HOMELESSNESS

Literal homelessness—lacking permanent housing of one's own—is a condition that has been present throughout human history. It has always been dangerous as well, given the necessity of shelter for survival. Nevertheless, the routine occurrence of homelessness in the past probably prevented the problem from generating any extraordinary degree of collective concern. Members of premodern societies often experienced losses or disruptions of residence as a result of food scarcity, natural disaster, epidemic disease, warfare, and other environmental and self-inflicted circumstances. Such forces contributed to the likelihood, if not the expectation, that most people would be homeless at some point in the life cycle.

Ironically, now that homelessness is relatively rare in Western societies, it has achieved a special notoriety. When shelter security becomes the norm, the significance of housing evolves beyond the purely functional. Homes, like jobs, constitute master statuses, anchoring their occupants in the stratification system. Hence, being without a home portends a more general and threatening disaffiliation, defined as "a detachment from society characterized by the absence or attenuation of the affiliative bonds that link settled persons to a network of interconnected social structures" (Caplow et al. 1968, p. 494). This is the broadest meaning associated with the concept of homelessness, at the opposite end of the continuum from its literal definition.

Homelessness, broadly construed, first appeared on the American scene during the early stages of colonial settlement, with paupers, indentured servants, petty criminals, unemployed seamen, and the mentally impaired forming a pool of individuals at risk of vagrancy. It began to assume major proportions as a social problem in the United States near the end of the nineteenth century. Over the several preceding decades, urban homeless populations had emerged in response to a series of events at the national level, including Civil War displacement; the arrival of impoverished European immigrants; seasonal employment patterns in agriculture, construction, and the extractive industries; and severe economic setbacks in the early 1870s and 1890s (Rooney 1970).

As a makeshift remedy, downtown warehouses and old hotels were converted into inexpensive, dormitory-style lodging facilities. The proximity of the lodging facilities to one another, along with the distinctive mix of commercial and recreational establishments growing up around them, helped to concentrate the homeless physically in areas that came to be known as skid rows (supposedly named for a "skid road" in Seattle used to slide logs downhill). At the turn of the century, these areas were less burdened by the seedy images later evoked by the term "skid row." Instead, they were vibrant neighborhoods offering a temporary resting place and a range of services to thousands of tramps, the mobile workers who laid the foundation for the U.S. industrial economy.

The manpower needs created by World War I subsequently drained skid row districts, but a pool of footloose veterans replenished them at war's end. An even greater surge in homelessness—one extending well beyond the boundaries of skid row—was soon sparked by the Great Depression. The widespread hardship of the period forced previously domiciled individuals into a migrant lifestyle, and shantytowns (dubbed "Hoovervilles") sprang up in urban and rural settings alike. These new manifestations of homelessness in turn stimulated the first generation of sustained research on the subject among sociologists. Anderson (1940), Sutherland and Locke (1936), and other scholars conducted studies of different segments of the homeless population as part of the Depression-era relief effort.

A second generation of research started in the 1950s. Large-scale single-city surveys—many of which were funded by urban renewal agencies—informed the debate over what to do about deteriorating skid row areas (Bahr and Caplow 1974; Bogue 1963). Demographic data obtained during the surveys showed homeless respondents to be predominantly male, white, single, older, and of local origins. The surveys also lent credibility to the popular view of the homeless as deviant "outsiders." Depending on the city under examination, between one-fourth and one-half reportedly were problem drinkers, a higher percentage had spent time in jail or prison, most were unable or unwilling to hold down steady employment, many suffered from poor health, and few were enmeshed in supportive social networks. This negative profile based on the survey findings was countered by a parallel body of ethnographic evidence. Field observers like Wallace (1965) portrayed the homeless of skid row in subcultural terms, as a cohesive group with their own language, norms, and status hierarchy. Participation in the subculture was believed to help members cope with a problem more serious than their presumed deviance: extreme poverty.

