The link between homeless women's mental health and service system use.
OBJECTIVE
With high rates of psychiatric and substance use problems, homeless women need a wide variety of services. This study, focusing on homeless women with and without symptoms of mental illness, examined the association of predisposing, enabling, and need factors (based on Aday-Andersen's health services utilization model) with use of behavioral, medical, and human services.


METHODS
Data from 738 homeless women from the National Survey of Homeless Assistance Providers and Clients were analyzed.


RESULTS
Homeless women with symptoms of mental illness showed higher rates of service use in behavioral, medical, and human domains, a finding that indicates that there are stronger service linkages for this group than for women without symptoms of mental illness. Predictors associated with service use differed by psychiatric symptoms among homeless women: predisposing and enabling factors influenced service use among homeless women without symptoms of mental illness, whereas need factors influenced service use among women with symptoms of mental illness.


CONCLUSIONS
Mental illness symptoms may be a trigger for receiving an array of services for homeless women once they gain entrance into a service system. There was a negative association between symptoms of mental illness and use of behavioral health services among homeless mothers, which may be the result of the fear of child welfare service intervention and loss of child custody. This service distribution inequity among homeless women using mental health services deserves attention by policy makers, researchers, and providers.
Tam
Tammy W
TW
Center for the Vulnerable Child, Children's Hospital and Research Center at Oakland, 747 52nd St., Oakland, CA 94609-1809, USA. ttam@mail.cho.org
Zlotnick
Cheryl
C
Bradley
Kimberly
K