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Explore the complex issue of veteran homelessness and its connection to mental health. Discover novel responses focused on addiction, housing, mental health, and primary care. Examine research examples to understand both strengths and shortcomings of these responses.
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Veteran Homelessness: the Mental Health Challenge Within Thomas O’Toole, MD1 Amy Kilbourne, PhD, MPH2 Andrew Saxon, MD, MSc3 Stefan G. Kertesz, MD, MSc4 1. Center on Systems, Outcomes & Quality in Chronic Disease & Rehabilitation (Providence, RI) 2. Center for Clinical Management Research (Ann Arbor, MI) 3. Center of Excellence in Substance Abuse Treatment and Education (Settle, WA) 4. Center for Surgical, Medical Acute Care Research and Transitions (Birmingham, AL)
Objectives • Show how multiple paths in and out of homelessness necessitate variability in policy and clinical responses • Use research examples to highlight both strengths and shortcomings of novel responses focused on: • Addiction • Housing • Mental Health • Primary Care
Overview • Kilbourne: public health models for preventable mortality in homelessness • Kertesz: framework for multimodal response paradigms • O’Toole: evolving care needs following treatment engagement • Saxon: housing and addiction outcomes after treatment
Context/Questions/Considerations • How does our research “fit” into the Secretary’s 5 Year Initiative to End Veteran Homelessness? • What research questions are relevant to ongoing policy and service delivery questions • How do we organize our approaches within the continuum of need, processes of care, environment of services, and heterogeneity of the population? • What are the limits, qualifications, and adaptations needed when applying evidence-based approaches to this population?
How do we get there? Housed Economic Security Food security Positive social networks Substance abuse treatment/recovery Mental health hygiene Chronic disease management Self-care Better care access Homeless Economic dislocation Competing needs Poor coping skills Social Isolation/Poor social networks Addiction Mental illness Physical Disabilities Pain • Identification - Prevention • Engagement • Resource alignment • Treatment • Longitudinal support • Structural / Population accommodations
Homeless Veterans Health Disparities Framework Adapted from CHERP Health Disparities Conceptual Framework (Kilbourne et al. 2006)
Environmental Context: Markets for jobs and housing Criminal justice and veteran policy Entitlement and mental health policies One view of homeless causation Note: with low assets, the liabilities don’t need to be that severe to slip into homelessness
Components to Promote an Exit from Homelessness (all shown with equal weight)
Health and Homelessness Health Care sites as “First Stops” for newly homeless The health encounter as a “treatable moment” for behavior change and treatment engagement Housing Security for Homeless Persons Health maintenance and support as a means of keeping people in housing
Next Steps Need for interventions that simultaneously address housing, substance use and mental health issues • Assertive community treatment / intensive case management • improves housing status, substance use and mental health outcomes. • Life Skills Training • improves the likelihood of maintaining housing
