Meeting the Needs of the Mentally Ill Homeless in Massachusetts-Based Emergency Shelters

A statewide survey (response rate = 79.5%) of the emergency shelters designed for homeless individuals was conducted in Massachusetts to determine the prevalence of serious mental illness among residents and extent to which they received psychiatric services. An average prevalence rate of 22%, ranging from 1% to 70%, was reported despite the fact that 87% of the shelters restricted admission of those exhibiting severe behavioral problems. Nearly three-quarters of the shelters reported providing some mental health services as part of their program, and 80% had established ties with professional mental health agencies. Linkages with these mental health agencies greatly enhanced placement options for mentally ill persons. When queried on the most pressing community-based service needed for the homeless mentally ill, nearly two-thirds of the shelters reported a need for additional housing alternatives.     

Factors in the transition to homelessness in the chronically mentally Ill

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for theprevious year were significantly correlated with TBH. Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

From Fragmentation to Integration

Abstract

Within the mental health field, there is an increased attention to issues of diversity. However, this awareness has not yet been applied to racially and culturally diverse gays and lesbians who are chronically mentally ill. Some of the reasons for this include the long history of homogeneity of American institutions; the underutilization of mental health services by minority groups; the stigmatization of the mentally ill; and homophobia, within both the psychiatric community and society at large. As a result, there is a need for mental health professionals to acknowledge minority gays and lesbians with chronic mental illness, and begin to provide programs that affirm their sexual orientation, race, and cultural identities.     

Factors in the Transition to Homelessness in the Chronically Mentally III

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for the previous year were significantly correlated with TBH Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

ATTITUDES TOWARD THE MENTALLY ILL:

Labeling theory posits that people labeled mentally ill experience negative societal reactions. Past research on this question is contradictory, due primarily to methodological problems. This study overcomes some of these problems by having respondents indicate their willingness to interact with a person with a specific mental disorder, or with an identically behaving person with a specific physical disorder. As expected, respondents reject the mentally ill significantly more than identically behaving physically ill persons, as supports labeling theory. Respondents also consider the mentally ill less predictable and to have less positive outcomes than those with physical illness. These beliefs highly correlate with rejection and account for some, but not all, of the effects of label on rejection.     

Brief admission program. An alliance of inpatient care and outpatient case management

1. Brief planned and crisis admissions to an inpatient psychiatric unit are presented as a component supportive of outpatient care and case management for chronically mentally ill patients. 2. Typical patients admitted to this inpatient short-term program are those experiencing a life stress or temporary crisis; chronically mentally ill patients who cycle and experience exacerbations of their illness; and those who need to make the transition from an acute inpatient unit to community living. 3. The Brief Admission Program treats the individual's response to and the consequences of a lifelong illness and enables the patient to return to his previous level of functioning and continue necessary outpatient treatment.     

Psychiatric nursing in the 1990s & beyond.

In the decade of the '90s, psychiatric mental health nursing will need to take stock of itself--its practice, its education, and its research--if it is to successfully prepare for the changes in care of the mentally ill. Like psychiatrists, we will need to rethink our agendas in light of new science and technology and rationalize the mental health delivery system and our role in it through systematic research and advocate for a system that provides quality care for the chronically ill and the poor. In the next century, we will need to rethink the basics of nursing care and the leadership roles of nurses as hospitals and the doctor's role within them changes. Psychiatric mental health nurses will need to be at the forefront in advocating for a delivery system that listens to patients and families, that humanizes the dehumanizing experience of hospitalization. The challenges before us are formidable.     

Homelessness Among Older Adults with Severe Mental Illness

ABSTRACT

This article tackles a problem that is often overlooked in the literature-the plight of homeless elders with severe mental disabilities. Drawing on his personal experience working with sheltered homeless persons who were mentally ill, the author argues for a focus not on self-sufficiency but on closely supervised care for this vulnerable population.     

Deinstitutionalization: a public policy perspective

1. Deinstitutionalization was initiated in an era of social reform to protect the rights of the mentally ill; however, a strong research base was absent and led to major flaws in the policy's implementation. 2. The chronically mentally ill are frequently poor advocates for themselves and, without even the most simple needs fulfilled, end up homeless. 3. The homeless mentally ill require comprehensive support systems with assured continuity of care. An emerging concept to deal with this issue is that of case management. 4. The mental health professional can strive to influence future public policy as patient advocate and nonpartisan educator.     

