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Homelessness and Mental Illness

Published online by Cambridge University Press:  03 January 2018

Jan Scott*
Affiliation:
University Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP

Abstract

In Great Britain 1–2 million people may be homeless. Most homeless people are men, but about 10–25% are women, of whom about half are accompanied by children. Significant mental illness is present in 30–50% of the homeless: functional psychoses predominate; acute distress and personality dysfunction are also prevalent. Co-morbidity of mental illness and substance abuse occurs in 20%, and physical morbidity rates exceed those of domiciled populations. The homeless mentally ill also have many social needs. Pathways to homelessness are complex; deinstitutionalisation may be only one possible cause of the increase in the number of homeless people. There is much recent research estimating the extent of mental illness and the characteristics of selected subgroups of accessible homeless people. The evaluation of potential service solutions has received less attention. This review outlines the research, highlights current views on the definition and classification of homeless populations, and offers some guidelines on avenues which need to be explored.

Type
Review Article
Copyright
Copyright © The Royal College of Psychiatrists 

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References

Alcohol, Drug Abuse and Mental Health Administration (1983) Alcohol, Drug Abuse and Mental Health Problems of the Homeless. Proceedings of a Round Table. Washington, DC: ADAMHA.Google Scholar
Alisky, J. M. & Iczkowski, B. A. (1990) Barriers to housing for deinstitutionalised psychiatric patients. Hospital and Community Psychiatry, 41, 9395.Google Scholar
Alstrom, C. H., Lindelius, R. & Salum, I. (1975) Mortality among homeless men. British Journal of Addiction, 70, 245252.Google ScholarPubMed
Arce, A. A., Tadlock, M., Vergare, M. J., et al (1983) A psychiatric profile of street people admitted to an emergency shelter. Hospital and Community Psychiatry, 34, 812817.Google Scholar
Arce, A. A., & Vergare, M. J. (1984) Identifying and characterising the mentally ill among the homeless. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 7590. Washington, DC: American Psychiatric Association.Google Scholar
Austerberry, H. & Watson, S. (1986) Housing and Homelessness. London: Routledge & Kegan Paul.Google Scholar
Bachrach, L. (1984) The homeless mentally ill and the mental health services. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 1154. Washington, DC: American Psychiatric Association.Google ScholarPubMed
Ball, F. L. & Havassy, E. (1984) A survey of the problems and needs of the homeless consumers of acute psychiatric services. Hospital and Community Psychiatry, 35, 917921.Google ScholarPubMed
Barrow, S. & Lovell, A. M. (1982) Evaluation of Project Reach Out 1981–2. New York: New York State Psychiatric Institute.Google Scholar
Bassuk, E. L. (1984) The homeless problem. Scientific American, 6, 4045.CrossRefGoogle Scholar
Bassuk, E. L. (1990) Who are the homeless families? Characteristics of sheltered mothers and children. Community Mental Health Journal, 26, 421430.CrossRefGoogle ScholarPubMed
Bassuk, E. L. Rubin, L. & Lauriat, A. (1984) Is homelessness a mental health problem? American Journal of Psychiatry, 141, 15461550.Google ScholarPubMed
Bassuk, E. L. Rubin, L. & Lauriat, A. (1986) Characteristics of sheltered homeless families. American Journal of Public Health, 76, 10971102.CrossRefGoogle ScholarPubMed
Baxter, E. & Hopper, K. (1982) The new mendicancy: homeless in New York City. American Journal of Orthopsychiatry, 52, 393408.CrossRefGoogle ScholarPubMed
Baxter, E. & Hopper, K. (1984a) Troubled on the streets: the mentally disabled homeless poor. In The Chronic Mental Patient (ed. Talbott, J.), pp. 4955. New York: Grune & Stratton.Google Scholar
Baxter, E. & Hopper, K. (1984b) Shelter and housing for the homeless mentally ill. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 103139. Washington, DC: American Psychiatric Association.Google Scholar
Bennett, M. I., Gudeman, J., Jenkins, L., et al (1988) The value of hospital based treatment for the homeless mentally ill. American Journal of Psychiatry, 145, 12731276.Google ScholarPubMed
Berry, C. & Orwin, A. (1966) No fixed abode: a survey of mental hospital admission. British Journal of Psychiatry, 112, 10191025.CrossRefGoogle Scholar
Birley, J. (1990) Blame homelessness, not the hospitals. Guardian, 14 March, p. 21.Google Scholar