In the 1970s, almost a century after skid row became a recognizable entity in the American city, its demise seemed imminent. Urban renewal and redevelopment projects had eliminated much of the infrastructure of skid row, while slackening demand for short-term unskilled labor was eroding one of the few legitimate economic roles the area could claim to play. Consequently, several investigators predicted skid row's disappearance and, by implication, the decline of the U.S. homeless population (Lee 1980). Yet within a decade of such forecasts, homelessness had resurfaced as an important national issue. During the 1980s media coverage of the so-called new homeless increased dramatically, and federal legislation (most notably the McKinney Act) was formulated to address their plight. The amount of social scientific inquiry rose as well. Indeed, the recent outpouring of scholarly monographs on the topic has surpassed that of any prior generation of research.

Despite this renewed interest, what is known about contemporary homelessness remains limited, for several reasons. Unlike most groups surveyed by sociologists, the homeless are not easily reached at residential addresses or telephone numbers. The demolition of skid row districts in general and of single-room-occupancy (SRO) hotels in particular, accompanied by social control measures designed to reduce the public visibility of drunks, panhandlers, and other "undesirables," has intensified the difficulties involved in finding homeless people, pushing a higher percentage of them into more dispersed, obscure locations. Those referred to as the doubled up, who stay with settled relatives or friends, are virtually inaccessible to investigators. Also poorly captured by surveys are the many individuals for whom homelessness is of brief duration or episodic in character. Even among the homeless who can be found, participation rates fall far short of perfect. The prospect of further stigma and humiliation keeps some from admitting their condition, thus excluding them from sample membership, while others are too suspicious or incoherent to take part in an interview.

Finally, the political context surrounding the latest wave of research magnifies the significance of each methodological obstacle just identified. Because the homelessness issue has been transformed into a referendum on the ability of the state to meet its citizens' needs, liberals and conservatives both use the slightest technical shortcoming as ammunition with which to attack any study unfavorable to their own position. Similarly, members of both camps—not to mention the media, advocacy groups, government agencies, and other actors—selectively draw on research results to frame the homelessness problem in a way that attracts (or diverts) public attention. Thus, apparently straightforward "facts" about homelessness—and there are few of these to begin with—become matters open to debate.

"Snapshot," or single-point-in-time, data on the size of the national homeless population illustrate the uncertain nature of the existing knowledge base. According to an early assertion by advocates, the number of homeless in the United States as of 1982 stood at 2.2 million, or approximately 1 percent of the total population of the country (Hombs and Snyder 1982). However, only two years later the U.S. Department of Housing and Urban Development (HUD) (1984) compiled a series of estimates, extrapolated from street counts and surveys of informants and shelter operators, that yielded a "most reliable" range of 250,000 to 350,000. A 1987 Urban Institute study arrived at a figure—500,000 to 600,000 homeless nationwide on a single day—that fell between the advocate and HUD extremes (Burt and Cohen 1989). More recently, the Census Bureau enumerated 240,000 homeless people in the course of its massive yet heavily criticized 1990 S-night (street and shelter) operation (U.S. Bureau of the Census 1992).

Although most experts now dismiss the advocate-generated 2 million figure as groundless, the remaining estimates vary considerably. One explanation for this variation is that all are point estimates, depicting the size of the homeless population at a specific moment (e.g., a particular day or week). To the extent that the number of homeless changed during the 1980s, studies conducted on different dates should produce different results. Indeed, the trend retrospectively uncovered by several investigators (Jencks 1994)—slow growth early in the decade, rapid increase in the middle, and decline after 1987–1988—seems consistent with the magnitudes of the HUD, Urban Institute, and Census estimates. Others believe that the homeless population grew rapidly throughout the decade, by as much as 25 percent annually in some places. That growth rate could be inflated, though, given the relative stability documented in one of the few large cities (Nashville, Tennessee) for which longitudinal observations are available (Lee 1989).

