Mobile Mental Health Services for the Homeless: A Research Proposal

Introduction: Homelessness and Mental Illness

Homelessness and mental illness are inextricably intertwined. One way that mental illness impacts people's lives is that it oftentimes renders them unable to carry out the functions of daily life, such as keeping a job, paying bills, and managing a household. In addition to disrupting the events of daily life, mental illness "may also prevent people from forming and maintaining stable relationships or cause people to misinterpret others' guidance and react irrationally" (National Coalition for the Homeless, 2009). What this means is that a population already vulnerable because of an inability to consistently manage self-care lacks the same safety net available to much of the rest of society.

People with mental illnesses are at greater risk of homelessness. This is particularly true for people with serious mental illnesses, especially those that might impair reality testing, such as schizophrenia, bipolar disorder, or major depression (National Coalition for the Homeless, 2009). California, like other areas of the country, sees a clear relationship between mental illness and homelessness. In fact, mental illness may be one of the most significant risk factors for homelessness. Of people with serious mental illness seen by California's public mental health system, approximately 15% experienced at least one bout of homelessness in a one-year period (Folsom et al., 2005). Furthermore, "according to the Substance Abuse and Mental Health Services Administration, 20 to 25% of the homeless population in the United States suffers from some form of severe mental illness. In comparison, only 6% of Americans are severely mentally ill" (National Coalition for the Homeless, 2009). This demonstrates that people with mental illness are dramatically overrepresented among the homeless population.

Furthermore, homelessness creates significant risks for people with mental illness. Homeless people are at greater risk of assault, early death, and a lower quality of life (National Coalition for the Homeless, 2009). In addition, all homeless people face problems accessing health care (National Coalition for the Homeless, 2009). Government assistance programs aimed at helping the mentally ill — such as Social Security disability, welfare, general relief, Medicaid, and Medicare — can be difficult or impossible to access for people who lack a permanent address. In addition, county mental health centers, which are designed to aid those who lack other means of obtaining health care, are overcrowded and unable to serve the entire population of those in need.

For people with serious mental illness, who require regular access to health care in order to preserve or obtain mental health, this lack of access can be even more detrimental than for the average population. Even those who do access mental health care have higher treatment dropout rates than mentally ill people who are not among the homeless (Salavera et al., 2013). Furthermore, even when given access to mental health resources, the overwhelming concerns of finding food and shelter may prevent them from utilizing those resources (National Coalition for the Homeless, 2009). This suggests that the issue of homelessness cannot be resolved without addressing underlying mental illness.

Problem Statement

Traditional approaches to treating mental illness in the homeless population have required homeless people to travel to mental health services. The overrepresentation of the mentally ill among the homeless, as well as the high percentage of people with mental illness who experience at least one bout of homelessness each year, suggest that this model has not been sufficient for delivering mental health services to those most at risk. Alternative mental health service delivery models — such as traveling psychiatrists, psychologists, and nurses who administer medications and provide therapy for the homeless where they are living, rather than requiring them to come in for services — have not been adequately explored.

Purpose of the Study and Research Hypotheses

The purpose of this study is to determine whether a program that provides mental health services to the homeless where they are found — on the street and in shelters — is able to provide relief to mentally ill individuals and lead to a decrease in mental illness among the homeless. This study focuses on whether deploying a team of traveling psychiatrists working alongside psychologists and nurses to serve the homeless population where they are currently living improves treatment utilization rates. Furthermore, the study examines whether reducing treatment dropout rates results in a decrease in the homeless rate among the mentally ill people identified in the study.

The study is guided by three research hypotheses. First, employing a mobile mental health team to interact with the homeless in Los Angeles County in situ, rather than requiring them to travel to a fixed location for services, will result in a higher treatment utilization rate among that population. Second, this mobile approach will result in lower treatment dropout rates for the homeless population. Third, employing a mobile mental health team in situ will result in a decrease in the homeless rate among the mentally ill people identified in the study.

References

Folsom, D. P., Hawthorne, W., Lindamer, L., Gilmer, T., Bailey, A., Golshan, S., Garcia, P., Unutzer, J., Hough, R., and Jeste, D. V. (2005). Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. American Journal of Psychiatry, 162, 370–376.

National Coalition for the Homeless. (2009, July). Mental illness and homelessness. Retrieved April 13, 2013 from National Coalition for the Homeless website:

Salavera, C., Tricas, J. M., & Lucha, O. (2013). Personality disorders and treatment drop out in the homeless. Neuropsychiatric Disease and Treatment, 9, 379–387. doi:10.2147/NDT.S38677