Epidemiology

Over the years, Americans have expressed considerable interest in and concern about the extent of alcohol, drug, and mental health problems among homeless persons. In recent decades, the nature of these problems has changed, as a function of both demographic and social policy changes, especially in the realms of mental health and housing. During the mid-twentieth century, the homeless population was more homogenous than it is today and was typified by men living in inner cities, many of them alcohol abusers. But beginning in the late 1960s and early 1970s, the homeless population became more diverse. A number of factors contributed to this trend, including the broad-scale release of patients from state mental hospitals, a demographic shift toward younger homeless individuals, the destruction of cheap housing in the inner cities, increased use of illicit drugs, and reduced federal spending for new housing construction, restoration, and rental assistance.

Today, in the United States and elsewhere, it is useful to distinguish three important subgroups among homeless persons: single adults, families (that is, one or more parents with children in tow), and unaccompanied adolescents. Different types of shelters have been created in most U. S. cities to house these subgroups, provide them with better protection and care, and more effectively respond to their somewhat different needs.

While rates of mental illness and substance abuse are higher in all three of these homeless subpopulations than for their domiciled peers, there are salient differences among these subgroups in terms of the type, severity, and origins of their psychiatric conditions. By understanding these differences in homeless subgroups, it is possible to tailor service programs to best respond to their needs.