It is hard to know whether the most credible point estimates accurately reflect the true scope of homelessness. If the homeless population is marked by high turnover, with many people entering and exiting quickly, the total number who experience homelessness over a longer period will be grossly underestimated by a point estimate. Two recent period-prevalence studies illustrate this dynamic. In the first study, counts of unduplicated shelter users in New York and Philadelphia suggest that roughly 1 percent of the residents of both cities are homeless each year, and the figure rises to 3 percent for a three-to-five-year interval (Culhane et al. 1994). In the second, 15 percent of the respondents to a nationally representative telephone survey reported that they had been literally homeless or had doubled up with someone else during their lifetimes (Link et al. 1995).

While definitional and methodological differences underlie much of the disagreement over the magnitude of the homeless population, generalizations about its composition have been complicated by (1) the selective emphasis of many inquiries on atypical "slices" of the whole (homeless veterans, the mentally ill, etc.) and (2) real variation in the characteristics of the homeless across communities. Contrary to media reports and popular perceptions, the modal homeless individual is still an unattached male with local roots, similar in fundamental ways to his skid row counterpart of the 1950s or 1960s. Yet there clearly have been significant compositional shifts during the intervening period. Blacks and other minorities, rarely found on skid row, are now overrepresented among the homeless, and women, children, young adults, and high school graduates constitute larger segments of the population both absolutely and proportionally than they once did (Burt 1992; Rossi 1989). Family groupings, usually headed by the mother alone, have become more common as well. Taking these elements of demographic continuity and change together, perhaps the safest conclusion to be drawn is that a trend toward greater diversity distinguishes the new homelessness from the old.

The same conclusion applies with respect to deviant characteristics. Alcoholism, which previously constituted the most noticeable form of deviance among the homeless, is now rivaled by other kinds of substance abuse, and mental illness has surpassed physical illness as an object of public concern. Beyond a rough consensus regarding the greater variety of such problems in the current homeless population, little of a definitive nature is known about them. For example, a review of nine studies cited mental illness prevalence rates that run from a low of one-tenth to a high of one-half of all homeless (U.S. General Accounting Office 1988), and occasional reports suggest that as many as 90 percent are at least mildly clinically impaired. This wide range leaves room for opposing arguments: on the one hand, that pervasive mental illness is the principal cause of contemporary homelessness; on the other, that its presumed causal role represents a stereotypic myth created by the visibility of a small minority of disturbed folk.

Even if the extent of mental illness has been exaggerated, there can be no doubt that the general well-being of the homeless remains low. This is hardly surprising in light of the stresses that accompany life on the street. The absence of shelter exposes homeless persons to the weather, violence, and other threatening conditions. They have trouble fulfilling basic needs that most Americans take for granted, such as finding a job, obtaining nutritionally adequate meals, getting around town, washing clothes, storing belongings, and locating toilet and bathing facilities. To cope with these difficulties, homeless people draw on a repertoire of subsistence strategies (Snow and Anderson 1993). One of the most common is temporary low-wage employment, often as a day laborer. For some, shadow work—engaging in unconventional activities outside the formal economy (scavenging, panhandling, selling blood, trading junk)—offers a means of survival. Others resort to crime, especially petty theft, prostitution, and drug dealing, or become dependent on service providers.

While frequently creative, such strategies heighten the physical health risks to which the homeless are subjected. Compared to the settled population, a larger percentage of homeless individuals suffer from chronic disorders, and rates for most infectious diseases are at least five to six times greater (Wright et al. 1998). The collective consequence of these conditions is a drastically shortened life expectancy. However, to identify homelessness as the direct cause of higher morbidity and mortality would be an oversimplification. Preexisting health problems can reduce a person's employability, prompting a downward "drift" toward homelessness and lessening the chances of returning to a normal life. Homelessness can also be a complicating factor in the provision of health care. In part because of their circumstances (e.g., lacking transportation, distrusting authorities, being unable to store medicine), many homeless miss appointments and do not follow through with their prescribed treatment. They are, in short, less than ideal patients from the perspective of health professionals, whose goal is to insure continuity of care.

