Background: Approximately 21% of unhoused individuals listed mental health care as an unmet need. As a result, this population heavily relies on the emergency department (ED) or psychiatric hospitalization for mental health services. Street Psychiatry programs work to holistically diagnose and treat mental illness on the street by addressing the tri-morbidity complex of homelessness (mental health, substance use, and physical disability) while improving access to care. Community interventions like these have historically been successful, as seen in a 2005 study revealing greater use of mobile outpatient services than traditional services for psychiatric and substance use support. The purpose of this study is to understand the mental health needs of our local unhoused population, determine their utilization of available resources, and identify key areas for meaningful intervention.
Methods: All adult homeless or housing insecure patients were recruited in partnership with The Night Ministry at an outreach site at the Forest Park Chicago Transit Authority (CTA) Blue line station or Howard CTA Red line station. Participants were eligible if they were older than eighteen years and deemed to have capacity, as assessed by screening questions. Once identified, participants completed a survey consisting of demographics, homeless history, substance use, psychiatric diagnoses, barriers to care, and community interventions. At the core of the survey were three standardized questionnaires: the PHQ-9, GAD-7, and a Trauma Screening Questionnaire (TSQ). All participants provided informed consent prior to completing the survey.
Results: A total of 37 patients completed the survey over a time period of two months. Additional survey collection and final data analysis are still in progress. Our preliminary findings show that the majority of participants (70.3%) were both chronically homeless (>1 year) and reported having a mental health diagnosis. Additionally, analysis revealed that those who had been homeless over one year had a higher likelihood of screening positive for depression on the PHQ-9 (p=0.029). Participants presented with higher than national average rates of mental illness including depression (40.5%), bipolar disorder (37.8%), and psychotic disorders (21.6%). Approximately 62.2% of participants screened positive for anxiety, while only 16.2% had a prior diagnosis. 51.3% of participants stated that mental health negatively impacts their life on a daily basis. Up to 40.5% of respondents were interested in treatment for substance use. 62.2% of respondents reported no use of mental health services within the previous year, while approximately half said they desire mental health services. Finally, the number one reported barrier in access to care was distance or transportation (43.2%).
Conclusion: Our preliminary findings reveal high rates of mental illness and significant barriers to care within the unhoused population. In addition, the low rate of utilization but increased desire for services points towards a lack of accessible care for this population. The findings emphasize the importance of community interventions, like Street Psychiatry programs that integrate psychiatry, case management, and substance use services, to effectively address medical and social factors impacting an individual’s mental health. Additionally, homelessness itself is highlighted as a significant contributor to poor mental health.
Learning Objectives:
Identify the ongoing mental health concerns for the unhoused and housing insecure community
Assess utilization of resources amongst people experiencing homelessness
Determine the interest in engaging with mental health resources and barriers in access to care
