Open access

Determinants of Unmet Mental Healthcare Needs of Single Adults Who Are Homeless or Vulnerably Housed

Publication: Canadian Journal of Community Mental Health
13 April 2018

Abstract

Persons who are homeless experience higher levels of mental illness, unmet mental healthcare needs, and physical healthcare needs than the general population. This study aimed (1) to determine the reasons contributing to having unmet mental healthcare needs (UMHCN) and (2) to examine the determinants of UMHCN among a representative sample of adults who are homeless or vulnerably housed in three Canadian cities (N=1190). Almost a quarter (23.3%) of the sample reported UMHCN in the past year. The reported reasons for having UMHCN pertained especially to the availability (31.5%), accommodation (22.1%), and acceptability (21.3%) of services. Age, city, and need-for-care variables were associated with UMHCN in multivariate analysis. Implications of the findings for policy and program planning are discussed.
Les personnes sans-abri présentent des niveaux plus élevés de maladie mentale, de besoins de soins de santé et de besoins non comblés de soins de santé mentale que la population générale. Cette étude visait (1) à déterminer les raisons des besoins non comblés des soins de santé mentale (BNCSM) et (2) à examiner les déterminants des BNCSM auprès d›un échantillon représentatif d›adultes sans-abri ou logés de façon précaire dans trois villes canadiennes (N = 1190). Près d›un quart (23,3%) de l›échantillon a rapporté des BNCSM lors de l›année passée. Les raisons principales des BNCSM portaient sur la disponibilité (31,5%), l’accommodement (22,1%), et l›acceptabilité (21,3%) des services. L’âge, la ville et les besoins de soins étaient les variables associées aux BNCSM en analyse multivariée. Les implications des résultats pour la planification des services et le développement des politiques sont discutées.

Formats available

You can view the full content in the following formats:

