Homelessness among individuals with psychotic disorders hospitalized for the first time: findings from the Suffolk County Mental Health Project.

Abstract

Although data suggest that homelessness among persons with severe mental disorders is both distressing and common, several important epidemiologic questions remain unanswered. This study reports on the occurrence of homelessness in a quasi-representative sample of persons newly hospitalized with psychotic disorders. The authors also compared rates of homelessness in different diagnostic groups and among groups with differing symptom profiles. The study was based on data from 237 first-admission patients hospitalized at 10 of the 12 inpatient facilities in eastern Long Island, N.Y. Consensus diagnoses were derived from multiple sources of information, including the Structured Clinical Interview for DSM-III-R. Patients were followed over a 24-month period after initial interview. Homelessness histories were based on subject self-reports. Fifteen percent of the patients had experienced at least one episode of homelessness before or within 24 months of their first psychiatric hospitalization. In more than two-thirds of these cases, the initial homeless episode had occurred before the first hospitalization. There were no significant differences in the risk of homelessness among diagnostic groups. Among subjects diagnosed with schizophrenia and related disorders, those with high levels of negative symptoms had a significantly greater risk of prehospitalization homelessness than those with low symptom levels. The high rate of homelessness observed must be viewed with profound concern by clinicians, consumers, and policymakers alike. The findings support the importance of intervening early in the course of disorder, particularly for persons diagnosed with psychotic illnesses.