Table Of ContentHOMELESSNESS
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.
