Social and Behavioral Sciences Commons^™

To Survive And To Thrive: Integrating Services For The Homeless Mentally Ill, Marie D. Hoff, Katherine H. Briar, Kristin Knighton, Angie Van Ry

The Journal of Sociology & Social Welfare

An intervention research project with homeless, chronically mentally ill persons demonstrated that linking rehabilitation services, such as employment skills and psycho-social stabilization, with survival services promotes success in serving this population. The project confirmed the central role of case managers in promoting engagement with mental health services and re-integration into stable community living.

Rediscovering The Asylum, Sharon M. Keigher

The Journal of Sociology & Social Welfare

Spending a night at a typical big city shelter for the homeless has reminded the author of the massive and regimented environment in institutions that she had mistakenly believed no longer existed after the much acclaimed "deinstitutionalization" of America. St. Mary's is run by a religious order attempting to provide charitable care in a nondemanding environment. Many demands are made, however. The lack of privacy and respect for individuality inherent in institutional life tends to erode the "inmate's" very conception of self. It controls their activities, time, and choices, and thus creates barriers to exit. Providing "shelter" for the homeless …

Assessing The Impact Of Serving The Long-Term Mentally Disabled Homeless, Laura E. Blankertz, Ram A. Cnaan, Marlene Saunders

The Journal of Sociology & Social Welfare

Homelessness has emerged as a major social problem. In an attempt to understand this problem, attention has been focused on postulating its causes, describing the individuals who hold this status, and estimating its magnitude. This study assesses the outcome of one social service program for long-term mentally disabled homeless individuals. It includes a synopsis of the state of the art in serving homeless individuals with severe mental health problems; a description of a program created to meet their needs; and an analysis of the outcome of this program.

Homeless Persons' Interest In Basic And Health Services: The Role Of Absolute, Relative, And Repressed Needs, Russell K. Schutt

The Journal of Sociology & Social Welfare

This study describes and explains the interest of homeless persons in housing, economic, and health-related services with intake interview data collected by a large urban shelter for single adults. Shelter guests were most interested in assistance with housing, job, and economic benefits, rather than health services. Three explanations of variation in service interests are identified: the "absolute needs" explanation expects service interests to vary directly with service needs, the "repressed needs" explanation expects service interests to vary inversely with alcoholism and mental illness, while the "relative needs" explanation expects interest in health-related services to be related to health needs, but …

The Supreme Court As Risk Manager: An Analysis Of Skinner, Todd F. Volyn, James F. Mogan, Lisa M. White

RISK: Health, Safety & Environment (1990-2002)

Examining a recent case in which the U.S. Supreme Court approved the collection of blood and urine samples from railroad employees, the authors conclude that, in attempting to improve railroad safety, both majority and minority opinions reflected undue emphasis on technical issues and inadequate attention to the intangible social values underlying traditional Constitutional rights to privacy.

Individual Response To Risk As A Function Of Normative Social Pressure: A Pilot Study Of Seat Belt Use, Kenneth D. Boehm, John T. Keating, Karl W. Pfefferkorn, Audra J. Pfeltz, Brady G. Serafin, Jessica L. Sullivan, Karen L. Thode, Kevin M. Vincent, Juanita V. Field

RISK: Health, Safety & Environment (1990-2002)

The authors attempt to clarify some of the variables that influence whether people act appropriately when a Risk is substantial and subject to individual control. They do so by reporting results of a pilot study of seat belt use. Also, the authors believe their approach to be generalizable to problems such as encouraging people to test for radon, to use condoms to prevent AIDS or to quit smoking.

The Withering Of Community Life And The Growth Of Emotional Disorders, Thomas F. Maher

The Journal of Sociology & Social Welfare

The architecture of this essay is as follows: I begin by assaying the communitarian crisis of the modern western world. Second, I offer a brief narrative of the social and cultural variables that foster rootlessness and social disintegration in much of urban industrial life. Third, I state a strong case for how this same process may be systematically undermining the nuclear family as a life-long community, threatening the dependence of children on care-giving adults, and, thereafter, the psychological development of children.

Housing, Community Support, And Homelessness: Emerging Policy In Mental Health Systems, Paul J. Carling

New England Journal of Public Policy

This article summarizes the dramatic changes in public policy through which public mental health systems are attempting to meet the housing and community support needs of persons with severe and persistent mental illnesses, including those who are homeless. It traces the historical approach to meeting these needs through defining people principally as patients and providing some combination of psychotropic medications, outpatient therapy, and structured, supervised quasi-institutional settings such as group homes, shelters, and segregated single-room-occupancy, or board-and-care facilities. A transition phase in public policy has emphasized defining these individuals essentially as service recipients who need greater or lesser amounts of …

The Kindred Bonds Of Mentally Ill Homeless Persons, Richard C. Tessler, Gail M. Gamache, Peter H. Rossi, Anthony F. Lehman, Howard H. Goldman