Black, M., Scheuer, M., Victor, C., et al (1991) Utilisation by homeless people of acute hospital services in London. British Medical Journal, 303, 958961.CrossRefGoogle Scholar
Blumberg, L. (1973) What to Do about the Men on Skid Row: Report of the Greater Philadelphia Movement to the Redevelopment Authority of the City of Philadelphia. Philadelphia: Greater Philadelphia Movemement.Google Scholar
Breakey, W. R. (1987a) Recent empirical research on the homeless mentally ill. Paper presented at ADAMHA meeting on Research Methodologies concerning Homeless Persons. Bethesda, Maryland, 13 July.Google Scholar
Breakey, W. R. (1987b) Treating the homeless. Alcohol Health and Research World, 1142.Google Scholar
Breakey, W. R., Fischer, P. J. & Cowan, C. D. (1986) Homeless people in Baltimore: demographic profile and enumeration. Paper presented at the Annual Meeting of the American Public Health Association, Las Vegas.Google Scholar
Brickner, P. W. (1984) Medical aspects of homelessness. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 243259. Washington, DC: American Psychiatric Association.Google Scholar
Brickner, P. W. & Kaufman, A. (1973) Case finding of heart disease in homeless men. Bulletin of New York Academy of Medicine, 49, 475484.Google ScholarPubMed
Brown, C., MacFarlane, S., Paredes, R., et al (1983) The Homeless of Phoenix: Who Are They? And What Should Be Done? Phoenix: Phoenix South Community Mental Health Centre.Google Scholar
Burt, M. R. & Cohen, B. E. (1989) Differences among homeless single women, women with children, and single men. Social Problems, 36, 508524.CrossRefGoogle Scholar
Caton, C. (1990) Solutions to the homeless problems. In Homeless in America (ed. Caton, C.), pp. 174190. Oxford: Oxford University Press.CrossRefGoogle Scholar
Caton, C., Wyatt, R. J., Grunberg, J., et al (1990) An evaluation of a mental health program for homeless men. American Journal of Psychiatry, 147, 286287.Google ScholarPubMed
Central Statistics Office (1989) Social Trends 19. London: HMSO.Google Scholar
Cohen, N. L., Putnam, J. F. & Sullivan, A. M. (1984) The mentally ill homeless: isolation and adaptation. Hospital and Community Psychiatry, 35, 922924.Google Scholar
Corrigan, E. M. & Anderson, A. C. (1984) Homeless alcoholic women on skidrow. Drug and Alcohol Abuse, 10, 534549.Google Scholar
Crystal, S., Ladner, S. & Towber, R. (1986) Multiple impairment patterns in the mentally ill homeless. International Journal of Mental Health, 14, 6173.CrossRefGoogle Scholar
Department of the Environment (1990) Action of Local Authorities in Discharging Duties under the 1985 Housing Act. London: HMSO.Google Scholar
Drake, M., O'Brien, M., & Biebuyck, T. (1982) Single and Homeless. London: HMSO for Department of the Environment.Google Scholar
Drake, R. E., Wallach, M. A. & Hoffman, J. S. (1989) Housing instability and homeless among after-care patients of an urban state hospital. Hospital and Community Psychiatry, 40, 4651.Google ScholarPubMed
Eagle, P. F. & Caton, C. L. M. (1990) Homeless and mental illness. In Homeless in America (ed Caton, C.), pp. 5975. Oxford: Oxford University Press.CrossRefGoogle Scholar
Fernandez, J. (1984) “In Dublin's fair city”: the mentally ill of ‘No fixed abode’. Bulletin of the Royal College of Psychiatrists, 12, 187190.CrossRefGoogle Scholar
Fischer, P. J. & Breakey, W. R. (1986a) Homelessness and mental health: an overview. International Journal of Mental Health, 14, 641.CrossRefGoogle Scholar
Fischer, P. J., Shapiro, S., Breakey, W. R., et al (1986b) Mental health and social characteristics of the homeless: a survey of mission users. American Journal of Public Health, 76, 519523.CrossRefGoogle ScholarPubMed
Freeman, S., Formo, A., Alampur, A., et al (1979) Psychiatric disorder in a skid-row mission population. Comprehensive Psychiatry, 32, 454461.CrossRefGoogle Scholar
Gelberg, L. & Linn, L. S. (1988) Social and physical health of homeless adults previously treated for mental health problems. Hospital and Community Psychiatry, 39, 510516.Google ScholarPubMed
George, S., Shanks, N. & Westlake, L. (1991) Census of homeless people in Sheffield. British Medical Journal, 302, 13871389.CrossRefGoogle ScholarPubMed
Goering, P., Paduchak, D. & Dubin, J. (1990) Housing homeless women: a consumer preference study. Hospital and Community Psychiatry, 41, 790794.Google ScholarPubMed
Goldberg, D. P. (1972) The Detection of Psychiatric Illness by Questionnaire. Oxford: Oxford University Press.Google Scholar
