Abstract
Few studies have examined barriers to physical and mental healthcare among homeless mentally adults. Methods This study examined physical and mental healthcare barriers reported by 154 recently homeless mentally ill persons. Results Practical concerns (e.g. transportation and cost) were key components of barriers to accessing general medical care among uninsured men with poorer overall mental health, PTSD, and STD infections. Perceived stigma was an important component of mental healthcare barriers reported most frequently by those with greater psychiatric symptoms. Conclusion Focusing on individual characteristics underlying barriers to healthcare may lead to better interventions for improving access to needed care.
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Association, A. P. (2000). (DSM-IV-TR) Diagnostic and statistical manual of mental disorders (4th ed., text revision ed.). Washington, DC: American Psychiatric Press, Inc.
Bachrach, L. L. (1992). What we know about homelessness among mentally illy persons: An analytical review and commentary. Hospital and Community Psychiatry, 43, 453–464.
Bassuk, E. L., Buckner, J. C., Perloff, J. N., & Bassuk, S. S. (1998). Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. American Journal of Psychiatry, 155(11), 1561–1564.
Bender, E. (2006). Hepatitis, TB rates found `Alarming’ among state hospital patients. Psychiatric News, 41(3), 5-a-27.
Blanchard, E., Jones-Alexander, J., Buckley, T., & Forneris, C. (1996). Psychometric properties of the PTSD Checklist (PCL). Behavioral Research Therapy, 34, 669–673.
Bourgois, P., Prince, B., & Moss, A. (2004). The everyday violence of Hepatitis C among young women who inject drugs in San Francisco. Human Organization, 63(3), 253–265.
Bradford, D. W., Gaynes, B. N., Kim, M. M., Kaufman, J. S., & Weinberger, M. (2005). Can shelter-based interventions improve treatment engagement in homeless individuals with psychiatric and/or substance misuse disorders? A randomized controlled trial. Medical Care August, 43(8), 763–768.
Clarke, P. N., Williams, C. A., Percy, M. A., & Kim, Y. S. (1995). Health and life problems of homeless men and women in the Southeast. Journal of Community Health Nursing, 12(2), 101–110.
D’Amore, J., Hung, O., Chiang, W., & Goldfrank, L. (2001). The Epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med, 8(11), 1051–1055.
Faustman, W. (Ed.). (1999). Overall J. Brief Psychiatric Rating Scale (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates Inc.
Fischer, P. J., & Breakey, W. R. (1991). The Epidemiology of Alcohol, Drug, and Mental Disorders Among Homeless Persons. American Psychologist November, 46(11), 1115–1128.
Folsom, D., Hawthorne, W., Lindamer, L., Gilmer, G., Bailey, A., & Golshan, S., et al. (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. The American Journal of Psychiatry, 162(2), 370.
Folsom, D., & Jeste, D. (2002). Schizophrenia in homeless persons: a systematic review of the literature. Acta Psychiatrica Scandinavica, 105(6), 404.
Gaba, R.J. (1997). Psychometric properties of the survey of children’s exposure to community violence: Screening version. Dissertation Abstracts International, 57, 4774.
Gallagher, T. C., Andersen, R. M., Koegel, P., & Gelberg, L. (1997). Determinants of regular source of care among homeless adults in Los Angeles. Medical Care, 35(8), 814–830.
Gillis, L., & Singer, J. (1997). Breaking through the barriers: Healthcare for the homeless. Journal of Nursing Administration, 27(6), 30–34.
Goodman, L. A., Thompson, K. M., Weinfurt, K., Corl, S., Acker, P., & Mueser, K. T., et al. (1999). Reliability of reports of violent victimization and posttraumatic stress disorder among men and women with serious mental illness. Journal of Traumatic Stress October, 12(4), 587–599.
Guydish, J., Bucardo, J., Clark, G., & Bernheim, S. (1998). Evaluating needle exchange: A description of client characteristics, health status, program utilization, and HIV risk behavior. Substance Use & Misuse, 33(5), 1173–1196.
Hahm, H. C., & Segal, S. P. (2005). Failure to seek health care among the mentally ill. American Journal of Orthopsychiatry, 75(1), 54–62.
Hwang, S. (2001). Mental illness and mortality among homeless people. Acta Psychiatrica Scandinavica June 2002;105(6):404–413, 103, 81–82.
Josephson, D. M., McDonell, M. B., & Anderson, S. A. (1996). Application of the SF36 and SF12 physical and mental health component summary scores in the VA outpatient setting. Journal of General Internal Medicine April, 1, 75.
Kaiser, H. F. (1974). An index of factorial simplicity. Psychomtrica, 39, 31–36.
Koenker, R. (2003). Quantile regression for longitudinal data. Journal of Multivariate Analysis, 91, 74–89.
Kushel, M., Gupta, R., Gee, L., & Haas, J. (2005). Housing instability and food insecurity as barriers to health care: results from the national survey of American families. Journal of General Internal Medicine, 20(Supplement 1), 116–117.
Lam, J. A., & Rosenheck, R. A. (1998). The effects of victimization on clinical outcomes of homeless persons with serious mental illness. Psychiatric Services, 49, 678–683.
