Homelessness: A National Perspective PDF
Preview Homelessness: A National Perspective
HOMELESSNESS A National Perspective TOPICS IN SOCIAL PSYCHIATRY Series Editor: Ellen L. Bassuk, M.D. The Better Homes Foundation Newton Centre, Massachusetts and Harvard Medical School Boston, Massachusetts ANATOMY OF PSYCHIATRIC ADMINISTRATION The Organization in Health and Disease Milton Greenblatt, M.D., in collaboration with Paul Rodenhauser, M.D. HOMELESSNESS A National Perspective Edited by Marjorie J. Robertson, Ph.D., and Milton Greenblatt, M.D. RESPONDING TO THE HOMELESS Policy and Practice Russell K. Schutt, Ph.D., and Gerald R. Garrett, Ph.D. A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. HOMELESSNESS A National Perspective Edited by Marjorie J. Robertson, Ph.D. Alcohol Research Group Institute of Epidemiology and Behavioral Medicine Berkeley, California and Milton Greenblatt, M.D. Olive View Medical Center Sylmar, California and University of California, Los Angeles Los Angeles, California Springer Science+Business Media, LLC Library of Congress Cataloging-in-Publication Data Homelessness : a national perspective / edited by Marjorie J. Robertson and Milton Greenblatt. p. cm. — (Topics in social psychiatry) Includes bibliographical references and Index. 1. Homelessness—United States. 2. Homeless persons--Health and hygiene—United States. I. Robertson, Majorie J. II. Greenblatt, Milton. III. Series. [DNLM: 1. Homeless Persons—psychology. HV4505 H7654] HV4505.H6553 1992 362.5'0973--dc20 DNLM/DLC for Library of Congress 91-45424 CIP ISBN 978-1-4899-0681-6 ISBN 978-1-4899-0679-3 (eBook) DOI 10.1007/978-1-4899-0679-3 © Springer Science+Business Media New York 1992 Originally published by Plenum Press, New York in 1992 Softcover reprint of the hardcover 1st edition 1992 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors THERESE ANDRYSIAK, St. John's Hospital, Santa Monica, California 90404 HIDA AVENT, Stepping Stone, 1833 18th Street, Santa Monica, California 90404 ELLEN L. BASSUK, Department of Psychiatry, Harvard Medical School, Boston, Mas- sachusetts 02115, and the Better Homes Foundation, 181 Wells Avenue, New ton, Massachusetts 02159 GARY BLASI, Legal Aid Foundation of Los Angeles, 1550 West 8th Street, Los An geles, California 90017 WILLIAM R. BREAKEY, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205 PHILIP W. BRICKNER, Department of Community Medicine, St. Vincent's Hospital and Medical Center, New York, New York 10011 M. AUDREY BURNAM, Social Policy Department, the RAND Corporation, Santa Monica, California 90407-2138 ROBERT J. CALSYN, Departments of Psychology and Gerontology, University of Mis souri-St. Louis, St. Louis, Missouri 63121 MARTIN D. COHEN, the Robert Wood Johnson Foundation Program on Mental Ill ness, Boston, Massachusetts 02115, and Massachusetts Mental Health Center, Boston, Massachusetts 02115 PATRICIA DOHERTY, Department of Community Medicine, St. Vincent's Hospital and Medical Center, New York, New York 10011 RICHARD J. FIRST, College of Social Work, Ohio State University, Columbus, Ohio 43210 PAMELA J. FISCHER, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205 TONI FLYNN, Salvation Army, San Luis Obispo, California 93401 v vi Contributors GERALD R. GARRETI', Department of Sociology, University of Massachusetts at Boston, Boston, Massachusetts 02125 MILTON GREENBLATI', Department of Psychiatry and Biobehavioral Sciences, and San Fernando Valley Program in Psychiatry, University of California, Los Angeles, Los Angeles, California 90024, and Department of Psychiatry, Olive View Medi cal Center, Sylmar, California 91342-1495 JOEL F. HANDLER, School of Law, University of California, Los Angeles, Los Angeles, California 90024 RENE I. JAHIEL, Graduate School of Management and Policy, New School of Social Research, New York, New York 10011 PAUL KOEGEL, Social Policy Department, the RAND Corporation, Santa Monica, California 90407-2138 SUSAN LADNER, National Academy Foundation, 660 Madison Avenue, New York, New York 10021 JACQUELINE LEAVITT, Graduate School of Architecture and Urban Planning, Univer sity of California, Los Angeles, Los Angeles, California 90024 JOHN McADAM, Department of Community Medicine, St. Vincent's Hospital and Medical Center, New York, New York 10011 KAy YOUNG MCCHESNEY, Department of Sociology, University of Missouri-St. Louis, St. Louis, Missouri 63121 ESTHER S. MERVES, Department of Sociology, Kenyon College, Gambier, Ohio 43022 GARY A. MORSE, Department of Psychology, University of Missouri-St. Louis, St. Louis, Missouri 63121 SARA PETRY, Olympic Mental Health, 4526 Federal Avenue, Everett, Washington 98203 JAMES PREIS, Mental Health Advocacy Services, Inc., 650 South Spring Street, Los Angeles, California 90014 JULIA M. ROBERTSON, Seven Counties Services, Inc., 137 West Muhammad Ali Boule vard, Louisville, Kentucky 40202, and Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202 MARJORIE J. ROBERTSON, Medical Research