Homelessness in Schizophrenia

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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

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  • Cited by (46)

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      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.

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    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.

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