Homelessness in Schizophrenia
Section snippets
How Big Is the Problem?
A single point-in-time count in January 2010 found 649,917 homeless people in the United States, of whom 109,812 were chronically homeless and 246,374 were unsheltered. Throughout the year, 1.59 million people in the United States spent at least one night in a shelter.1 There were 26,248 homeless people in New York City’s Department of Homeless Services records in 2006, 2525 of whom were veterans.2 The 2006 Australian census estimated 104,676 homeless individuals.3 In 2007 in the United Kingdom
Obstacles in treating homeless people with schizophrenia
Treating schizophrenia in the homeless has proved challenging in several aspects. Many patients with schizophrenia experience great difficulty accessing the health care system. Many studies have shown great stigma attached to the treatment of the mentally ill, especially toward those with more obvious characteristics of schizophrenia. Lack of coordinated programs and disparities within the health care system create obstacles for treatment of homeless people with schizophrenia.
Outreach
In late 1980s, the Homeless Emergency Liaison Project (HELP)15 aimed to offer treatment to seriously mentally ill homeless people living on the streets in New York City. The psychiatrist in the project team was empowered to order police to transport homeless people who met program criteria of mental illness and risk of harm to an inpatient unit. Of 298 individuals served by the program, 80% had schizophrenia, 73% had comorbid medical conditions—vascular disease, anemia, tuberculosis,
Future directions for the mentally ill homeless
Homeless people with mental illness, in particular those with schizophrenia, are a vulnerable yet underserved population who deserve special attention from the policy makers and health care providers. Their particular characteristics, for example, cognitive dysfunction and comorbid substance use, should be acknowledged, evaluated, and addressed in treatment plans. Doing so without amplifying the stigma already existing in society and even among care providers, however, is difficult. ACT is the
References (71)
A Quality of Life Interview for the chronically mentally ill
Eval Program Plann
(1988)- et al.
Schizophrenia and increased risks of cardiovascular disease
Am Heart J
(2005) - et al.
The prevalence of psychotic symptoms in homeless adolescents
J Am Acad Child Adolesc Psychiatry
(1990) - et al.
Impact of an integrated service system on client outcomes by gender in a national sample of a mentally ill homeless population
Gend Med
(2008) - HUD’s 2010 annual homeless assessment report to congress. 2011. Available at:...
- et al.
The use of data to assist in the design of a new service system for homeless veterans in New York City
Psychiatr Q
(2008) - Chamberlain C, Mackenzie D. Australian Census Analytic Program “Counting the Homeless”. 2008. Available at:...
- UK Housing Review 2007/2008. Available at: http://www.york.ac.uk/res/ukhr/ukhr0708/compendium.htm. Accessed January 12,...
- Edgar B, Doherty J, Meert H. Review of statistics on homeless in europe, FEANTSA European Federation of National...
- et al.
The epidemiology of alcohol, drug and mental disorders among homeless persons
Am Psychol
(1991)
Mental illness and mortality among homeless people
Acta Psychiatr Scand
National institute of mental health diagnostic interview schedule: its history, characteristics, and validity
Arch Gen Psychiatry
The structured clinical interview for DSM-III-R (SCID), I: history, rationale, and description
Arch Gen Psychiatry
Reliability and validity of the addiction severity index with a homeless sample
J Subst Abuse Treat
Client outcomes II: longitudinal client data from the Colorado treatment outcome study
Milbank Q
Statewide treatment outcome assessment in Colorado: the Colorado Client Assessment Record (CCAR)
Community Ment Health J
Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans
Psychiatr Serv
Psychiatry takes to the streets, the New York City initiative for the homeless mentally ill
Am J Psychiatry
An experimental comparison of three types of case management for homeless mentally ill persons
Psychiatr Serv
A comparative Study of the 12-Months Prevalence of physical health problems among homeless people in Madrid and Washington, DC
Int J Ment Health
A comparative analysis of serious injury and illness among homeless and housed low income residents of New York City
J Trauma
Mortality among homeless people with schizophrenia in Sidney, Australia: a 10-year follow-up
Acta Psychiatr Scand
Health care utilization among homeless adults prior to death
J Health Care Poor Underserved
Mortality among men using homeless shelters in Toronto, Ontario
JAMA
