title: Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings.
abstract: OBJECTIVE
  To determine the standardized rates of mental disorder, health service use and barriers to care in a representatively diverse sample of homeless adults in three different sized urban centers in British Columbia, Canada.
  
  
  METHODS
  Five hundred homeless adults from Vancouver, Victoria and Prince George were recruited. The MINI-International Neuropsychiatric Interview PLUS was used to determine current and lifetime rates of mental disorder, mental disorder episodes and suicidality. Health service use and barriers to care were recorded.
  
  
  RESULTS
  Overall, 92.8 % of participants met criteria for a current mental disorder: 82.6 % for alcohol or drug dependence, 57.3 % anxiety disorder, 31.5 % mood disorder. Over half (53.4 %) met criteria for a concurrent disorder. Only 14.9 % had seen a psychiatrist and 12.7 % a mental health team in the year prior to the survey. Most common barriers included being poorly connected to the system of care and issues related to homelessness. Mental disorder rates across sites were high, however, differences were found that reflected the composition of the samples.
  
  
  CONCLUSIONS
  Improving the mental health state of the homeless will require significant capacity for mental health and concurrent disorder programming that is tailored to the community it intends to serve. Demographic features of the population may help in directing assessments of need.
authors.affiliation: Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada. m.krausz@mac.com
authors.forename: Reinhardt Michael
authors.initials: RM
authors.lastname: Krausz
authors.forename: Adam F
authors.initials: AF
authors.lastname: Clarkson
authors.forename: Verena
authors.initials: V
authors.lastname: Strehlau
authors.forename: Iris
authors.initials: I
authors.lastname: Torchalla
authors.forename: Kathy
authors.initials: K
authors.lastname: Li
authors.forename: Christian G
authors.initials: CG
authors.lastname: Schuetz
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D014505:Urban Population