Challenges for psychiatry in serving homeless people with psychiatric disorders.

The authors examine current challenges confronting psychiatry in caring for homeless people with psychiatric disorders. After reviewing how psychiatry has historically addressed homelessness and mental illness, the authors discuss the roles that the profession has developed in working with homeless populations. These roles, which encompass clinical, administrative, academic, and advocacy functions, have evolved as a result of trends both in homelessness services and within the profession of psychiatry. Challenges implicit in this evolution are discussed, including recent trends in homelessness, particularly an increase in prevalence, especially among families and children and some clinical subpopulations. The authors propose that these epidemiological trends are affecting the mental health care needs of homeless people. To be effective and credible in continuing to help solve the problems of homeless people with psychiatric disorders, psychiatry must adapt to these new challenges, using the roles it has developed.

[1]  A. Stueve,et al.  The Role of the Psychiatrist: Job Satisfaction of Medical Directors and Staff Psychiatrists , 2001, Community Mental Health Journal.

[2]  D. Luchins,et al.  Mental health courts and the complex issue of mentally ill offenders. , 2001, Psychiatric services.

[3]  H. McQuistion,et al.  Psychosocial Rehabilitation: Issues and Answers for Psychiatry , 2000, Community Mental Health Journal.

[4]  A. Stueve,et al.  The role of the community psychiatrist as medical director: a delineation of job types. , 2000, Psychiatric services.

[5]  F. R. Lipton,et al.  Tenure in supportive housing for homeless persons with severe mental illness. , 2000, Psychiatric services.

[6]  S Tsemberis,et al.  Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. , 2000, Psychiatric services.

[7]  L. Seidman,et al.  Housing placement and subsequent days homeless among formerly homeless adults with mental illness. , 1999, Psychiatric services.

[8]  S. Metraux,et al.  Family Dynamics, Housing, and Recurring Homelessness Among Women in New York City Homeless Shelters , 1999 .

[9]  A. Leon,et al.  Predictors of Management Problems in Supported Housing: A Pilot Study , 1999, Community Mental Health Journal.

[10]  D. Cutler,et al.  The Community Psychiatrist: Hamlet, King Lear, or Fishmonger? Traditional vs. Nontraditional Roles and Settings , 1998 .

[11]  S. Bassuk,et al.  Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. , 1998, The American journal of psychiatry.

[12]  A. Stueve,et al.  The role of the psychiatrist as program medical director. , 1998, Psychiatric services.

[13]  G. Keepers,et al.  A three-decade perspective on community and public psychiatry training in Oregon. , 1998, Psychiatric services.

[14]  C. Zlotnick,et al.  Foster care children and family homelessness. , 1998, American journal of public health.

[15]  H. Lamb,et al.  Persons with severe mental illness in jails and prisons: a review. , 1998, New directions for mental health services.

[16]  K. Hopper,et al.  Homelessness, severe mental illness, and the institutional circuit. , 1997, Psychiatric services.

[17]  E. Susser,et al.  Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter. , 1997, American journal of public health.

[18]  E. Susser,et al.  Adverse childhood experiences: are they risk factors for adult homelessness? , 1997, American journal of public health.

[19]  P. Koegel,et al.  Childhood risk factors for homelessness among homeless adults. , 1995, American journal of public health.

[20]  P. Shrout,et al.  Risk factors for homelessness among women with schizophrenia. , 1995, American journal of public health.

[21]  L. Dixon,et al.  Modifying the PACT model to serve homeless persons with severe mental illness. , 1995, Psychiatric services.

[22]  Bruce G. Link,et al.  Lifetime and five-year prevalence of homelessness in the United States. , 1994, American journal of public health.

[23]  H. Steadman,et al.  A national survey of jail diversion programs for mentally ill detainees. , 1994, Hospital & community psychiatry.

[24]  E. Susser,et al.  Prevalence of HIV infection among psychiatric patients in a New York City men's shelter. , 1993, American journal of public health.

[25]  M. Shinn,et al.  Predictors of shelter use among low-income families: psychiatric history, substance abuse, and victimization. , 1992, American journal of public health.

[26]  R. Drake,et al.  Homelessness and dual diagnosis. , 1991, The American psychologist.

[27]  E. Susser,et al.  Childhood antecedents of homelessness in psychiatric patients. , 1991, The American journal of psychiatry.

[28]  R M Royall,et al.  Health and mental health problems of homeless men and women in Baltimore. , 1989, JAMA.

[29]  E L Struening,et al.  Psychiatric problems in homeless men. Lifetime psychosis, substance use, and current distress in new arrivals at New York City shelters. , 1989, Archives of general psychiatry.

[30]  P. Koegel,et al.  The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. , 1988, Archives of general psychiatry.

[31]  E. McGlynn,et al.  Review of California's Program for the Homeless Mentally Disabled , 1988 .

[32]  L. Gelberg,et al.  Mental health, alcohol and drug use, and criminal history among homeless adults. , 1988, The American journal of psychiatry.

[33]  E. Susser,et al.  Childhood experiences of homeless men. , 1987, The American journal of psychiatry.

[34]  L. Bachrach The homeless mentally ill in the general hospital: a question of fit. , 1986, General hospital psychiatry.

[35]  J. Talbott,et al.  The homeless mentally ill. The perspective of the American Psychiatric Association. , 1986, JAMA.

[36]  J. Anthony,et al.  Mental health and social characteristics of the homeless: a survey of mission users. , 1986, American journal of public health.

[37]  H. Lamb Deinstitutionalization and the homeless mentally ill. , 1984, Hospital & community psychiatry.

[38]  K. Hopper,et al.  Private Lives/Public Spaces: Homeless Adults on the Streets of New York City , 1981 .

[39]  Kathryn Falk,et al.  Training in Community Psychiatry: New Opportunities , 2004, Psychiatric quarterly.

[40]  J. Belcher Are jails replacing the mental health system for the homeless mentally ill? , 2004, Community Mental Health Journal.

[41]  K. Hopper,et al.  Two genealogies of supported housing and their implications for outcome assessment. , 2003, Psychiatric services.

[42]  R. Aquila,et al.  The rehabilitation alliance in practice: The clubhouse connection. , 1999 .

[43]  M. Silver,et al.  Finding alternatives to the streets for the homeless mentally Ill: Efficacy at a state hospital intensive placement unit , 1994, Journal of Psycholinguistic Research.

[44]  A. Kondratas Comment on Dennis P. Culhane et al.'s "Public Shelter Admission Rates in Philadelphia and New York City: The Implications of Turnover for Sheltered Population Counts" , 1994 .

[45]  W. Breakey Mental Health Services for Homeless People , 1992 .

[46]  E. Struening,et al.  Physical Health Status, Substance Use and Abuse, and Mental Disorders Among Homeless Adults , 1990 .

[47]  H. Lamb The Homeless mentally ill : a task force report of the American Psychiatric Association , 1984 .