Prevalence of mental illness in homeless men in Munich, Germany: results from a representative sample
Acta Psychiatr Scand
Age and severe mental disorders in homeless and disaffiliated people in inner Melbourne
Med J Aust
One-month prevalence of mental disorders in the United States based on five epidemiologic catchment area sites
Arch Gen Psychiatry
Mental illness and substance use among sheltered homeless persons in lower density population areas
Psychiatr Serv
Mental illness among homeless individuals in a suburban county
Psychaitr Serv
The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis
PLoS Med
Risk factors for long term homelessness: findings from a longitudinal study of first time homeless single adults
Am J Public Health
Schizophrenia in homeless persons: a systematic review of literature
Acta Psychiatr Scand
Comparison of prevalence of schizophrenia among residents of hostels for homeless people in 1966 and 1992
BMJ
Symptoms of schizophrenia and psychosis according to foreign birth in a Canadian sample of homeless persons
Psychiatr Serv
Cited by (46)
Low income and schizophrenia risk: A narrative review
2022, Behavioural Brain ResearchCitation Excerpt :Their unmet basic needs included food, housing, personal and neighborhood safety, and money for necessities, and were associated with increased levels of perceived stress [79]. Major unmet basic needs identified among patients with severe mental illness include food security and housing [80,82]. Two recent reviews summarize evidence in support of a relationship between food insecurity and psychological distress based on studies of various designs, conducted in countries of different income levels in a variety of populations [83,84].
Schizophrenia and Epigenetic Aging Biomarkers: Increased Mortality, Reduced Cancer Risk, and Unique Clozapine Effects
2020, Biological PsychiatryCitation Excerpt :We measured smoking in cumulative PY, but it is possible that quantifying dose and duration separately may yield different results (70). Moreover, SZ is a complex heterogeneous disorder with diverse socioeconomic ramifications such as increased risk of poverty, unemployment, stigma, social isolation, housing instability, and poor health care (22–24). Stress is well established to influence aging (71), and education and income are associated with biological age (20).
Homeless youth with first-episode psychosis: A 2-year outcome study
2020, Schizophrenia ResearchCitation Excerpt :It could be explained, in part, by greater illness severity as suggested by a trend in higher PANSS scores, by high prevalence of SUD comorbidities (e.g., symptoms or psychotic relapse induced by intoxication or withdrawal), because of waiting in hospital to obtain appropriate supervised housing or because of mental health deterioration associated with poor outpatient follow-up, or stressful life conditions. Indeed, it may be harder for the homeless to attend appointments, as they present more cognitive deficits (Foster et al., 2012), SUD (Foster et al., 2012), legal issues (Foster et al., 2012), less social support (Bonin et al., 2007) and less financial means to afford transportation as well as their primary needs (consequently, they spend many hours every day trying to find meals and shelter). Most subjects in both groups adhered to prescribed medications, with no differences detected between groups, although lower adherence was previously described among the homeless (Bickley et al., 2006) and among ISMI patients (Velligan et al., 2009).
Clinical and cognitive correlates of unsheltered status in homeless persons with psychotic disorders
2018, Schizophrenia ResearchCitation Excerpt :Further, persons with psychotic disorders often have difficulties managing even routine landlord-tenant conflicts (Lamb and Bachrach, 2001). Moreover, they are less likely to engage in rehabilitative services that facilitate sheltered housing (Foster et al., 2012; Lincoln et al., 2009). Beyond these factors, the degree of psychotic and negative symptoms might distinguish between those in sheltered and unsheltered locations (Drake et al., 1991); for example, distrust and paranoia may create obstacles to obtaining or maintaining housing.
What can we learn about brain donors? Use of clinical information in human postmortem brain research
2018, Handbook of Clinical Neurology
Disclosures: All authors work as volunteers performing mental health screenings of homeless persons at shelters in Augusta, Georgia, as part of the Helping Hands program, sponsored by a grant from American Psychiatric Foundation. Adriana Foster, has received grant support from National Institute of Mental Health and Sunovion on topics unrelated to this article. James Gable and John Buckley do not have any conflicts of interest to report.