A systematic study of mental illness, substance abuse, and treatment in 600 homeless men

Six hundred homeless men from St. Louis shelters and streets were interviewed using the Diagnostic Interview Schedule (DIS). The majority of homeless men in St. Louis are single and black, with a mean age in their mid- 30s. On average, they have not quite a high school education and most have had recent employment difficulties. Major mental illness is overrepresented among these homeless men, although the majority do not suffer from major nonsubstance mental illness. If substance abuse is included, however, the majority (77%) have a history of a psychiatric disorder. Substance abuse was found to complicate almost all psychiatric illness in this population. Three- fourths (75%) of the men have a history of substance abuse, predominantly alcohol. One-fourth met criteria for antisocial personality; one-fourth are convicted felons. Half of the men have received inpatient psychiatric care. The majority of inpatient services are being used for substance abuse treatment. Only half of those who have a history of inpatient treatment have received outpatient treatment. This suggests underutilization of outpatient resources which may be due in part to lack of cooperation with outpatient treatment. The result is excessive reliance on hospitalization for crisis management and substance-abuse treatment. The problems of the homeless men are far more complex than what major (nonsubstance) mental illness contributes.