The homeless mentally ill: myths and realities

This literature review summarises the historical background of homelessness. It suggests that the current view of homeless people as chronic mentally ill is the latest phase in a series of the different ways in which society has perceived and labelled the homeless. We have argued that homelessness is a product of the lack of housing provision to the poorest section of society and that the psychiatric needs of many of the homeless might be a direct result of poverty and homelessness. This review also highlights difficulties in interpreting data produced by surveys of homeless people. These difficulties include the multiple definitions of homelessness used and also the major methodological errors which limit the usefulness of their findings. In particular sampling methods used may have overestimated the more visible part of the homeless population, overestimating the levels of psychiatric morbidity. Even if these limitations are ignored the data produced by these studies do not allow planning of effective mental health services for homeless people as their results depend mainly on diagnostic classification rather than disability or need. What is required is a study of needs where the appropriateness of particular services is defined, the sampling method is explicit and the definitions of homelessness are precise and consistent.