New England Journal of Public Policy

While the unraveling of the kinship bond has long been suspected to play a role in the epidemiology of homelessness, the connection between kinship and homelessness has been little studied. Based on a normative analysis of the role of family structure in response to adversity, this article explores the impact of the amount and quality of kinship ties on episodes of homelessness experienced by discharged psychiatric patients in Ohio. Survey data derived from personal interviews with both former patients and their kin indicate more strain in relations with kin of the homeless than the nonhomeless. The strain in the kinship …

Program Design And Clinical Operation Of Two National Va Initiatives For Homeless Mentally Ill Veterans, Robert Rosenheck, Catherine A. Leda, Peggy Gallup

New England Journal of Public Policy

In 1987, in response to reports of large numbers of veterans among America's homeless, the Department of Veterans Affairs established two new national health care initiatives, which have seen over 40,000 homeless veterans since their inception. We present here evaluation and treatment data on a sample of 14,000 of them. Because of differences in their design, the two programs vary in the degree to which they emphasize community outreach, homelessness prevention, and the provision of aftercare services to patients discharged from other VA programs. In spite of these differences, veterans treated in the two programs have similar health care problems …

Homelessness, Alcohol, And Other Drug Abuse: Research Traditions And Policy Responses, Gerald R. Garrett

New England Journal of Public Policy

Although homeless alcoholics and other drug abusers more often elicit public scorn than sympathy, ironically they enjoy a celebrity status as research subjects. This article provides an overview of research literature on the homeless and their alcohol and drug problems. The evolution of public policies concerning control, rehabilitation, and treatment of homeless substance abusers is also traced with special attention to the interaction between scientific literature and policy responses over the past century. Although homeless populations today are more diverse than their counterparts in earlier decades, the analysis suggests that the policies and programs developed in response to the crisis …

Homeless Children Having Children, Yvonne M. Vissing

New England Journal of Public Policy

Homeless teenagers who have babies pose a significant population of concern for those in health and human services. This article explores demographic, structural, and economic changes for homeless young and single-parent families. It proposes that their homelessness is due to these barriers and the problems that result. Case studies illustrate the process of troubled teens becoming homeless women with babies. Policy recommendations for assisting these youngsters are offered.

Aids And The Homeless Of Boston, James J. O'Connell, Joan Lebow

New England Journal of Public Policy

Homeless persons with AIDS and HIV infection face significant health hazards during the daily struggle for survival on the streets and in the crowded shelters of our cities. This article offers a historical perspective on the evolution of the AIDS epidemic within the homeless population of Boston and examines the demographics, risk behaviors, and survival statistics of that epidemic. The Boston Health Care for the Homeless Program is presented as a model of service delivery that offers quality health care to homeless persons with AIDS while addressing the special needs of those bound by the immediacy of the next meal …

Ending Homelessness Among Mentally Disabled People, Steven A. Hitov

New England Journal of Public Policy

This article examines some of the many shortcomings of the mental health system operated by the Massachusetts Department of Mental Health (DMH) and explores the impact of that system on single homeless individuals who suffer from some form of serious or long-term mental disability. To afford that discussion context, however, the article first briefly examines those forces which have, and have not, significantly contributed to the large number of mentally disabled homeless persons. It suggests certain changes, including a shift in departmental focus from hospitals to community services and the creation of a housing subsidy system exclusively for DMH clients, …

The Manufacture Of Dependency: Shelterization Revisited, Kostas Gounis

New England Journal of Public Policy

Emergency shelters have been the most comprehensive and enduring response to homelessness in the United States, with New York City leading the way since the early 1980s. Shelters have emerged as a hybrid between a degraded type of "public housing" and a new form of "institutionalization." The persistence of shelter dependency, or "shelterization," is an intractable problem that frustrates policymakers and service providers. Popular among certain circles of professional pathologists is the view that shelterization is a form of "adaptation" to the violent, anomic, and generally antisocial environment of the shelter. This explanation of shelter dependency is theoretically flawed and …

The New England Shelter For Homeless Veterans: A Unique Approach, Ken Smith, James M. Yates

New England Journal of Public Policy

It has been estimated that veterans comprise one third of the homeless population. To combat this national disgrace, many small veterans' groups have been formed nationwide to serve their homeless "brothers" in such settings as shelters, group homes, and outreach centers.

