Unmet need for medical care among homeless adults with serious mental illness.
OBJECTIVE
The objective of this study was to determine the rates and predictors of unmet medical needs among homeless adults with serious mental illness entering a community-based case management program and those of receipt of medical care in the subsequent 3-month period.


METHODS
We analyzed baseline and follow-up data for 7213 homeless clients in the multisite Access to Community Care and Effective Services and Supports program.


RESULTS
Overall, 43.6% of the sample reported having an unmet need for medical care at baseline; of these subjects, only 36.1% received medical services during the 3 months following program entry. Using multivariate logistic regression modeling, we found that, at baseline, independent correlates of an unmet medical need included lower educational level, increased depressive and psychotic symptoms and greater number of potentially competing needs. None of these variables, however, adversely affected the likelihood of receiving medical care during follow-up. Factors associated with receiving medical services in the 3 months following program entry included receiving outpatient psychiatric services and reporting stronger therapeutic alliance with one's case manager.


CONCLUSIONS
Collaborative case management may play an important role in meeting mentally ill homeless persons' medical needs. Greater efforts are needed to identify and link at-risk clients with appropriate medical services.
Desai
Mayur M
MM
Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA. mayur.desai@yale.edu
Rosenheck
Robert A
RA
D000328:Adult; D003237:Connecticut; D005260:Female; D006301:Health Services Needs and Demand; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D012720:Severity of Illness Index