illness, substance abuse, and treatment in 600 homeless men. Ann Clin Psychiatry 4:111–120

    Google Scholar 

  • Smith EM, North CS, Spitznagel EL (1992b) Alcohol, drugs, and psychiatric comorbidity among homeless women: an epidemiologic study. J Clin Psychiatry (in press)

  • Snow DA, Baker SG, Anderson L, Martin M (1986) The myth of pervasive mental illness among the homeless. Soc Probl 55:407–423

    Google Scholar 

  • Susser E, Struening EL, Conover S (1989) Psychiatric problems in homeless men. Arch Gen Psychiatry 46:845–850

    PubMed  Google Scholar 

  • Susser E, Conover C, Struening EL (1990) Mental illness in the homeless: Problems of epidemiologic method in surveys of the 1980s. Community Ment Health J 26:391–412

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

North, C.S., Smith, E.M. A systematic study of mental health services utilization by homeless men and women. Soc Psychiatry Psychiatr Epidemiol 28, 77–83 (1993). https://doi.org/10.1007/BF00802096

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00802096

Keywords

Navigation