PWH BY AGE, HIV/AIDS, MENTAL ILLNESS AND VETERAN STATUS

Service Utilization by People without Homes Living in San Francisco by Age, HIV/AIDS, Mental Illness, and Veteran Status

By,

Randell G. Silva

A Dissertation

Submitted in Partial Fulfillment of the Requirements for the

PhD Clinical Psychology

California School of Professional Psychology

At Alliant International University

, 2010

Graduation June 2012

Abstract

Mental health issues are prevalent among people without homes (PWH) and frequently impede access to mental health services. Access to mental health services increases housing stability, improves and helps stabilize mental health symptoms, and reduces relapse from comorbid substance abuse issues. The San Francisco Project Homeless Connect (PHC), an assertive community treatment approach began in 2004 in San Francisco, has been called a national best practice model by the Interagency Council on Homelessness (2009); however, longitudinal data is not available. Categorical data analyzed by Silva (2007) demonstrate PWH request mental health services more than medical services. The purpose of this study is to: (a) Determine if older PWH request more services due to increasing needs that come with age, (b) determine if there is an association between veteran status and requests for mental health/substance abuse services, and (c) determine if there is an association between veteran status and HIV/AIDS status. Data collected by the San Francisco PHC in May 2005 will be analyzed. Seven hundred and eighty-three PWH participated. As appropriate, Chi-square analyses will be conducted to test each hypothesis. The following hypotheses, derived from literature review of factors affecting requests for services by PWH, will be subjected to statistical analysis. Hypothesis 1: older (>45 year-old) PWH request mental health/substance abuse services significantly more than younger (<45 year-old) PWH (purpose a). Hypothesis 2: Veterans PWH request significantly more mental health/substance abuse treatment than non-Veteran PWH (purpose b). Hypothesis 3: Veterans living without a home will request HIV/AIDS services more than PWH who are not veterans (purpose c). Results will be based on statistical analysis of factors associated with request for PWH to mental health and other supportive services. The statistical significance of each hypothesis outlined above will be determined by Chi-square analyses. These findings will provide better understanding of what factors are associated with request for services by PWH.

Table of Contents

Abstract2

Introduction6

Age7

HIV/AIDS and Survival Sex10

Mental Illness12

Veterans14

Summary16

Literature Review19

Integrated Treatment Model20

Street Outreach Models22

Shelter Use24

Housing27

Barriers to Care Created by Mental Illness30

Age34

HIV/AIDS35

Mental Health and Substance Abuse38

Veterans41

Method45

Participants45

Demography and Housing History45

Data Collectors/Volunteers46

Measures47

Procedures48

Data Analysis49

Hypotheses49

References51

Appendix A62

Appendix B63

Introduction

The problem is people without homes (PWH) with mental illness are suffering day in and day out needlessly in the city of San Francisco (Saliou, Fichelle, McLoughlin, Thauvin, & Lejoyeux, 2005; Silva, 2007). Many PWH are too ill to manage affairs many of us take for granted, and there is little hope they will change their circumstances without intervention (Hser, Hoffman, Grella, & Anglin, 2001; Rathod & Addenbrooke, 2005). Programs that target their services toward mentally ill PWH, reach many people without homes (Silva, 2007). What is not known if requests for service by the aged and veteran PWH indicate higher or lower use of services? This study will statistically examine the associations ...