Langenbucher, J. W., Labouvie, E., Martin, C. S., Sanjuan, P. M., Bavly, L. & Kirisci, L., et al. (2004). An application of item response theory analysis to alcohol, cannabis, and cocaine criteria in DSM-IV. Journal of Abnormal Psychology, 113(1), 72–80.
Lewis, J. H., Andersen, R. M., & Gelberg, L. M. D. M. (2003). Health care for homeless women: Unmet needs and barriers to care. Journal of General Internal Medicine, 18(11), 921–928.
Mojtabai, R. M. (2005). Perceived reasons for loss of housing and continued homelessness among homeless persons with mental illness. Psychiatric Services, 56(2), 172–178.
Muthen, B., & Muthen, L. (1998). MPlus. Los Angeles: Muthen & Muthen.
North, C., & Smith, E. (1993). A systematic study of mental health services utilization by homeless men and women. Social Psychiatry and Psychiatric Epidemiology, 28, 77–83.
Padgett, D., & Streuning, E. (1990). Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Medical Care, 28, 805–821.
Padgett, D., Streuning, E., Andrews, H., & Pittman, J. (1995). Predictors of emergency room use by homeless adults in New York City: The influence of predisposing, enabling and need factors. Social Science & Medicine, 41(4), 547.
Pirl, W. F., Greer, J. A., Weissgarber, C. R., Liverant, G. M., & Safren, S. A. (2005). Screening for infectious diseases among patients in a state psychiatric hospital. Psychiatric Services, 56(12), 1614–1616.
Robertson, M. J. (1986). Mental disorder among homeless persons in the United States: An overview of recent empirical literature. Administration and Policy in Mental Health and Mental Health Services Research, 14(1), 14–27.
Rosenberg, S., Brunette, M., Oxman, T., Marsh, B., Dietrich, A. & Mueser, K., et al. (2004). The STIRR model of best practices for blood-borne diseases among clients with serious mental illness. Psychiatric Services, 55(6), 660–665.
Rosenberg, S., Drake, R., Wolford, G., Mueser, K., Oxman, T. & Vidaver, R., et al. (1998). Dartmouth assessment of lifestyle instrument (DALI): A substance use disorder screen for people with severe mental illness. American Journal of Psychiatry February, 155(2), 232–238.
Rosenberg, S., Goodman, L., Osher, F., Swartz, M., Essock, S. & Butterfield, M., et al. (2001). Prevalence of HIV, Hepatitis B, and Hepatitis C in people with severe mental illness. American Journal of Public Health Chronic Disease. January, 91(1), 31–37.
Rosenheck, R. A., & Lam, J. A. (1997). Client and site characteristics as barriers to service use by homeless persons with serious mental illness. Psychiatric Services, 48(3), 387–390.
Ryan, S. (1993). Psychometric analysis of the sexual abuse exposure questionnaire. Dissertation Abstracts International, (54), 2268.
Salyers, M., Bosworth, H., Swanson, J., Lamb-Pagone, J., & Osher, F. (2000). Reliability and validity of the SF-12 health survey among people with severe mental illness. Medical Care, 38(11), 1141–1150.
Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised Conflict Tactics Scale (CTS2): Development and Preliminary Psychometric Data. Journal of Family Issues, (17), 283–316.
Sullivan, G., Burnam, A., Koegel, P., & Hollenberg, J. (2000). Quality of life of homeless persons with mental illness: Results from the course-of-homelessness study. Psychiatric Services, 51(9), 1135–1141.
Swanson, J., Holzer, C., Ganju, V., & Jono, R. (1990). Violence and psychiatric disorder in the community: Evidence from the epidemiologic catchment area surveys. Hospital and Community Psychiatry, 41, 761–770.
Swanson, J., Swartz, M., Essock, S., Osher, F., Wagner, H. & Goodman, L., et al. (2002). The social-environmental context of violent behavior in persons treated for severe mental illness. American Journal of Public Health INDIGENOUS HEALTH. September, 92(9), 1523–1531.
Swartz, M. S., Swanson, J. W., Hannon, M. J., Bosworth, H. S., Osher, F. C. & Essock, S. M., et al. (2003). Regular sources of medical care among persons with severe mental illness at risk of Hepatitits C Infection. Psychiatric Services, 54(6), 854–859.
Tessler, R., Rosenheck, R., & Gamache, G. (2001). Comparison of homeless veterans with other homeless men in a large clinical outreach program. Psychiatric Quarterly, 73, 109–119.
Ware, J. E., Kosinski, M., Turner-Bowker, D. M., & Gandek, B. (2002). How to Score Version 2 of the SF-12 Health Survey (With a Supplemental Documenting Version 1). Lincoln RI, Quality Metric Incorporated.
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Kim, M.M., Swanson, J.W., Swartz, M.S. et al. Healthcare Barriers among Severely Mentally Ill Homeless Adults: Evidence from the Five-site Health and Risk Study. Adm Policy Ment Health 34, 363–375 (2007). https://doi.org/10.1007/s10488-007-0115-1
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DOI: https://doi.org/10.1007/s10488-007-0115-1