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Am J Psychiatry 1991; 148:330-336
Copyright © 1991 by American Psychiatric Association
Housing instability and homelessness among rural schizophrenic patients
RE Drake, MA Wallach, GB Teague, DH Freeman, TS Paskus and TA Clark
New Hampshire-Dartmouth Psychiatric Research Center.
OBJECTIVE: The authors examined housing instability among treated
schizophrenic patients in a rural area and compared the findings with those
from their previous study of urban patients. METHOD: Seventy-five patients
with schizophrenia or schizoaffective disorder who were treated in a rural
mental health center were assessed with research interviews and ratings by
their clinical case managers. The patients were followed for 1 year to
identify episodes of psychiatric hospitalization, incarceration, and
literal homelessness. RESULTS: Of the 75 patients, 19 (25%) had housing
situations characterized as unstable by their case managers. For the
majority, housing instability signified tenuousness of living arrangements
rather than literal homelessness. Noncompliance with medications, alcohol
use, and negative symptoms accounted for 30% of the variance in unstable
housing. During follow-up, the unstably housed patients, compared to those
in stable living situations, were no more likely to be rehospitalized but
were somewhat more likely to be jailed and significantly more likely to be
literally homeless. CONCLUSIONS: In the authors' previous study of urban
psychiatric patients, unstably housed patients were more likely to be
literally homeless, highly symptomatic, and rehospitalized during follow-up
than the rural patients with unstable housing. Better outcomes in the rural
area appeared to be related to the greater availability of housing
alternatives and to intensive case management. For patients with unstable
housing in both settings, noncompliance with medications and substance
abuse, as well as housing arrangements, should be assertively addressed.
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