Institute of San Francisco, Institute of Epidemiology and Behavioral Medicine, Alcohol Research Group, 2000 Hearst Avenue, Berkeley, California 94709 DEE ROTH, Office of Program Evaluation and Research, Ohio Department of Mental Health, Columbus, Ohio 43266-0414 RUSSELL K. SCHUTI', Department of Sociology, University of Massachusetts at Boston, Boston, Massachusetts 02125, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115 Contributors vii MILES F. SHORE, Department of Psychiatry, Harvard Medical School, Boston, Mas sachusetts 02115, and Massachusetts Mental Health Center, Boston, Mas sachusetts 02115 NAOMI SIEGEL, Private Practice, Santa Monica, California 90025 ANDREA L. SoLARZ, American Psychological Association, 1200 Seventeenth Street, N.W., Washington, DC 20036 AMy SOMERS, AIDS Foundation San Diego, 4080 Centre Street, San Diego, California 92103 ' DERRELL TIDWELL, Outreach Team to the Homeless Mentally Ill, st. John's Hospital, Santa Monica, California 90404 BEVERLY G. TOOMEY, College of Social Work, Ohio State University, Columbus, Ohio 43210 J. THOMAS UNGERLEIDER, Neuropsychiatric Institute, University of California, Los Angeles, Los Angeles, California 90024 WILLIAM J. VICIC, Department of Community Medicine, St. Vincent's Hospital and Medical Center, New York, New York 10011 MARY BETH WELCH, Urban Studies Program and Women's Studies Program, Califor nia State University, Northridge, Northridge, California 91331 JUDITH WILHITE, InfoUse, 2560 Ninth Street, Berkeley, California 94710 Series Editor's Preface During the 1980s, we witnessed remarkable advances in medical knowledge along with skyrocketing health care costs. The explosion in information coupled with pressing economic considerations have resulted in dramatic changes in the health care industry. These have included privatization, increasing specialization, and the growth of consumerism. As an outgrowth of these changes, physicians are now regulated and controlled through new practices and policies such as managed care and legal statutes (accompanied by the threat of litigation). Although some of these changes have improved the quality of care and access to services, these trends have spawned a growing medical technocracy. By adapting to financial imperatives, concentrating on the creation of new administrative systems, and focusing on ever-smaller fragments of human physiology, providers have shift ed their views of the origin and treatment of illness. For example, psychiatrists have become more biologically entrenched, at times needlessly sacrificing context and circumstance. Despite the critical importance of a biological approach to patient care, we cannot condone the diminishing emphasis on the patient as a whole. Such an approach includes patients' families; the quality of their lives and experiences; and the personal, social, and political structures that may have contributed to their illnesses. We are introducing a new book series, Topics in Social Psychiatry, in an effort to reintroduce the importance of context to the welfare of our patients. Just as we are reawakening to the fragility of our environment and its immediate and long-term effect on our lives, this series attempts to refocus on the psychosocial, spiritual, and political contexts that affect our patients. Without understanding our connectedness to other people, groups, and cultures and the natural world, we cannot understand the fundamental needs of patients and appropriate methods of care. It is fitting that Homelessness: A National Perspective heralds the series. Disen franchised, disadvantaged groups have been particularly hard hit by the tech nological morass afflicting our medical system; the desperate plight of homeless persons suffering from chronic mental illness is a case in point. Moreover, the issue of homelessness highlights the importance of understanding the effects of structural and systemic forces on individuals and families. This tragic social problem illustrates the complex interplay of macrolevel factors on individuals, especially those who suffer from disabilities. Marjorie Robertson and Milton Greenblatt have edited a comprehenSive volume ix x Series Editor's Preface that discusses the heterogeneous nature of the homeless population, their diverse needs, and strategies for change. An encyclopedic reference about homelessness, this book strongly conveys the problem's complexity and the importance of context. The editors have covered the causes of homelessness; mental health, health, and substance abuse issues; needs of special populations such as veterans, the elderly, women, and children; and policy-related issues. Health care providers, researchers, and policymakers alike will benefit from reading this book. Homelessness: A National Perspective's grounding in thorough research and compassionate insight ensures its status as a standard text in the field. ELLEN L. BASSUK, M.D.
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