Utilization of mental health and substance abuse services among homeless adults in Los Angeles.
OBJECTIVE
Even though psychiatric disorders are disproportionately present among the homeless, little is known about the extent to which homeless people receive treatment for those problems or the factors that are associated with receiving treatment. This article examines utilization and predictors of mental health and substance abuse treatment among a community-based probability sample of homeless adults.


METHODS
The data analyzed here were collected through face-to-face interviews with 1,563 homeless individuals. Bivariate analyses examined differences between homeless men and women in (1) the prevalence of major mental illnesses and substance dependence and (2) utilization of inpatient and outpatient treatment services for those with specific diagnoses. Logistic regression analyses identified predictors of mental health treatment among those with chronic mental illness and substance abuse treatment among those with recent substance dependence.


RESULTS
Two-thirds of these homeless adults met criteria for chronic substance dependence, whereas 22% met criteria for chronic mental illness, with substantial overlap between those two disorders: 77% of those with chronic mental illness were also chronic substance abusers. Only one-fifth of each of those two groups reported receiving treatment for those disorders within the last 60 days. Mental health service utilization was predicted largely by factors related to need (eg, diagnosis, acknowledgment of a mental health problem), whereas substance abuse service utilization was predicted by myriad additional factors, reflecting, in part, critical differences in the organization and financing of these systems of care.


CONCLUSIONS
More attention must be directed at how to better deliver appropriate mental health and substance abuse services to homeless adults.
Koegel
P
P
RAND, Santa Monica, CA 90401, USA. Paul_Koegel@rand.org
Sullivan
G
G
Burnam
A
A
Morton
S C
SC
Wenzel
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002908:Chronic Disease; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000706:statistics & numerical data*