Poor health and other disadvantages associated with homelessness tend to worsen as the length of time on the streets increases. Some people still experience the longer-duration bouts common in the skid row era; close to 10 percent may be homeless for five continuous years or more. These "chronics," by virtue of their visibility, disproportionately influence public perceptions of who the homeless are, but they now constitute the exception rather than the rule. Results from most surveys indicate that the median episode of homelessness lasts between two months and one year (Burt 1992; Link et al. 1995). Of the persons who fall into this "temporary" category, some are homeless only once in their lives. Many, though, exhibit a more complex pattern marked by frequent exits from and returns to homelessness (Piliavin et al. 1996). For such individuals, being without shelter is just one manifestation of prolonged residential instability.

Whether temporarily or chronically homeless, few prefer to be in that state. But if preference can be ruled out, what forces account for the new homelessness? Among the numerous answers elicited by this question so far, two general classes are discernible. Structural explanations treat homelessness as a function of large-scale trends that constrain people's chances for success and that are beyond their immediate control. Scholars point in particular to (1) the decreasing availability of affordable housing; (2) the growth of the poverty population; (3) changes in the economy (e.g., deindustrialization and the expansion of the service sector) resulting in fewer decent-paying, limited-skill jobs; (4) intensifying competition among members of the baby boom cohort during their adult years; (5) the declining appeal of marriage (and the heightened vulnerability of unmarried women and men); (6) the deinstitutionalization movement in mental health care policy; and (7) wider access to controlled substances, dramatically illustrated by the crack cocaine "epidemic" (Burt 1992; Jencks 1994; Wright et al. 1998). The rise of the new homeless is typically attributed to the convergence of two or more of these trends in the 1980s.

The availability of affordable housing has probably received the most attention of any structural factor, in part because all the other trends are thought to operate in conjunction with this one to produce homelessness. The thrust of the housing thesis is that government action, a supply–demand imbalance, inner-city revitalization, and related events have not only priced many low-income households out of rental status but have also eliminated a key fallback option historically open to them: SRO units in downtown residential hotels (Hoch and Slayton 1989; Ringheim 1990). With the depletion of the SRO stock, displacement from other sectors of the housing market may lead directly to a homeless outcome.

In contrast to the structural approach, individualistic explanations posit traits, orientations, or experiences specific to the person as the main causes of homelessness. Few researchers have found much evidence that lacking permanent residence is a freely chosen lifestyle. Nevertheless, the enlargement of the emergency shelter system in recent years has made it easier for poor people who are exposed to domestic conflict or doubled up in a crowded unit to voluntarily head for a shelter as a way of coping with their untenable housing situations. In similar fashion, older thinking about the inherent immorality and wanderlust of skid row denizens has given way to revisionist claims that the primary antecedents of homelessness are deficits in talent or motivation or the debilitating effects of mental illness or substance abuse. Traumatic life events, either in childhood (e.g., sexual violence, placement in foster care or an orphanage) or adulthood (divorce, job loss, a serious health problem), can increase the likelihood of homelessness as well.

Interestingly, many experts who subscribe to some version of the individualistic view have had to invoke associated structural trends—deinstitutionalization in the case of mental illness, for example—in order to explain the size and compositional changes that have occurred in the homeless population in recent years. The tendency to draw on both individualistic and structural perspectives has grown more pronounced with the realization that a theory of homelessness, like that of any social phenomenon, can never be fully satisfying when cast in exclusively micro- or macro-level terms. To date, the work of Rossi (1989) offers the most compelling cross-level synthesis. He contends that structural changes have put everyone in extreme poverty at higher risk of becoming homeless, especially those poor people who exhibit an "accumulation of disabilities," such as drug abuse, bad health, unemployment, and a criminal record. Being "disabled" forces one to rely on a network of friends and family for support, often over prolonged periods. If the strain placed on this support network is too great and it collapses, homelessness is the likely result.

