Addressing challenges in prescribing for vulnerable unsheltered homeless populations with mental illness

ABSTRACT

Background: Homeless individuals face an undue burden of both medical and psychiatric comorbidity, with the unsheltered homeless constituting a particularly vulnerable subpopulation. Homeless individuals have special needs that should be considered when prescribing medications, including limited financial resources, concerns for personal safety and survival, unreliable transportation and nutrition, and lack of access to electricity, bathrooms, and secure storage. These social determinants should impact decision-making regarding type of medication, half-life, modality of delivery, side-effect profiles, monitoring requirements, complexity of regimens, and pharmacy utilized. As clinicians working with homeless individuals with serious mental illness, we must adapt our practices to promote medication adherence and treatment success among this vulnerable population. Objectives: This paper will examine the unique set of challenges that are essential to explore when prescribing medications to unsheltered homeless populations. Unrealistic expectations can contribute to non-adherence to treatment and it is essential for providers to be aware of the key issues that impact adherence for populations suffering from homelessness. We will explore avenues that enhance successful prescribing for unsheltered homeless with mental illness that will arm clinicians with practical strategies. Conclusions: Thoughtful prescribing of medications that considers homeless individuals’ unique barriers to treatment can improve treatment of this vulnerable population.

KEYWORDS:

• Homelessness
• Barriers
• Serious mental illness

Disclosure statement

No potential conflict of interest was reported by the author(s).