Characteristics of the Homeless Mentally III in Case Management: Differentiation Using Major Diagnostic Categories

The homeless mentally ill are more disabled than other homeless people and require more services, but important variations exist. This study examined relationships between broad Axis I diagnostic clusters and demographic and service variables for 328 clients receiving case management at a community program for the chronic mentally ill homeless. Demographic characteristics, medical history, educational, psychological, and marital history, and case management variables were examined for psychotic, affective, and miscellaneous other clients. Differences were found in such areas as suicide attempts and current suicide status, psychiatric treatment history, education, overall impairment of functioning, length of time homeless, and time in case management but not in status at termination or number of senlices required. Psychotics had lower adaptive functioning, spent less time in case management, but had as successful outcomes as affective clients. Psychiatric diagnosis provides information that might assist case management for the homeless mentally ill.     

Characteristics of the homeless mentally ill in case management: Differentiation using major diagnostic categories

The homeless mentally ill are more disabled than other homeless people and require more services, but important variations exist. This study examined relationships between broad Axis I diagnostic clusters and demographic and service variables for 328 clients receiving case management at a community program for the chronic mentally ill homeless. Demographic characteristics, medical history, educational, psychological, and marital history, and case management variables were examined for psychotic, affective, and miscellaneous other clients. Differences were found in such areas as suicide attempts and current suicide status, psychiatric treatment history, education, overall impairment of functioning, length of time homeless, and time in case management but not in status at termination or number of services required. Psychotics had lower adaptive functioning, spent less time in case management, but had as successful outcomes as affective clients. Psychiatric diagnosis provides information that might assist case management for the homeless mentally ill.     

Program evaluation of services for the homeless : Challenges and strategies

The rapid growth of the homeless population in North America has given rise to a sharp increase in the number of task forces and studies aimed at setting up either programs for the homeless, or policies for controlling the phenomenon. Whenever there is a need for program evaluations in this process, numerous methodological and strategic challenges have to be faced. Due to the characteristics of the clientele, evaluation studies of services for the homeless call for innovative approaches. This paper reviews the research strategies (types of evaluations, designs, and indicators) that have been developed to assess programs for chronic inebriates and mentally ill homeless. The findings from previous evaluations are then summarized and their consequences for evaluation practice are considered.     

The career of the mentally ill: an integration of psychiatric, labeling/social construction, and lay perspectives

This paper provides a new way of conceptualizing the career of the mentally ill. Most persons who experience an episode of a serious mental disturbance lead a normal life, while a few persons lead lifetimes that revolve around their mental disorders. The processes leading to either result can only be understood by integrating the traditional labeling and psychiatric perspectives with lay understandings of the concepts of "mental illness" and "nervous breakdowns." A selection of key concepts from these perspectives leads to a better understanding of the different paths persons take as they move through the pre-patient, inpatient, and post-patient phases of the "career of the mentally ill." This perspective makes understandable a number of counterintuitive relationships. For example, it explains why most hospitalized mental patients (1) have a negative stereotype of the "mentally ill," (2) do not perceive themselves as "mentally ill, yet (3) perceive themselves as benefiting from treatment, and (4) do not progress into a career of secondary deviance.     

Service Providers to the Homeless Mentally Ill: Their Thoughts,Perceptions, and Recommendations for the Homeless

A qualitative research study was conducted to obtain an understanding of the people who provide senvices to persons who are homeless and mentally ill. Selvice providers were asked about the kinds of selvices they provide, what they consider beneficial to this population, the kinds of selvices they would like to provide, and what is needed to allevwte the homeless problem. Selvices found in the study included, those that meet basic needs, psychiatric/medical selvices, social setvices, and activities. Service providers indicated the major selvice priority is housing and the necessity of: (a) a safe environment, (b) additional psychiatric/social selvices, (c) day programs, and (d) health care. It is recommended that selvice providers advocate for the necessary improvements in services including, collaborative workshops and training sessions to the public and to each other.     

The experiences of youth serving as caregivers for mentally ill parents: a background review of the literature

Young caregivers of mentally ill parents are a vulnerable population. These vulnerabilities include risks for developmental issues, poor socialization, and poor school performance. The purpose of this background review of the literature is to explore the experiences of young caregivers of mentally ill parents and detect the gaps in the literature. The guiding research questions were: What is the experience of young caregivers of mentally ill parents? and What is the experience for those who witness or must assist their parent during a crisis? The majority of research has been conducted outside the United States, primarily in the United Kingdom, and studies have focused mostly on young caregivers of parents with physical rather than mental illness. No studies focused on young caregivers who witnessed or assisted their mentally ill parent in crisis. Information gained through this review will add to the body of knowledge for child mental health and build a case for additional research.     