Goldfinger, S. M. & Chaftez, L. (1984) Developing a better service delivery system for the homeless mentally ill. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 91108. Washington, DC: American Psychiatric Association.Google Scholar
Grunberg, J. & Eagle, P. F. (1990) Shelterization: how the homeless adapt to shelter living. Hospital and Community Psychiatry, 51, 521525.Google Scholar
Harris, M. & Bachrach, L. (1990) Perspectives on homeless mentally ill women. Hospital and Community Psychiatry, 23, 253254.Google Scholar
Heptinstall, D. (1989) Glimmer of psychiatric hope for homeless men in London. Social Work Today, 23 February, pp. 1617.Google Scholar
Herrman, H., McGorry, P., Bennett, P., et al (1989) Prevalence of severe mental disorders in disaffiliated and homeless people in inner Melbourne. American Journal of Psychiatry, 146, 11791184.Google ScholarPubMed
Herzberg, J. (1987) No fixed abode: a comparison of men and women admitted to an East London psychiatric hospital. British Journal of Psychiatry, 150, 621627.CrossRefGoogle Scholar
Holden, C. (1986) Homelessness: experts differ on root causes. Science, 232, 569570.CrossRefGoogle ScholarPubMed
James, A. (1991) Homeless women in London: the hostel perspective. Health Trends, 23, 8083.Google ScholarPubMed
Jones, B. E. (1986) Treating the Homeless: Urban Psychiatry's Challenge. Washington, DC: American Psychiatric Press.Google Scholar
Kay, R. (1985) The Homeless Mentally Ill, vol. IX, no. 11, pp. 69. Washington, DC: US Department of Human Sciences.Google Scholar
Kelly, J. T. (1985) Trauma: with the example of San Francisco's shelter program. In Health Care of Homeless People (eds Brickner, P., Scharer, L., Conanan, B., et al), pp. 7785. New York: Springer Verlag.Google Scholar
Koegal, P. & Burman, A. (1987) Alcoholism among homeless adults in the inner city of Los Angeles. Archives of General Psychiatry, 45, 10111018.CrossRefGoogle Scholar
Koegal, P. & Burman, M. (1988) The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Archives of General Psychiatry, 45, 10851092.CrossRefGoogle Scholar
Kroll, J., Carey, K., Hagedorn, D., et al (1986) A survey of homeless adults in urban emergency shelters. Hospital and Community Psychiatry, 37, 283286.Google ScholarPubMed
Lamb, R. (1984) Deinstitutionalization and the homeless mentally ill. In The Homeless Mentally Ill (ed. Lamb, R.). Washington, DC: American Psychiatric Association.Google ScholarPubMed
Lamb, R. (1990) Will we save the homeless mentally ill? American Journal of Psychiatry, 147, 649651.Google ScholarPubMed
Lamb, R. & Lamb, D. (1990) Factors contributing to homelessness among the chronically and severely mentally ill. Hospital and Community Psychiatry, 41, 301305.Google ScholarPubMed
Larew, B. I. (1980) Strange strangers: serving transients. Social Casework, 63, 107113.CrossRefGoogle Scholar
Leach, J. & Wing, J. (1980) Helping Destitute Men. London: Tavistock.Google Scholar
Levine, I. S. (1984) Service programs for the homeless mentally ill. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 173200. Washington, DC: American Psychiatric Association.Google Scholar
Linn, L., Gelberg, L. & Leake, B. (1990) Substance abuse and mental health status of homeless and domiciled low-income users of a medical clinic. Hospital and Community Psychiatry, 41, 306310.Google ScholarPubMed
Lipton, F. & Sabatini, A. (1984) Constructing support systems for homeless chronic patients. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 153172. Washington, DC: American Psychiatric Association.Google Scholar
Lamb, R., Nutt, S. & Sabatini, A. (1988) Housing the homeless mentally ill: a longitudinal study of a treatment approach. Hospital and Community Psychiatry, 39, 4045.Google Scholar
Lowry, M. & Conlon, R. (1987) The Homeless: Myths Versus Reality. Washington, DC: Democratic Study Group, US House of Representatives.Google Scholar
McCarthy, M. (1980) London's Health Services in the 80's. King's Fund Project Paper No. 25.Google Scholar
Maitra, A. K. (1982) Dealing with the disadvantaged-single homeless, are we doing enough? Public Health, 96, 141144.CrossRefGoogle Scholar
Marshall, J. (1992) Psychiatric morbidity in homeless women. British Journal of Psychiatry, 160, 761768.CrossRefGoogle ScholarPubMed
Marshall, M. (1989) Collected and neglected: are Oxford hostels for the homeless filling up with the disabled psychiatric patients? British Medical Journal, 299, 706709.CrossRefGoogle ScholarPubMed
Matthews, P. (1986) Doctors for the homeless and rootless. British Medical Journal, 292, 16721674.CrossRefGoogle Scholar
