Challenges for Psychiatry in Serving Homeless People With Psychiatric Disorders

Abstract

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.

Key Features of a Unique Community Psychiatry Fellowship: The Emory University Fellowship in Community Psychiatry/Public Health

“…The need for expanding the pipeline of leaders within community psychiatry has been recognized in diverse arenas, including community mental health centers (Ribner 1980), service providers for individuals who are homeless and have a serious mental illnesses (McQuistion et al 2003), and state mental health systems (Harbin et al 1982), to name a few. The ongoing evolution of postgraduate fellowship training opportunities in community psychiatry is a critical aspect of achieving this goal.…”

Promoting Children’s Mental Health in Family Supportive Housing: A Community–University Partnership for Formerly Homeless Children and Families

“…Very little has been published on family supportive housing, although initial reports indicate that family supportive housing may increase residential stability and that adult caregivers report satisfaction with housing (Hanrahan et al 2005;Nolan et al 2005). No published data could be found regarding the mental health status of children in supportive housing environments, or the resources available to address their psychosocial needs, although the increasing number of children in such housing environments has been noted (e.g., McQuistion et al 2003).…”

“…Studies of families in shelters and in the community indicate that homeless children face a greater likelihood than poor housed children of experiencing hunger, multiple school placements, exposure to violence, and maltreatment (e.g., Anooshian 2005;Gewirtz and Edleson, in press;Masten et al 1993), parental substance abuse, and/or parental mental illness (Bassuk et al 1996Burt et al, 1999;McQuistion et al 2003;Vostanis et al 1997). A subset of these children also have experienced out-of-home placement by child protection authorities or through voluntary placement by parents with housed relatives (Shinn et al 2006).…”

Use of mental health services among people with co-occurring disorders and other mental health co-morbidities: employing the Behavioral Model of Vulnerable Populations

“…Burnam, 2001; Compton et al, 2003; McQuistion et al, 2003). Some of the most notably examined co-morbidities exist between people experiencing mental health disorders and: substance abuse (Curran et al, 2000); homelessness (Compton et al, 2003); who are victims of violent crime (Choe, Teplin, & Abram, 2008); diagnosed with HIV/AIDS (Burnam, 2001); and in receipt of public benefits.…”