![]() Difficulties in establishing and maintaining relationships can militate against the development of cooperation with health care providers and may be an important factor in explaining what is often inaccurately described as a "lack of motivation."ĭistrust-In addition to their distrust of authority, many homeless people are disenchanted with health and mental health care providers. Such isolation often causes (and sometimes is caused by) a limited capacity to establish supportive relationships with other people. Any health care program for homeless adults should expect that 25 to 40 percent of patients will suffer from serious alcohol or drug abuse problems (Fischer and Breakey, 1986).ĭisaffiliation-Although many homeless people establish individual support networks outside a family structure, some homeless people typically lack those networks that enable most people to sustain themselves in society. Multiplicity of Needs-In addition to physical and mental health problems and difficulties with such things as housing and income maintenance, homeless people often also suffer from drug or alcohol abuse. Some former patients complain that neuroleptic medications, prescribed for a schizophrenic illness, may make them too drowsy and interfere with their alertness against the dangers on the streets. For an alcoholic trying to stay sober, a homeless existence may present too many opportunities for drinking. For many, it may be difficult to keep a supply of medication while living on the street. William Breakey (in press) has identified characteristics of homeless people that affect the provision of treatment and the planning of health care services:ĭaily Activities-Some homeless people live under circumstances that pose particular problems for developing a treatment plan. However, one must also look at the people who are homeless. At no time did the committee encounter anything that could be appropriately called a ''system" of services.īefore describing how these various programs bring general health care and mental health care to the homeless, we must address two major issues: (1) what makes serving the homeless, in contrast to the indigent in general, more difficult? and (2) based upon the literature and the site visits, what elements enhance a program's ability to provide such services to this population? In Chapter 3, we discussed those aspects of treatment that are especially difficult to implement when the patient is homeless. However, what the committee observed were discrete services and programs. In studying health care and related services for homeless people, the committee sought to examine a broad range of services developed over a period of time, rather than to focus only on specialized services or services that have been developed recently. Although the sites are not representative of the entire universe of programs for the homeless, they were selected to include the broadest range of programs possible and to be geographically dispersed throughout the country. The information presented in this chapter is largely based on the 11 site visits made by members of the study committee and its staff. The purpose of this chapter is to describe programs that seek to bring general health and mental health care services to homeless people. They generally brought services to homeless people rather than waiting for them to come in increasingly, they rely on public funding because the problem has grown beyond a level that the private sector can support. They arose in response to a crisis rather than developing as part of a well thought out plan. Similarly, attempts to provide health and mental health care services, regardless of variations in such areas as history, funding levels, and nature of support, also have certain common elements. Regardless of differences among homeless people or regional variations in services, however, homeless people are more susceptible to certain diseases, have greater difficulty getting health care, and are harder to treat than other people, all because they lack a home. In observing and describing these health care and health care-related services, one must be mindful of the heterogeneous nature of the homeless population, as well as the structure of the communities in which such services have developed. Recognition of the special health care needs of homeless people has encouraged the development of special services for them. For homeless people there are additional barriers. Indigent people (with or without a home) experience many obstacles in obtaining health care. To the extent that homeless people have been able to obtain needed health care services, they have relied on emergency rooms, clinics, hospitals, and other facilities that serve the poor.
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