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PubMedDate not supplied

The road in and out of homelessness: perceptions of recovering substance abusers.

In this phenomenological study the authors explored the meaning of homelessness from the perspective of previously homeless substance abusers. The sample involved 8 adult males recruited from a substance abuse treatment program. Through the use of open-ended questioning, two major themes were identified: the road to homelessness and the road out of homelessness. The road to homelessness comprised an explanation for the participants' homelessness: painful background experiences, negative self-concept, ineffective coping skills, and a sense of hopelessness. The road out of homelessness described the recovery process and included turning points, experiences of caring relationships, and a new way of viewing the world. The findings offer a beginning understanding of the experience of homelessness and recovery, and have implications for intervention and future research for subpopulations of persons who are homeless.

Adaptation, Psychological↗
PubMed2005

Psychiatric emergency service use and homelessness, mental disorder, and violence.

OBJECTIVE: This study examined relationships between homelessness, mental disorder, violence, and the use of psychiatric emergency services. To the authors' knowledge, this study is the first to examine these issues for all episodes of care in a psychiatric emergency service that serves an entire mental health system in a major city. METHODS: Archival databases were examined to gather data on all individuals (N=2,294) who were served between January 1, 1997, and June 30, 1997, in the county hospital's psychiatric emergency service in San Francisco, California. RESULTS: Homeless individuals accounted for approximately 30 percent of the episodes of service in the psychiatric emergency service and were more likely than other emergency service patients to have multiple episodes of service and to be hospitalized after the emergency department visit. Homelessness was associated with increased rates of co-occurring substance-related disorders and severe mental disorders. Eight percent of persons who were homeless had exhibited violent behavior in the two weeks before visiting the emergency service. CONCLUSIONS: Homeless individuals with mental disorders accounted for a large proportion of persons who received psychiatric emergency services in the community mental health system in the urban setting of this study. The co-occurrence of homelessness, mental disorder, substance abuse, and violence represents a complicated issue that will likely require coordination of multiple service delivery systems for successful intervention. These findings warrant consideration in public policy initiatives. Simply diverting individuals with these problems from the criminal justice system to the community mental health system may have limited impact unless a broader array of services can be brought to bear.

Adult↗
PubMedDate not supplied

The medical problems of homeless clinic patients: a comparative study.

OBJECTIVE: To compare the prevalence of major medical problems in homeless and nonhomeless patients. PATIENTS: All 475 persons seeking care at an ambulatory clinic serving the medically indigent for one calendar year. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Demographic and clinical data were collected by structured interviews and medical record reviews for all patients seeking care at the clinic between March 1989 and April 1990. Comparisons were made between homeless patients, those patients with unstable housing, and those with stable housing. There was no significant between-group difference in age, gender, ethnicity, and health insurance coverage. Homeless patients were more likely to be unemployed (p less than 0.001) and were found to have higher prevalence of alcohol abuse, injuries/fractures, and dental and gynecologic problems (p less than 0.05). CONCLUSIONS: There were more similarities than differences in the prevalences of major medical problems in homeless vs. nonhomeless community clinic patients. Where differences did exist, homeless persons consistently had a higher prevalence of illness than did the nonhomeless.

Adult↗
PubMed2006

Outbreak of tuberculosis in a homeless population involving multiple sites of transmission.

SETTING: During 2002-2003, a large outbreak of tuberculosis (TB) occurred among persons using multiple homeless facilities in King County, Washington. OBJECTIVE: To control the transmission of TB in multiple settings. DESIGN: In 2002, contacts exposed to patients in homeless facilities were screened using tuberculin skin tests (TSTs) and symptom review. Based on these screening results, sites of transmission were identified and prioritised, and exposed cohorts at these sites were offered intensive screening tests in 2003 (e.g., symptom review, TST, chest radiograph [CXR], sputum examination and culture). Mycobacterium tuberculosis isolates from patients were genotyped using PCR-based methods to identify outbreak-associated patients quickly. RESULTS: During 2002-2003, 48 (15%) of 313 patients diagnosed in King County were outbreak-associated; 47 culture-positive patients had isolates that matched the outbreak strain by genotyping. Three facilities visited by >12 patients in 2002 had a higher prevalence of TST positive results (approximately 30%) among clients compared with the background rate (7%) in the homeless community. Screening contacts with one sputum culture was as sensitive as CXR in detecting TB disease (77% vs. 62%, respectively). CONCLUSIONS: A comprehensive, resource-intensive approach likely helped to control transmission. This outbreak highlights the vulnerability of homeless populations and the need to maintain robust TB programs in urban settings.

Adult↗
PubMed1988

Bridging the gap--health care for the homeless.

In Australia and other countries concern exists about the extent of homelessness. Because we live in a period in which access to adequate shelter is an increasing problem for many persons, we report on the health needs of long-term homeless persons. Little attention was given to their health needs during the International Year of Shelter for the Homeless in 1987.

Adult↗
PubMed2000

The role of an espiritista in the treatment of a homeless, mentally ill hispanic man.

