There have always been homeless people in the United States, but their plight has only recently stirred widespread public reaction and concern. Part of this new recognition stems from the problem's prevalence: the number of homeless individuals, while hard to pin down exactly, is rising. In light of this, Congress asked the Institute of Medicine to find out whether existing health care programs were ignoring the homeless or delivering care to them inefficiently. This book is the report prepared by a committee of experts who examined these problems through visits to city slums and impoverished rural areas, and through an analysis of papers written by leading scholars in the field.

Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed. Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.

This volume highlights the socioeconomic concerns related to medical care for homeless patients and places them at the interface of common psychiatric and medical problems clinicians encounter. Written by experts in psychiatry and other medical specialties, this volume is a concise, yet comprehensive overview of the homeless crisis, its costs, and ultimately, best practices for improved outcomes. The text begins by examining the scope and epidemiology of the problem and discusses its costs. It then examines the best practices for both physical and psychiatric care before concluding with a section on working with special populations that have unique concerns across the country including LGBTQ, women, children, veterans, and aging adults. As the first medical book on homelessness, it is designed to cover a broad range of concerns in a concise, practical fashion for all clinicians working with homeless patients. Clinical Management of the Homeless Patient is written by and for psychiatrists, general internists, geriatricians, pediatricians, addiction medicine physicians, VA physicians, and all others who may encounter this crisis in their work.

Dr. O'Connell's collection of stories and essays, written during thirty years of caring for homeless persons in Boston, gently illuminates the humanity and raw courage of those who struggle to survive and find meaning and hope while living on the streets.

"Brings together leading and emerging researchers to advance understanding of the complex relationships between homelessness and health. Covering a wide range of topics from youth homelessness to end-of-life care, contributors outline policy and practice recommendations to respond to this public health crisis."--Back cover.

A case-based, clinical guide applicable to a variety of settings, this book offers evidence-based expert advice on the difficult challenges inherent in working with underserved homeless populations. The American Association of Community Psychiatrists' Clinical Guide to the Treatment of the Mentally Ill Homeless Person is a concise, practical work that gives busy clinicians the information they need; it not only is more up-to-date than existing publications, but also offers case- and site-based content that provides more hands-on, practical advice. Written by clinicians, for clinicians, it offers approaches to therapy and rehabilitation from the vantage point of the treatment environment, from street to housing and everything in between. The book reflects approaches to the clinical care of homeless people refined over two decades, building not only on the work of academic research but more importantly on the firsthand experience of clinicians. Its organization by treatment setting or specific subpopulation allows readers quick access to the chapters most relevant to their work. The first five chapters follow a sequence of naturalistic settings -- such as shelters and the work of Assertive Community Treatment Teams -- that demonstrate a model of engagement, intensive care, and ongoing rehabilitation. Subsequent chapters define specific scenarios that depict patients at various points on the engagement-rehabilitation continuum. Each chapter contains a clinical case example; guides to differential diagnosis, treatment planning, and accessing entitlements; and a flow chart for rehabilitation, including opportunities for student/resident or community involvement. The book emphasizes: A real-world orientation that provides a nuts-and-bolts approach to such cases as families, homeless children, veterans -- even individuals in rural settings. Cases that enable readers to follow the progress of individuals as they progress through the network of care. The importance of Assertive Community Treatment and "housing first" models of rehabilitation. Data supporting the importance of Critical Time Intervention, particularly with regard to homeless families. Examples of clinical interviewing techniques for engagement and treatment of challenging individuals who are being seen in community settings. These illustrated techniques can be incorporated into educational curricula. This is an indispensable resource for any mental health professional working with homeless populations and is also useful for medical students' clinical rotation in community psychiatric settings. Its examples of clinically engaging the homeless person are equally instructive for teaching interviewing skills to any professionals -- whether in law enforcement, social work, substance abuse treatment, or the clergy -- who encounter these forgotten members of society.

A comprehensive manual for understanding and responding to health care issues associated with homelessness, based in the experience of primary care providers throughout the United States.