Morrisey, J. & Levine, I. (1987) Researchers discuss latest findings, examine needs of homeless mentally ill persons. Hospital and Community Psychiatry, 38, 811812.Google Scholar
Morse, G. & Calsyn, R. (1986) Mentally disturbed homeless people in St Louis: needy, willing, but underserved. Journal of Mental Health, 14, 7494.Google Scholar
O'Neill, M. (1988) Tunnel vision. Insight, September, pp. 1215.Google Scholar
O'Neill, M. (1989) Users of Resettlement Units: a Report of a Survey Carried Out in Fifteen Resettlement Units and a Census Carried Out in All Twenty-Two. London: Resettlement Agency.Google Scholar
Priest, R. (1976) The homeless person and the psychiatric services: an Edinburgh survey. British Journal of Psychiatry, 128, 128136.CrossRefGoogle ScholarPubMed
Rivlin, L. (1986) A new look at the homeless. Social Policy, 310.Google Scholar
Rossi, P., Wright, J., Fisher, G., et al (1987) The urban homeless: estimating composition and size. Science, 235, 13361341.CrossRefGoogle ScholarPubMed
Roth, D. & Bean, G. (1986) New perspectives on homeless findings from a statewide epidemiological study. Hospital and Community Psychiatry, 37, 712719.Google ScholarPubMed
Scott, J. (1991) Resettlement unit or asylum? Paper presented at the Royal College of Psychiatrists, Brighton, 3 July.Google Scholar
Scott, J. & Boustead, M. (1991) Characteristics of homeless adults in temporary accommodation. British Journal of Clinical and Social Psychiatry Supplement on Poverty, 7, 182187.Google Scholar
Scott, R., Gaskell, P. & Morrell, D. (1966) Patients who reside in common lodging houses. British Medial I Journal, ii, 15611564.CrossRefGoogle Scholar
Shanks, N. (1983) Medical provision for the homeless in Manchester. Journal of the Royal College of General Practitioners, 33, 4043.Google ScholarPubMed
Shelter (1989) Raise the Roof Campaign. London: Shelter Publications.Google Scholar
Stark, C., Scott, J., Hill, M., et al (1989) A Survey of the ‘Long-Stay’ Users of DSS Resettlement Units: a Research Report. London: Department of Social Security.Google Scholar
Stearn, J. (1987) No home, no health care? Roof 1619.Google Scholar
Susser, E., Struering, E. & Conover, M. (1987) Childhood experiences of homeless men. American Journal of Psychiatry, 144, 15991601.Google ScholarPubMed
Susser, E., Conover, M. & Struering, E. (1989) Problems of epidemiologic method in assessing the type and extent of mental illness among homeless adults. Hospital Community Psychiatry, 40, 261265.Google ScholarPubMed
Susser, E., Conover, S. & Struering, E. (1990) Mental illness in the homeless: problems of epidemiological method in surveys of the 1980's. Community Mental Health Journal, 26, 387410.Google Scholar
Talbott, J. & Lamb, R. (1984) Summary and recommendations. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 110. Washington, DC: American Psychiatric Association.Google Scholar
Tandon, P. K. (1986) Health care for the homeless. Journal of the Royal College of General Practitioners, 36, 292294.Google ScholarPubMed
Thornicroft, G. & Bebbington, P. (1989) Deinstitutionalisation from hospital closure to service development. British Journal of Psychiatry, 155, 739753.CrossRefGoogle ScholarPubMed
Tidmarsh, D. & Wood, S. (1972) Psychiatric aspects of destitution. In Evaluating a Community Psychiatric Service (eds Wing, J. & Haley, A.). Oxford: Oxford University Press.Google Scholar
Timms, P. (1990) Psychiatric care of the homeless a domiciliary asylum service. Paper presented at the Royal College of Psychiatrists Quarterly Meeting, Birmingham, July.Google Scholar
Timms, P. & Fry, A. (1989) Homelessness and mental illness. Health Trends, 21, 7071.Google ScholarPubMed
Victor, C., Connelly, J., Roderick, S., et al (1989) Use of hospital services by homeless families in an Inner London health district. British Medical Journal, 299, 725727.CrossRefGoogle Scholar
Weller, B., Weller, M., Coker, E., et al (1987) Crisis at Christmas 1986. Lancet, i, 553554.CrossRefGoogle Scholar
Whiteley, J. S. (1955) Down and out in London: mental illness in lower social groups. Lancet, ii, 608610.CrossRefGoogle Scholar
Williams, S. & Allen, I. (1989) Health Care for Single Homeless People. London: Policy Studies Institute.Google Scholar
Wright, J. (1987a) Selected Topics in the Health Status of America's Homeless: Special Report to the Institute of Medicine. Massachussettes: University of Amherst.Google Scholar
Wright, J. D. (1987b) The National Health Care for the Homeless Program. In The Homeless in Contemporary Society (eds Bingham, R., Green, R. & White, S.). London: Sage.Google Scholar
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