References

Argintaru N., Chambers C., Gogosis E., Farrell S., Palepu A., Klodawsky F., and Hwang S. W. 2013 A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities BMC Public Health 13 1 1
Aubry T., Goering P., Veldhuizen S., Adair C. E., Bourque J., Distasio J., and Tsemberis S. 2016 A multiple-city RCT of Housing First with assertive community treatment for homeless Canadians with serious mental illness Psychiatric Services 67 3 275 -281
Aubry T., Klodawsky F., and Coulombe D. 2012 Comparing the housing trajectories of different classes within a diverse homeless population American Journal of Community Psychology 49 1–2 142 -155
Aubry, T., Klodawsky, F., Hay, E., & Birnie, S. (2003). Panel study on persons who are homeless in Ottawa: Phase 1 results. Ottawa, Canada: University of Ottawa, Centre for Research on Community Services.
Aubry T., Nelson G., and Tsemberis S. 2015 Housing First for people with severe mental illness who are homeless: A review of the research and findings from the At Home/Chez Soi demonstration project Canadian Journal of Psychiatry 60 11 467 -474
Baggett T. P., O’Connell J. J., Singer D. E., and Rigotti N. A. 2010 The unmet health care needs of homeless adults: A national study American Journal of Public Health 100 7 1326 -1333
Bhui K., Shanahan L., and Harding G. 2006 Homelessness and mental illness: A literature review and a qualitative study of perceptions of the adequacy of care International Journal of Social Psychiatry 52 2 152 -165
Bijl R. V. and Ravelli A. 2000 Psychiatric morbidity, service use, and needs for care in the general population: Results of the Netherlands Mental Health Survey and Incidence Study American Journal of Public Health 90 4 602 -607
Chartier-Otis M., Perreault M, and Belanger C. 2010 Determinants of barriers to treatment for anxiety disorders Psychiatric Quarterly 81 2 127 -138
Chondraki P., Madianos M. G., Dragioti E., and Papadimitriou G. N. 2014 Homeless mentally ill in Athens area: A cross-sectional study on unmet needs and help-seeking International Journal of Social Psychiatry 60 6 544 -553
Cocco K. M and Carey K. B. 1998 Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients Psychological Assessment 10 4 408 -414
Covenant House Toronto. (2016). Covenant House impact report 2016. Toronto, Canada: Covenant House. Retrieved from http://www.covenanthousetoronto.ca/homeless-youth/Page/Files/2316_Covenant_House_AR_2016.pdf.
Dezetter A., Duhoux A., Menear M., Roberge P., Chartrand E., and Fournier L. 2015 Reasons and determinants for perceiving unmet needs for mental health in primary care in Quebec Canadian Journal of Psychiatry. Revue canadienne de psychiatrie 60 6 284 -293
Durbin A., Sirotich F., and Durbin J. 2014 Predictors of unmet need for medical care among justice-involved persons with mental illness Psychiatric Services 65 6 826–829
Fazel S., Geddes J. R., and Kushel M. 2014 The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations The Lancet 384 9953 1529 -1540
Forchuk C., Brown S. A., Schofield R., and Jensen E. 2008 Perceptions of health and health service utilization among homeless and housed psychiatric consumer/survivors Journal of Psychiatric and Mental Health Nursing 15 5 399 -407
Frankish C. J., Hwang S. W., and Quantz D. 2005 Homelessness and health in Canada: Research lessons and priorities Canadian Journal of Public Health/ Revue Canadienne de Sante’e Publique S23 -S29
Gelberg L., Andersen R. M., and Leake B. D. 2000 The Behavioral Model for Vulnerable Populations: Application to medical care use and outcomes for homeless people Health Services Research 34 6 1273
Gelberg L. and Linn L. S. 1992 Demographic differences in health status of homeless adults Journal of General Internal Medicine 7 6 601 -608
Holmes Nelson C. and Park J. 2006 The nature and correlates of unmet health care needs in Ontario, Canada Social Science & Medicine 62 2291 -2300
Hwang S. W., Aubry T., Palepu A., Farrell S., Nisenbaum R., Hubley A. M., and Dowbor T. 2011 The health and housing in transition study: A longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities International Journal of Public Health 56 6 609 -623
Hwang S. W., Ueng J. J., Chiu S., Kiss A., Tolomiczenko G., Cowan L., and Redelmeier D. A. 2010 Universal health insurance and health care access for homeless persons American Journal of Public Health 100 8 1454 -1461
Kessler R. C., Berglund P. A., Bruce M. L., Koch J. R., Laska E. M., Leaf P. J., and Wang P. S. 2001 The prevalence and correlates of untreated serious mental illness Health Services Research 36 6 Pt 1), 987
Khandor, E., & Mason, K. (2007). The Street Health Report 2007. Toronto, Canada: Street Health. Retrieved from Street Health website: www.streethealth.ca
Khandor E., Mason K., Chambers C., Rossiter K., Cowan L., and Hwang S. W. 2011 Access to primary health care among homeless adults in Toronto, Canada: Results from the Street Health survey Open Medicine 5 2 e94
Kim M. M., Swanson J. W., Swartz M. S., Bradford D. W., Mustillo S. A., and Elbogen E. B. 2007 Healthcare barriers among severely mentally ill homeless adults: Evidence from the five-site health and risk study Administration and Policy in Mental Health and Mental Health Services Research 34 4 363 -375
Lasser K. E., Himmelstein D. U., and Woolhandler S. 2008 Access to care, health status, and health disparities in the United States and Canada: Results of a cross-national population-based survey Health Policy: Crisis and Reform in the US Health Care Delivery System 379
Lebrun-Harris L. A., Baggett T. P., Jenkins D. M., Sripipatana A., Sharma R., Hayashi A. S., and Ngo‐Metzger Q. 2013 Health status and health care experiences among homeless patients in federally supported health centers: Findings from the 2009 patient survey Health Services Research 48 3 992 -1017
Lefebvre J., Cyr M., Lesage A., Fournier L., and Toupin J. 2000 Unmet needs in the community: Can existing services meet them? Acta Psychiatr Scand 102 1 65 -70