This paper presents a case study from an emergency psychiatric outreach team that serves homeless and mentally ill persons in New York City. Mr. V was homeless and believed that he was possessed by evil spirits who were causing his physical and mental problems. He was hospitalized involuntarily twice for medical reasons, but he refused to cooperate in his treatment and returned to the streets after his first hospitalization. After one visit by a spiritual healer during his second hospitalization, Mr. V began to participate in his treatment. He was discharged to a nursing home, and after three years he had not returned to the streets.

Aged↗
PubMed1995

Mental disorder among a homeless population in Belfast: an exploratory survey.

This study aimed to identify the prevalence of mental disorder in hostels for the homeless in Belfast, Northern Ireland. In addition, it attempted to assess the facilities and support offered from both the hostels and the Health Service to homeless people who have a mental disorder. Lastly it sought to determine whether or not psychiatric hospital bed closure had any influence on the prevalence of homelessness among these persons in Belfast. An exploratory approach was adopted, using semi-structured interviews as the method of data collection. The sample consisted of 12 hostels for the homeless with a total occupancy of 250 residents. Officers in charge were surveyed. The results obtained indicated that approximately 25% of the homeless in Belfast hostels have a diagnosed mental disorder and that hospital closure has had a direct effect on the size of this percentage. In addition, it was found that the hostels generally are not able to offer the levels of therapy and support given in hospital or in designated hostels for people with mental health problems. Responses also suggest that support from Health Service personnel is less than satisfactory. While the findings in this study do not look at the entire homeless population in Northern Ireland, interesting and useful information emerged that has implications for policy and further areas of study elsewhere.

Health Facility Closure↗
PubMed1998

Independent living skills and posttraumatic stress disorder in women who are homeless: implications for future practice.

OBJECTIVE: Service delivery through community-based programs is the future of occupational therapy. This study examined independent living skills, traumatic experiences, and symptoms of Posttraumatic Stress Disorder (PTSD) in a sample of women residing in a supportive housing program for women and families who are homeless in order to determine the needs of this population and the possible role of occupational therapy in such a community-based program. METHOD: Twenty-four women residing in a supportive housing shelter in Kansas City, Missouri, volunteered to participate in this study. The participants were evaluated for independent living skills with the Kohlman Evaluation of Living Skills. A structured interview format was used to determine whether participants experienced a trauma and whether they met diagnostic criteria for PTSD. RESULTS: Results indicated that women who are homeless have deficits in independent living skills, especially in the area of money management. Results also indicated that traumatic experiences and PTSD are more prevalent among women who are homeless than among women in the general population. The relationship between independent living skills and PTSD among women who are homeless was not made clear by this study. CONCLUSION: The information gathered in this study underscores the importance of identifying and addressing occupational and mental health issues of women who are homeless. Results suggest that occupational therapists have a major role to play, evaluating and facilitating independent living skills, as members of multidisciplinary treatment teams in supportive housing programs for persons who are homeless.

Activities of Daily Living↗
PubMed1992

Homelessness: what is a psychologist to do?

Contrasts person-centered and structural explanations for homelessness. Methodological problems in studies of homeless people tend to exaggerate the role of individual deficits as causes of homelessness. A review of data on the distribution of poverty and of inadequate and unaffordable housing, with special emphasis on families, suggests the importance of structural causes. Data from 700 families requesting shelter and 524 families randomly drawn from the public assistance case load in New York City provide more support for a structural than for an individual deficit model. Individual demographic factors are also important. Implications are drawn for research and action by psychologists.

Ill-Housed Persons↗
PubMed1994

Swimming upstream: the strengths of women who survive homelessness.

A study of the strengths and personal resources of women who had overcome homelessness revealed that the experience of homelessness for these women was a temporary state of disruption resulting from an effort to free themselves from conditions associated with despair, such as abuse or addictions, and to search for a better life. Personal, interpersonal, and transpersonal categories of strengths were identified that enabled these women to move in a positive direction toward health and self-actualization. The synthesizing metaphor "swimming upstream" describes the stoic determination required to go against the overwhelming negative forces of their environment.

Adaptation, Psychological↗
PubMed1992

Psychiatry and the homeless mentally ill: a reply to Dr. Lamb.

Homeless mentally ill persons are highly visible subjects of ongoing public discussion and potent symbols of a host of contemporary social problems. They present psychiatry with a scientific challenge that calls for further elucidation of the sources of their mental illness and for fashioning possible solutions to their problems. They also present a moral challenge that requires psychiatrists to acknowledge the cultural, political, legal, and economic context of the mental problems of the homeless in the course of deciding what should be done to help them. H. Richard Lamb has proposed a program of aggressive outreach and psychiatric hospitalization for the homeless mentally ill. The authors believe that his proposal misconstrues the problems and needs of homeless mentally ill individuals; it would also needlessly infringe upon their freedom, further stigmatize them, and probably not help them. The authors offer an alternative understanding of the plight of the homeless mentally ill which places their problems within a larger context of social trends and domestic issues that society has been reluctant to confront. Psychiatrists can help the homeless mentally ill by championing their liberty rights and by focusing public discourse on the broad national need for improved access to medical and psychiatric care.