Though Rossi's central idea—that structural factors and individual problems combine to make certain segments of the poor more vulnerable to homelessness than others—seems reasonable to social scientists, it could prove less acceptable to members of the general public. Based on previous research into public beliefs about the causes of poverty, most Americans might be expected to hold the homeless responsible for their lot. However, the small amount of evidence that bears directly on this expectation contradicts rather than confirms it. Findings from a local survey, supplemented with data from a national opinion poll, indicate that (1) more people blame homelessness on structural variables and bad luck than on individualistic causes and (2) many hold a mixture of structural and individualistic beliefs, consistent with the complex roots of the condition (Lee et al. 1990).

The relative frequency of the two types of beliefs is a matter of substantial political significance, since the study just cited shows that each type implies a distinctive set of policy attitudes. As a rule, members of the public who believe in structural causes consider homelessness a very important problem, feel that the response to it has been inadequate, and endorse a variety of corrective proposals, including a tax increase and government-subsidized housing. This policy orientation stands at odds with that for individualistic believers, who tend to devalue homelessness as an issue and favor restrictive measures (vagrancy enforcement, access limitation, etc.) over service provision. Regardless of which orientation ultimately registers the greatest impact on policy making, the sharp contrast between them says much about how homelessness has managed to stay near the top of the U.S. domestic social agenda for the past two decades.

Homelessness also persists as an issue because it is so hard to solve. Out of frustration, many communities have resorted to controlling the homeless. Historically, mechanisms to achieve this goal have included expulsion, spatial containment, and institutionalization (the latter for the sake of monitoring, rehabilitation, or punishment). Other efforts have been aimed at amelioration. For example, the Stewart B. McKinney Homeless Assistance Act recognizes the responsibility of the federal government to meet the basic needs of the "down and out." Since the McKinney Act was signed into law in 1987, it has authorized billions of dollars for food, shelter, health care, and other forms of aid (Foscarinis 1996). However, most of the funding is used to support emergency relief programs. The act designates only modest amounts for reintegration initiatives (for example, moving people into transitional or permanent housing) and virtually nothing for prevention. In short, it treats symptoms but not causes.

The effectiveness of legislation like the McKinney Act is further hindered by our federal system of government, which requires an unrealistically high degree of coordination among units at different levels to insure successful and equitable implementation. The current political climate does not bode well for such legislation, either. Repeated challenges have been made to the McKinney Act; critics want to reduce the size of the federal commitment, redirect the homeless toward existing social services (although many do not appear eligible to receive benefits), and give local government more flexibility. In practice, this is likely to mean a continuation of the piecemeal approach already taken in many places, with an assortment of nonprofit organizations, religious groups, advocates, volunteers, and state and municipal agencies attempting to do their part. As long as communities lack specific intervention strategies for keeping at-risk residents from losing their housing and for equipping them with essential skills, there will be little change in the status quo.

The United Nations' designation of 1987 as the "Year of Shelter for the Homeless" attests that homelessness has been an international as well as an American concern. The situation in Europe resembles that in the United States in several respects. Although rates of homelessness appear to be slightly lower across the dozen or so European countries for which data are available, the number of people affected annually (at least 2.5 million) is large (Wright et al. 1998). The compositional profile of the European homeless population looks familiar: Its members are disproportionately single, male, from disadvantaged socioeconomic backgrounds, and in poor physical and mental health. Like their American counterparts, they have become homeless as a result of both structural pressures (e.g., a poverty and affordable housing "squeeze") and individual experiences (family breakup, substance abuse, etc.). Remedies for these causes are no easier to come by in Europe than they are in the United States. The primary response thus far has been to offer emergency relief, with the burden of service provision falling on the private sector.

Homelessness takes a different, more acute form in the developing countries of the Third World, where rapid population growth outstrips the expansion of the housing stock and the economy by a wide margin. Compounding the growth–housing mismatch are prevailing patterns of spatial redistribution: Rural-to-urban migration streams have created huge pools of homeless people in tenements, in squatter communities, and on the streets of many large cities. Besides such demographic trends, periodic events of the kind that once created literal homelessness in premodern societies—drought, earthquakes, food shortages, and the like—still contribute to the problem today outside the West. War (including "ethnic cleansing") and political instability add to the toll.

