Assessing health status and exploring health needs in women with experiences of homelessness and serious mental illness

Women with experiences of chronic homelessness and serious mental illness (SMI) represent a distinct and highly marginalized subgroup of homeless individuals, whose needs maybe different from men experiencing chronic homelessness, and from women experiencing short-term family homelessness. Housing First (HF) is an evidence-based practice that works to end chronic homelessness for individuals with SMI. HF provides a unique opportunity to address health needs of individuals as they transition from homelessness to supportive housing. The purpose of this mixed methods study was to provide preliminary information regarding the health status and health needs of women in a HF program that also provides on-site integrated health care. Demographic, health condition, and health care quality information was reviewed for all 123 individuals in the program and differences between men and women were examined. Among the program participants, 9 women agreed to in-depth individual interviews regarding health, access to healthcare, sense of control over healthcare decision-making, and program support. Quantitative findings showed equally high levels of chronic disease and substance use, as well as high levels of receipt of recommended quality measures in both women and men. Emergent qualitative themes include: the impact of ongoing pain on health, the importance of housing in order to effectively self-manage chronic illness, and a high sense of personal control over one's own health. These findings highlight the high level of multi-morbidity in this population and the potential for supportive housing to effectively address the health needs and values of women with experiences of homelessness and SMI.