Examining healthcare barriers among severely mentally ill homeless adults in the Five-Site Health and Risk Study

Introduction. People who are homeless and have serious mental illness face a complex array of psychosocial and socioeconomic problems, which tend to simultaneously increase their risk for chronic health problems while decreasing their access to both general medical care and specialty psychiatric treatment. This study examines the frequency of physical and mental healthcare barriers reported by recently homeless persons with serious mental illness and the specific characteristics that are most associated with these two types of barriers.

Methods. Participants included adults who were between the ages of 18 and 60, provided informed consent, and met the diagnostic criteria for serious mental illness. this analysis focuses only on those subjects who reported being homeless (i.e. sleeping outside with shelter; sleeping inside an empty building, hallway, car, subway, or train station; or sleeping in a public shelter or a church) in the past 6 months (n=154) at the time that they completed the survey.

Results. Using logistic regression to examine the relative effects of the independent variables on one of the two outcome variables related to barriers to care, practical concerns (e.g. transportation and cost) were key components of barriers to accessing general medical care among uninsured men with poorer overall mental health, PTSD, and STD infections. Perceived stigma was an important component of mental healthcare barriers reported most frequently by those with greater psychiatric symptoms.

Conclusion. Focusing on individual characteristics underlying barriers to healthcare may lead to better interventions for improving access to needed care.