Maisto S. A., Conigliaro J., McNeil M., Kraemer K., and Kelley M. E. 2000 An empirical investigation of the factor structure of the AUDIT Psychological Assessment 12 3 346 -353
Meadows G., Burgess P., Bobevski I., Fossey E., Harvey C., and Liaw S.-T. 2002 Perceived need for mental health care: Influences of diagnosis, demography and disability Psychological Medicine 32 299 -309
Mojtabai R., Olfson M., and Mechanic D. 2002 Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders Archives of General Psychiatry 59 77 -84
Nakonezny P. A. and Ojeda M. 2005 Health services utilization between older and younger homeless adults The Gerontologist 45 2 249 -254
Ojeda V. D. and Bergstresser S. M. 2008 Gender, race-ethnicity, and psychosocial barriers to mental health care: An examination of perceptions and attitudes among adults reporting unmet need Journal of Health and Social Behavior 49 3 317 -334
Ottawa Inner City Health. (2010). Annual Report 2014. Ottawa, Canada: Ottawa Inner City Health Inc. Retrieved from http://ottawainnercityhealth.ca/uploads/files/Annual_Reports/Annual_Report_2015.pdf
Palepu A., Gadermann A, Hubley A. M., Farrell S., Gogosis E., Aubry T., and Hwang S. W. 2013 Substance use and access to health care and addiction treatment among homeless and vulnerably housed persons in three Canadian cities PLoS ONE 8 10 e75133.
Penchansky R. and Thomas J. W. 1981 The concept of access: Definition and relationship to consumer satisfaction Medical Care 19 2 127 -140
Perese E. F. 2007 Stigma, poverty, and victimization: Roadblocks to recovery for individuals with severe mental illness Journal of the American Psychiatric Nurses Association 13 5 285 -295
Prins M., Bosmans J., Verhaak P., van der Meer K., van Tulder M., van Marwijk H., and Bensing J 2011 The costs of guideline‐concordant care and of care according to patients’ needs in anxiety and depression Journal of Evaluation in Clinical Practice 17 4 537 -546
Rabinowitz J., Gross R., and Feldman D. 1999 Correlates of a perceived need for mental health assistance and differences between those who do and do not seek help Social Psychiatry and Psychiatric Epidemiology 34 141 -146
Salyers M. P., Bosworth H. B., Swanson J. W., Lamb-Pagone J., and Osher F. C. 2000 Reliability and validity of the SF-12 Health Survey among people with severe mental illness Medical Care 38 11 1141 -1150
Sareen J., Jagdeo A., Cox B. J., Clara I., ten Have M., Belik S.-L., and Stein M. B. 2007 Perceived barriers to mental health service utilization in the United States, Ontario and the Netherlands Psychiatric Services 58 3 357 -364
Sherbourne C. D., Dwight-Johnson M., and Klap R. 2001 Psychological distress, unmet need, and barriers to mental health care for women Women’s Health Issues 11 3 231 -243
Skinner H. E. 1982 The Drug Abuse Screening Test Addictive Behaviors 7 363 -371
Steele L., Dewa C., and Lee K. 2007 Socioeconomic status and self-reported barriers to mental health service use Canadian Journal of Psychiatry 52 3 201.
Stergiopoulos V., Dewa C., Durbin J., Chau N., and Svoboda T. 2010 Assessing the mental health service needs of the homeless: A level-of-care approach Journal of Health Care for the Poor and Underserved 21 3 1031–1045
Stergiopoulos V., Hwang S. W., Gozdzik A., Nisenbaum R., Latimer E., Rabouin D., and Goering P. N. 2015 Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A randomized trial Journal of the American Medical Association 313 905 -915
Sunderland, A., & Findlay, L. C. (2013). Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey— Mental Health. Health Reports (Catalogue no. 82-003-X)
Tsemberis, S. (2010). Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction. Center City, MN: Hazelden.
Tsemberis S., McHugo G., Williams V., Hanrahan P., and Stefancic A. 2007 Measuring homelessness and residential stability: The residential time-line follow-back inventory Journal of Community Psychology 35 29 -42
Urbanoski K. A., Cairney J., Bassani D. G., and Rush B. R. 2008 Perceived unmet need for mental health care for Canadians with co-occurring mental and substance use disorders Psychiatric Services 59 3 283 -289
Urbanoski K. A., Rush B. R., Wild T. C., Bassani D. G., and Castel S. 2007 Use of mental health care services by Canadians with co-occurring substance dependence and mental disorders Psychiatric Services 58 7 962 -969
Ware J. E. Jr., Kosinski M., and Keller S. D. 1996 A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity Medical Care 34 3 220 -233
Wen C. K., Hudak P. L., and Hwang S. W. 2007 Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters Journal of General Internal Medicine 22 1011 -1017
Wojtusik L. and White M. C. 1998 Health status, needs, and health care barriers among the homeless Journal of Health Care for the Poor and Underserved 9 2 140 -152

Information & Authors

Information

Published In

cover image Canadian Journal of Community Mental Health
Canadian Journal of Community Mental Health
Volume 36Number 3November 2017
Pages: 41 - 57

History

Version of record online: 13 April 2018

Key Words

  1. homelessness
  2. unmet mental healthcare needs
  3. accessibility
  4. mental health

Mots-clés

  1. itinérance
  2. besoins non comblés de soins de santé mentale
  3. accessibilité
  4. santé mentale

Authors

Affiliations

Arnaud Duhoux [email protected]
University of Montreal and Centre de recherche Charles-Le Moyne—Saguenay-Lac St. Jean sur les Innovations en santé
Tim Aubry
John Ecker
Rebecca Cherner
Ayda Agha
St. Michael’s Hospital
Matthew J. To
St. Michael’s Hospital
Stephen W. Hwang
St. Michael’s Hospital and University of Toronto
Anita Palepu
University of British Columbia

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

There are no citations for this item

View Options

View options

PDF

View PDF

Login options

Check if you access through your login credentials or your institution to get full access on this article.

Subscribe

Click on the button below to subscribe to Canadian Journal of Community Mental Health

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media