Attitude of Health Personnel↗
PubMed1988

The future role of state hospitals.

Much has been written about the future of state hospitals for the mentally ill; however, their precise role in a system committed to community care has yet to be resolved. Ethical and moral dilemmas characterize the debate and focus on the notion that community care is preferable to hospitalization. Missing from these discussions has been the realization that a majority of chronically mentally ill persons are below the poverty level and are dependent upon the public sector for their care. Particularly relevant to these discussions are the needs of those chronically mentally ill persons who are homeless. This paper describes a follow-up study of patients released from hospitals and the process that leads to homelessness. The role of the state hospital in providing services to this population is examined from the vantage point of these individuals receiving care elsewhere.

Community Mental Health Services↗
PubMedDate not supplied

Social and clinical features as predictors of outcome in outpatient alcohol withdrawal.

OBJECTIVE: To identify patient features--both social and clinical--that may be associated with treatment failure in outpatient alcohol withdrawal. DESIGN: A prospective observational cohort study of patients who underwent outpatient management of the alcohol withdrawal syndrome. SETTING: Community hospital-based outpatient alcohol treatment program. PATIENTS: The 179 patients who were eligible for and participated in a clinical trial of drug therapy for outpatient management of the alcohol withdrawal syndrome. MAIN RESULTS: Treatment failure occurred for 45% (80/179) of the patients. Failure rating did not vary according to diverse sociodemographic features such as age, level of education, income, medical insurance status, and marital status. Persons who were homeless did as well as those who were not. In contrast, two clinical features of withdrawal were associated with significantly higher rates of treatment failure: craving and withdrawal symptom severity. High cravers had a treatment failure rate of 56% (22/39), compared with 36% (41/115) for those with lower scores (p less than 0.03). Among those with moderate-to-high withdrawal symptom severity, 49% (74/151) represented treatment failures, compared with 22% (6/27) of those in the low-symptom group (p less than 0.01). CONCLUSIONS: While these data do not confirm that socially disadvantaged persons are at increased risk for withdrawal treatment failure, two clinical features--craving and withdrawal symptom severity--may help identify high-risk patients.

Adult↗
PubMed2005

Taking it to the street: a psychiatric outreach service in Canada.

This paper describes a model of flexible psychiatric outreach service in Canada designed to meet the needs of persons who are homeless or marginally housed and have mental illness. The activities of the Psychiatric Outreach Team of the Royal Ottawa Hospital for individual clients and the community agencies who serve them are profiled, followed by a demographic and mental and physical health profile of the clients seen in the past year. The differences from other models of service and the benefits and limitations of this unique multidisciplinary team are discussed, with implications for future service development for this vulnerable population.

Adolescent↗
PubMed2004

Alcoholic subtypes: are two sufficient?

AIMS: Guided by the literature on alcohol subtypes, cluster analytical solutions ranging from two to five were evaluated for a large (n = 802), ethnically diverse sample of alcoholic in-patients. DESIGN: Personal interview data were collected from in-patients regarding their substance abuse and psychiatric disorder status, risk factors for psychopathology and health outcomes. SETTING: The data were collected at five alcohol in-patient treatment settings in New York; three settings were in New York City, one in Rochester and one in Buffalo. PARTICIPANTS: The sample included 802 participants (481 males and 321 females) with racial/ethnic group diversity (418 blacks, 180 whites, 187 Hispanics, 17 of other ethnic origin). MEASUREMENTS: Subjects were assessed with standardized measures of substance abuse and psychiatric disorders, family history of alcoholism, psychopathy, temperament, alcohol expectancies and clinical health variables. FINDINGS: Based on internal and external criteria and compatibility with the existing literature, four subtypes were identified: mild course, polydrug, negative affect and chronic/antisocial. On external criteria, the polydrug subtype had the highest rate of family criminality, high-risk sexual behavior and intravenous drug use; the negative affect subtype had the highest rate of childhood sexual abuse, attempted suicide and childhood homelessness; the chronic/antisocial personality (ASP) subtype had the most severe pattern of drinking and antisocial behavior. CONCLUSIONS: Findings are discussed with regard to the etiological and clinical utility of the four-subtype formulation, and consistency with recent studies in molecular genetics and pharmacology.

Adult↗
PubMed2006

Resilience in homeless adults: a review of literature.

Although the concept of resilience has been studied for the past three decades, a paucity of research has focused on this concept in homeless adults, particularly among homeless adults who are persons of color African-Americans have been characterized as being resilient and it has been reported that African-Americans are disproportionately represented among the homeless population nationwide. The purpose of this article is to review the scope of research previously done in the area of resilience in homeless adults and to highlight the importance of the concept of resilience in the lives and existence of this at-risk group. Homeless adults face enormous stressors on a daily basis as they navigate a minefield of mental, physical, and environmental risks. How they respond and how they adapt to these stressors can potentially affect their health outcomes as well as their quality of life. The seven articles retrieved for this article support the contention that further research is needed to increase the understanding of how the concept of resilience impacts the ability of homeless adults, and in particular persons of color to endure and survive despite their adverse conditions.

Adaptation, Psychological↗