Most studies show the majority of people who become homeless are without a place to live for only a short period of time.  Homelessness usually is a result of and unexpected event such as:

• An eviction
• Natural disaster
• House fire

The short period of time homeless people usually have more social and economic resources to draw on than those who remain homeless for longer periods of time.

A much smaller group of homeless people either is:
 
• Episodically homeless (have many episodes of homelessness but each for short periods of times)
• Or is chronically homeless (have few episodes of homelessness but each for long periods of time)

The estimated 200,000 people who experience chronic homelessness usually have:
 
• Disabling health
• And behavioral health problems

Recent studies suggest that at least:
 
• 40 percent have substance use disorders
• 25 percent have some form of physical disability or disabling health condition, and 20 percent have serious mental illnesses.
 
It is often that individuals have more than one of these conditions.  These factors contribute to a person’s risk for becoming homeless and the difficulty he or she experiences in overcoming it.

People who experience chronic homelessness tend to be:

• Slightly older than those who experience shorter homeless episodes
• Non-white
• And male

Families and youth experience chronic homelessness as well.

It is no longer true that people with serious mental illnesses spend most of their lives in large, impersonal state institutions.  The focus of care for people with serious mental illnesses has shifted over the past 30 years from the state hospitals to the communities.  In 1955, the number of patients in state psychiatric hospitals dropped from 560,000 people to 77,000 people in 1996.

Much of this decrease can be attributed to:

• Deinstitutionalization, which sought, in part, to address well-publicized abuses in state hospitals by shifting treatment to less restrictive settings for people with serious mental illnesses
• The introduction in the 1950s of antipsychotic medication
• And by the creation of the Medicaid and Supplemental Security Income (SSI) programs in the 1960s that provided financial incentives for community care

The realities the seriously mentally ill individuals faced in their communities were in contrast to the hopes of deinstitutionalization.  The Community Mental Health Centers Act of 1963 was designed to address the needs of people with mental illnesses in their communities, however, the vast variety of needed services and supports never materialized.

Problems were:

• Fewer CMHCs than anticipated were created
• Those established offered primarily clinic-based services that frequently were inaccessible or inappropriate for individuals with the most serious disorders

Result was:

• Many individuals leaving institutions never connected with community-based mental health services
• Others cycled in and out of jails and prisons
• Others were among the first to be displaced when urban neighborhoods and single-room-occupancy hotels were gentrified in the 1980s

The Community Support Program in the late 1970s, now administered by SAMHSA’s Center for Mental Health Services (CMHS), was adopted as the framework for developing a comprehensive range of services that would allow people with serious mental illnesses to live successfully outside of institutions.  Some of these services included:

• Outreach
• Income and medical assistance benefits
• 24-hour crisis assistance
• Psychosocial rehabilitation
• Employment services
• Long-term supportive services
• Medical and mental health treatment
• Family support
• Residential services
• Case management
• Rights protection
• And advocacy

These services remain as the cornerstone of comprehensive, community-based systems of care for people with serious mental illnesses.

Communities with programs specifically designed to serve people with serious mental illnesses who are homeless include:

• Emergency shelters
• Outreach programs
• Drop-in centers
• Transitional housing
• And health care

The outreach programs have been especially effective in helping people with serious mental illnesses that are homeless, especially those individuals unable or unwilling to accept help from more traditional office-based providers.

Success stories exist, however, the numbers of people in need far exceed the capacity of programs that provide the intensive outreach and case management services required.  Many people with serious mental illnesses receive fragmented and uncoordinated treatment, housing, and support services, if they receive them at all.  They may cycle:

• In and out of hospitals
• Jails
• Shelters
• And life on the streets

All the above accomplished at an enormous cost to both themselves and their communities.

Continued in Part 2

Source:  Substance Abuse and Mental Health Services Administration.  Blueprint for Change:  Ending Chronic Homelessness for Persons with Serious Mental Illnesses and Co-Occurring Substance Use Disorders.  DHHS Pub. No. SMA-04-3870, Rockville, MD:  Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2003.

Written by:  Connie Limon  Visit http://smalldogs2.com/AboutHumanServices for more information about the responsibilities of human service specialists.  For a variety of FREE reprint articles visit http://www.camelotarticles.com

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