A Boston group, the Vietnam Veterans Workshop, based its New England Shelter for Homeless Veterans on the simple but powerful concept of veteran helping veteran. The shelter created a program to accomplish three important functions: providing the basic necessities of a bed, a meal, clothing, and a hot shower; rehabilitating the veterans by offering various activities to comfort and …

Aggressive Outreach To Homeless Mentally Ill People, Ellen Nasper, Melissa Curry, Elizabeth Omara-Otunnu

New England Journal of Public Policy

Historically, people with chronic mental illnesses have been particularly at risk for homelessness. In 1984, the Connecticut Department of Mental Health (DMH) articulated policy to insure housing for mentally ill persons. One facet of that policy is to increase mental health services to homeless people. The Greater Bridgeport Community Mental Health Center has addressed this need through the formation of the Homeless Outreach Team (HOT). This article describes the development, organization, clinical work, and future of HOT. The team is run jointly by the Mental Health Center (funded through DMH) and Family Service-Woodfield, a United Way-funded agency that provides case …

The Pendulum Swings: How Changes In Federal And State Policy Have Affected The Status Of Homeless People With Mental Illness In Ohio, Kim Bryant

New England Journal of Public Policy

Public policy in the problem areas of homelessness and mental illness has been reactive, rather than proactive, for the past thirty to forty years. As a result of this approach, federal and state policies have swung, like a pendulum, from one extreme to the other, taking the homeless mentally ill population on a most difficult ride. Public policies concerning these issues must become proactive, even if it means a complete overhauling of federal and state social service systems. Only with proactive policies will mentally ill individuals, and all people, have the housing, food, and health care they need, and the …

Victimization And Homelessness: Cause And Effect, Pamela J. Fischer

New England Journal of Public Policy

The literature on the contemporary homeless population is reviewed to examine the association of victimization with homelessness. Although few studies have specifically focused on victimization, findings derived from studies investigating pathways to homelessness, prevalence of health, mental health, and substance-use disorders, and demographic profiles and life histories suggest that victimization both causes homelessness and is an outcome of losing housing. Causal sequences ending in homelessness most frequently involve domestic violence, which mainly affects women, although other types of abuse may extrude individuals from their established housing. Once they become homeless, the risk of violence escalates for people living on the …

Classification And Its Risks: How Psychiatric Status Contributes To Homelessness Policy, Anne M. Lovell

New England Journal of Public Policy

This article examines the extent to which psychiatric classification in public policy research contributes to the equation of homelessness and mental illness. Surveys that measure psychiatric status of homeless persons are reviewed to understand whether they contribute to biased rates of mental illness among homeless persons. The relationship between psychiatric classification and the concept of need is examined and alternatives to current classification are proposed. Classification is discussed particularly in relation to policies of segmentation for "single" homeless adults.

Mentally Ill Persons In Emergency And Specialized Shelters: Satisfaction And Distress, Russell K. Schutt, Stephen M. Goldfinger

New England Journal of Public Policy

Emergency and specialized mental health shelters represent different service philosophies and are meant to appeal to different segments of the homeless and homeless mentally ill population. This article describes the different characteristics and needs of users of emergency and specialized mental health shelters for homeless persons in Boston. Service satisfaction is described in relation to these characteristics and needs as well as in terms of shelter type. Implications are identified for social and mental health service policies for the homeless.

The Needs Of Hartford's Homeless Mentally Ill, Steven Kessler

New England Journal of Public Policy

A state budget deficit in Connecticut threatens the closing of state mental hospitals and holds the potential of displacing chronically mentally ill patients into homelessness. This article explores the historical association between deinstitutionalization of patients from mental hospitals and subsequent homelessness. One third to two thirds of homeless individuals are mentally ill and require intensive, specific, and targeted responses by the community to end their homelessness. Trends in the care of the chronically mentally ill and the conditions of those who are homeless in Connecticut are explored. Model treatment programs are discussed to suggest possible actions, and recommendations that would …

America's Health Care System: The Reagan Legacy, Terri Combs-Orme, Bernard Guyer

The Journal of Sociology & Social Welfare

Because of the dominance of the private sector in health care in the United States, health conditions are not as susceptible to changes in public policy as they are in other Western countries. however, the elderly and young children are directly affected by the federal government's health care policies and while both groups were the focus of major changes introduced by the Reagan administration, these changes were opposed buy Congress. Nevertheless, changes in health care funding and administrative arrangements have had a negative impact on the needy and, in addition, they have been exacerbated by the Reagan administration's wider social …

Nothing Recedes Like Success - Risk Analysis And The Organizational Amplification Of Risks, William R. Freudenburg

RISK: Health, Safety & Environment (1990-2002)

Professor Freudenburg believes that there is room for improvement in Risk analysis, particularly in drawing on systematic studies of human behavior in the calculation of real, empirical probabilities of failure. The need is argued to be especially acute where technological Risks are associated with low expected probabilities of failure and are managed by human organizations for extended periods of time. This permits complacency to set in.

A Public Health View Of Environmental Regulation, John Graham

Maine Policy Review

The laws and regulations that govern the use of environmental resources have complicated effects on our society and our economy. Efforts to regulate environmental impacts are frequently controversial precisely because they have such complicated effects. No single perspective can adequately encompass all of the issues that arise in environmental regulation and environmental protection. Even the terms themselves suggest the fundamentally opposed philosophies that approach the assessment of environmental laws: While proponents of greater environmental activism emphasize the need to "protect" the environment, critics of more stringent controls emphasize that these laws "regulate" and limit the actions of individuals. At the …