North C S, Smith E M
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
Soc Psychiatry Psychiatr Epidemiol. 1993 Apr;28(2):77-83. doi: 10.1007/BF00802096.
Psychiatric illness is overrepresented among the homeless, but mental health services are underutilized in this population in proportion to their needs. The current study was concerned with 900 homeless men and women randomly sampled and systematically interviewed with the Diagnostic Interview Schedule; it focuses on psychiatric and substance abuse rehabilitation service patterns and stated needs of this population in relation to specific psychiatric disorders. Although rates of lifetime treatment utilization were fairly high in comparison with general population utilization patterns, rates of treatment in the current year were low. In particular, outpatient services have been neglected for reliance upon inpatient services. Although the major reason cited for not obtaining treatment by homeless persons with mental illness was lack of insurance and inability to pay for it, having health insurance was not associated with mental health services utilization, nor were other important predictors apparent. Mental health professionals serving mentally ill homeless populations would best serve them by focusing on creative and innovative ways to improve the availability and attractiveness of ambulatory care services.
精神疾病在无家可归者中更为常见，但心理健康服务在这一人群中的利用程度与其需求不成比例。当前的研究涉及900名无家可归的男性和女性，他们是随机抽样并通过诊断访谈表进行系统访谈的；该研究关注精神疾病和药物滥用康复服务模式，以及这一人群与特定精神障碍相关的既定需求。尽管与一般人群的利用模式相比，终身治疗利用率相当高，但当年的治疗率较低。特别是，门诊服务因依赖住院服务而被忽视。尽管患有精神疾病的无家可归者未接受治疗的主要原因是缺乏保险且无力支付，但拥有医疗保险与心理健康服务的利用并无关联，其他重要的预测因素也不明显。为患有精神疾病的无家可归人群提供服务的心理健康专业人员，若专注于创新方法以提高门诊护理服务的可及性和吸引力，将能为他们提供最佳服务。
