Homelessness and Mental Illness Are Inextricably Intertwined. Research Proposal

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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 their 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 that is already vulnerable because of an inability to consistently manage self-care lacks the same safety net as 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, particularly those that might impact their 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 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% of them 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). What this demonstrates is that the homeless are dramatically overrepresented among the homeless population.

Furthermore, homeless creates a significant risk 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 have problems with accessing health care (National Coalition for the Homeless, 2009). Government assistance programs that are 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 ways to attain health care, are overcrowded an unable to serve the entire population of those in need. For people with serious mental illness, who need regular access to health care in order to preserve or obtain mental health, this lack of access can be even more detrimental than to the average population, because even those who 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 they are given access to mental health resources, the overwhelming concerns of finding food and shelter may prevent them from accessing those resources (National Coalition for the Homeless, 2009). What this suggests is that the issue of homeless cannot be resolved without treating 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 of homelessness. 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 to access mental health services, have not been adequately explored.

Purpose of the Study

The purpose of the 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 the mentally ill and lead to a decrease in mental illnesses among the homeless.

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This study will focus on whether deploying a team of four traveling psychiatrists working with a team of psychiatrists and nurses to work with the homeless population where they are currently living helps improve treatment utilization rates among the homeless. 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.

Research Hypothesis

Employing a mobile mental health team to interact with the homeless in Los Angeles County in situ, rather than requiring them to come into a location to access mental health services, will result in a higher treatment utilization rate among that population. Employing a mobile mental health team to interact with the homeless in Los Angeles County in situ, rather than requiring them to come into a location to access mental health services, will result in lower treatment dropout rates for the homeless population. Employing a mobile mental health team to interact with the homeless in Los Angeles County in situ, rather than requiring them to come into a location to access mental health services, will result in a decrease in the homeless rate among the mentally ill people identified in the study.

Methodology

Subjects

This study will focus on the homeless population in Los Angeles County. The subjects in the study are homeless people, living in shelters and on the streets, during the time of the study. The study will identify 100 mentally ill homeless people living on the streets or in the shelter, and not in the process of transitioning to permanent housing at the time that the study begins. The subjects will be identified by members of the mental health team by administering the DSM-IV to members of the homeless population.

Instruments

The first instrument is the DSM-IV, which is the diagnostic tool for identifying the subjects. Then, patient treatment charts will be used to determine whether patients have remained in treatment or dropped out of treatment. Finally, those same charts will be able to provide information about whether the patients have transitioned into permanent housing.

Data Collection or Procedures

It is important to keep in mind that the subjects will be accessing mental health care through the mobile mental health team. What this mental health care involves will depend upon the professional judgment of the members of the mental health professionals. Moreover, because of concerns about confidentiality of mental health care, the details about the health care services may be kept confidential. However, the team will be asked to keep records about how frequently the subjects access mental health services, whether they dropout of services, and whether they transition into permanent housing during the treatment period.

Methods of Data Analysis

The data analyzed in this study will be quantitative. It will not focus on the format of treatment provided. Instead, it will focus on whether the subjects are accessing mental health care services, whether they drop out of services (and at what point in treatment people drop out), and whether they transition to permanent living situations. Those numbers will them be compared to a control group of homeless people who are accessing mental health services through a traditional county mental health service provider. The numbers will be compared using a p-value of .05 in order to determine whether providing mental health services to the homeless mentally ill in situ results in a significant difference in treatment access, treatment dropout rates, and transition to homelessness. Because the data will consist of relatively simple numbers, a simple program like Microsoft Excel can be used to track, analyze, and display the data.

Intended Results

The intended result of the study is to demonstrate that providing mental health care services to homeless people in situ results in greater participation in….....

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