Health Care Integration for Formerly Homeless People With Serious Mental Illness

Abstract

Objective: The primary objective of this study was to evaluate medical health and health care in a program of integrated primary and behavioral health care for people with experiences of homelessness and mental illness. Methods: Using a retrospective chart review, we examined health status and rates of health care quality indicators in a group of 123 Housing First participants with histories of chronic homelessness and diagnoses of serious mental illness, including a subgroup of 43 participants who received integrated medical and behavioral health care. Results: In addition to having serious mental illness, participants had high rates of comorbid chronic disease and risk behavior: 76% had at least one chronic disease, 59% had two or more chronic diseases, 6.5% had HIV, and 83% used tobacco. The integrated care program subgroup had relatively high rates of documentation of some health care quality indicators: 62% with body mass index, 73% with blood pressure, 77% with tobacco use history, 87% with substance use history. Conclusions: Our study confirms that people with experiences of homelessness and serious mental illness also have serious medical comorbidities and documents the feasibility of providing on-site integrated primary care and health screenings in supportive housing programs.

Keywords:

• homelessness
• serious mental illness
• co-occuring disorders
• housing first
• integrated care
• primary care

ACKNOWLEDGMENTS

Dr. Weinstein's research at Pathways to Housing was partially supported by a Heath Resources and Service Administration Faculty Development in Primary Care Award (No.: D55HP10334 PI: Howard Rabinowitz). The views and opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the funding institution. The authors would like to thank the service teams, staff, and clients at Pathways to Housing-PA, Christine Simiriglia, executive director of Pathways to Housing-PA, and Sam Tsemberis, founder and chief executive officer of Pathways to Housing.

Notes

1. Alcohol was excluded because the program did not have a consistent method of documenting alcohol use versus alcohol abuse.