Physical health problems of the psychiatric client

The psychiatric nurse can make significant contributions to the client's overall state of health by attending to the physical health care needs of clients in psychiatric settings. Psychiatric clients die at a younger age than the general population and their incidence of physical health problems tends to be higher. As major providers of psychiatric care, especially to the chronically mentally ill, nursing skills are crucial to the physical and mental health of vulnerable clients. The case reports provide examples of how the interaction between physical and psychological states influence care.     

Service providers to the homeless mentally Ill: Their thoughts,perceptions, and recommendations for the homeless

A qualitative research study was conducted to obtain an understanding of the people who provide services to persons who are homeless and mentally ill. Service providers were asked about the kinds of services they provide, what they consider beneficial to this population, the kinds of services they would like to provide, and what is needed to alleviate the homeless problem. Services found in the study included, those that meet basic needs, psychiatric/medical services, social services, and activities. Service providers indicated the major service priority is housing and the necessity of: (a) a safe environment, (b) additional psychiatric/social services, (c) day programs, and (d) health care. It is recommended that service providers advocate for the necessary improvements in services including, collaborative workshops and training sessions to the public and to each other.     

Mental disease postpartum and parent‐infant interaction—evaluation of videotaped sessions

In order to investigate the influence of maternal mental illness postpartum on mother‐infant and father‐infant interaction, infants of 14 mentally ill women admitted to hospital within 6 months after delivery were compared to infants of 22 women who had been somatically ill. Videotaped sessions when the infant was 10 months old revealed that mothers in the psychiatric sample showed less sensitivity in comparison to mothers in the somatic sample. When the infant was 2 years old, mothers in the psychiatric sample showed less positive affect and less link‐infant follow (stimulation dimension) as compared to the somatic mothers. However, there were no differences between fathers in the psychiatric sample and fathers in the somatic sample in any of the interaction variables. In the psychiatric sample, fathers showed more warmth as compared to mothers. In the somatic sample, fathers scored higher than mothers on autonomy but lower than mothers on link‐infant follow (stimulation dimension). A possible interpretation of our data was that the mental illness of the mothers may lead to a more active parenting role of the father in order to buffer the deficit in the mother‐infant relation. Copyright © 2001 John Wiley & Sons, Ltd.     

Differential Labeling of Mental Illness Revisited: Patterns Before and After the Rise of Managed Care

With the National Comorbidity Survey of the early 1990s, Thoits (2005) recently showed that lower-status mentally ill individuals were not more often hospitalized or pressured into psychiatric treatment than comparably ill persons of higher status, disconfirming a central hypothesis of labeling theory. However, that finding may have been due to changes in the mental health treatment system introduced by the spread of managed care. The differential labeling hypothesis is reexamined here with data from the Epidemiological Catchment Area Studies (ECA) collected in the early 1980s before managed-care plans began to dominate the insurance marketplace and from the National Comorbidity Survey Replication conducted in the early 2000s when managed care had saturated the market. Little systematic support for the differential labeling hypothesis was found in the three studies, although, over time, the higher rates of mental hospitalization among less educated and low-income individuals found in the ECA survey disappeared. Trends across the studies suggest that educated and affluent persons with psychiatric problems more frequently sought hospital care. These findings further undermine the validity of the differential labeling hypothesis and suggest that service utilization or treatment-seeking factors may help explain mental hospitalization rates.     

Schizoid Personality Traits Among the Homeless Mentally III: A Quantitative and Qualitative Report

This paper examines the interplay among schizoid personality traits, chronicity of homelessness, and engagement in treatment in a homeless mentally ill population. Both qualitative and quantitative information will be provided about a sample of 125 homeless mentally ill individuals receiving psychiatric treatment in a comprehensive services drop-in clinic. Naturalistic observations and a case vignette suggested that schizoid traits were prevalent and may have been playing a role in treatment engagement and chronicity of homelessness. This hypothesis was tested using quantitative research methods. The results showed that schizoid personality disorder and schizoid personality traits were prevalent in the sample. The presence of schizoid traits was positively correlated with chronicity of homelessness. Further, two schizoid traits (being content without sexual involvement with others, and lacking close friends or confidants) were positively correlated with remaining in treatment at 3 months. Implications of these findings for future research and treatment design will be discussed.