Mental health care for homeless adults: Comparing self-reported and provider perceptions of need

Men and women who experience homelessness have high rates of psychopathology, yet there is a scarcity of resources with which they can get help for their mental health concerns. Previous researchers have identified high prevalence rates of mental health issues in this population, including depression, anxiety, posttraumatic stress disorder, and psychotic conditions, as well as substance abuse and dependency. Furthermore, researchers have examined the success of various programs designed to meet the mental health needs of homeless adults, only to find that these interventions have poor attendance and high dropout rates. While previous needs analyses have been conducted to determine how to better treat the homeless and mentally ill, these studies have tended to use only one source of input, either from homeless individuals themselves or those who provide mental health care to this population. The present study explored the similarities and discrepancies between consumer and provider perceptions of need. The author created two nearly identical needs questionnaires that were distributed to homeless adults who utilized services of a large homeless agency, located in an urban area in the Pacific Northwest, as well as to staff members and volunteers who worked in the agency. The areas assessed included perceived support and tangible help, areas of concern, treatment needs and barriers to care. Results revealed that, while both consumers and providers identified homeless agencies as the greatest sources of support and tangible help, providers tended to view homeless adults as being more pathological than homeless individuals saw themselves. Furthermore, homeless individuals indicated that they were less likely to use mental health services than providers perceived. While providers saw individual therapy and medication management to be the most favored treatments for homeless individuals, consumers identified skills training and psycho-educational groups as more favorable, in general. Finally, in regards to barriers to care, each group identified barriers that were outside their own locus of control as more problematic than the barriers of which they had control. Explanations for these results, as well as implications for treating this population, are discussed