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Hundreds of thousands of Americans spend the night in shelters or on the streets, and a high proportion of them have serious mental illnesses. How this situation has come about and how to change it are questions that concern the general public as well as mental health professionals. There are signs that the beginning of a solution may be emerging.

About 600,000 people are homeless on any given night, and 2 million at some time in any given year. Over a five-year period, 2%-3% of the population, as many as 8 million people, will be homeless for at least one night. Of these, 80% find a home within a few weeks, but about 10% remain homeless for a year or more. The United States Department of Health and Human Services estimates the number of chronically homeless at 100,000-200,000.

About a quarter to a third of the homeless have a serious mental illness -- usually schizophrenia, bipolar disorder, or severe depression -- and the proportion is growing. A study published in 2004 showed a 20-year rise in the rate of psychiatric illness among the homeless in St. Louis. In the year 2000, 30% had a combination of mental health and drug or alcohol problems (dual diagnosis) and another 15% had mental health problems alone. A survey of more than 10,000 patients treated for serious mental illness in San Diego County found that 15% had been homeless during the previous year.

The main sources of support for the homeless are Social Security provided by the federal government and emergency public shelters, mostly operated by voluntary lay groups or religious organizations. Shelters are often filthy, dangerous, and crime-ridden. There is little privacy and staff members frequently have no specialized training. Many of the mentally ill avoid shelters because they fear violence and theft or cannot tolerate the noise, crowds, and confusion.

Chronic homelessness is often the latest chapter in a story that begins in childhood. One study of first-time applicants to homeless shelters with histories of psychiatric hospitalization found that half of them had been institutionalized or placed in foster... (Authors)
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2005
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A program of the U.S. Department of Health and Human Services Substance Abuse & Mental Health Services Administration, Center for Mental Health Services