No abstract

Quality of life (QOL) is a key indicator in mental health planning, program evaluation, and evaluation of patient outcomes. Yet few studies have focused on QOL in homeless populations. More specifically, research has yet to identify profiles of homeless individuals based on their QOL using cluster analysis. This study developed a typology of QOL for a sample of 455 homeless individuals recruited from 27 community and public organizations in Quebec (Canada). The typology was developed based on QOL scores, as well as sociodemographic, clinical, and service use variables. Study participants had to be at least 18 years old, with current or previous experience of homelessness. A questionnaire including socio-demographics, residential history, service utilization, and health-related variables was administered. Four clusters were identified using a two-step cluster analysis. QOL was highest in the cluster consisting of older women with low functional disability, and relatively few episodes of homelessness. The second cluster with high QOL scores included individuals living in temporary housing with relatively few mental health or substance use disorders (SUDs). The third cluster with low QOL included middle-aged women living in temporary housing, with criminal records, personality disorders, and SUDs. QOL was also lower in the fourth cluster composed of individuals with multiple homeless episodes and complex health problems as well as high overall service use. Findings reinforced the importance of disseminating specific programs adapted to the diverse profiles of homeless individuals, with a view toward increasing their QOL.

When evaluating housing preferences, it is important to elicit the viewpoints of mental health consumers as well as their case managers. Special attention should be given to the type of housing where consumers currently live. A variety of housing, not just autonomous housing, is needed to meet the specific housing preferences of individuals with serious mental illness.

Mental illness symptoms may be a trigger for receiving an array of services for homeless women once they gain entrance into a service system. There was a negative association between symptoms of mental illness and use of behavioral health services among homeless mothers, which may be the result of the fear of child welfare service intervention and loss of child custody. This service distribution inequity among homeless women using mental health services deserves attention by policy makers, researchers, and providers.