What is perhaps most striking about homelessness in the Third World context is its youthful face. Visitors to developing nations cannot help but notice the ubiquitous street children; UNICEF estimates that there may be as many as 100 million globally (Glasser 1994). A majority are "on the street" during the daytime, typically performing some sort of economic activity (begging, vending, etc.), but they have a family and dwelling to return to at night. Perhaps 10 percent qualify as literally homeless or "of the street." The children belonging to this group may have run away from difficult family circumstances, been discarded as "surplus kids" by parents unable or unwilling to care for them, or been discharged from an orphanage or other institutional setting. Because children of the street must hustle to survive, they are occasionally romanticized as savvy and resilient. But they also lack adequate diets, are susceptible to criminal victimization, and engage in behaviors such as drug use and prostitution that jeopardize their health.

Sadly, the prospects for weaving a safety net to catch homeless children and adults—let alone for targeting the sources of the problem—must be judged slim in the face of the financial debts, service demands, and other burdens under which Third World governments operate. Possibly because these burdens are so overwhelming, homelessness—while important—has yet to achieve dominant-issue standing. As one informed observer put the matter, "neither the resources to address the plight of the homeless nor the degree of aroused public sympathy present in the United States are in evidence in the developing world" (Knight 1987, p. 268). However, that is the sector of the world in which a vast majority of all homeless persons will continue to live for the foreseeable future.

references

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BARRETT A. LEE

Homelessness

Modern forms of homelessness

BIBLIOGRAPHY

Homelessness is a condition of detachment from society characterized by the absence or attenuation of the affiliative bonds that link settled persons to a network of interconnected social structures.

Homelessness takes many forms, depending on the type of detachment involved and the local circumstances. Homeless families and homeless men appear, so far as can be determined, in all largescale societies. Homeless women and children are relatively rare. Their appearance denotes wide spread disorder and instability, such as follow famines and civil wars.

Degrees of homelessness. Homeless families fall into three general types: permanent wanderers, such as gypsies and carnival performers; wanderers with a fixed base, especially migratory farm workers; and refugees, for whom homelessness is an accident and not a way of life. Homeless men fall into a variety of categories.- single men in itinerant occupations, such as peddlers, tinkers, and sailors; migratory laborers; vagrants and beggars; religious mendicants; outlaws and other fugitives; and hoboes and derelicts.

These types suggest that homelessness is a matter of degree, ranging from temporary to perma nent and from the loss of a single affiliation to the absence of all affiliations. In general, homelessness is less acute for families than for individuals. The homeless family may have no place in any community, but its members carry a web of roles and obligations with them wherever they go. Some, like the gypsies, develop something like a portable community independent of the surrounding social structure. Others, like the millions of families displaced toward the end of World War II, are ren dered homeless without their consent and resume normal affiliations at the first opportunity.

There is even more variation in degree of home-lessness among men without families. Some, like the itinerant worker, may preserve multiple affiliations: occupational, religious, political, and so on. They are only as homeless as their mobility forces them to be. Others, like religious mendicants, elect one overriding identification that supplants all of their former roles.

At the extreme point of the scale, the modern skid row man demonstrates the possibility of nearly total detachment from society. The present discussion is focused on this end of the homelessness scale and omits any consideration of the minor degrees of homelessness represented by Bohemians, “beatniks,” troubadours, residents in alien societies, and other adventurers whose partial detachment from role obligations is arranged deliberately and with substitute goals in view.

Homelessness as a syndrome. The common characteristics of homeless populations display a distinct and unmistakable pattern that is roughly applicable to any homeless population though fully descriptive of none. Homeless persons are poor, anomic, inert, and nonresponsible. They command no resources, enjoy no esteem, and assume no burden of reciprocal obligations. Social action, in the usual sense, is almost impossible for them. Lacking organizational statuses and roles, their sphere of activity extends no further than the provision of personal necessities on a meager scale. Their decisions have no implications for others. Only the simplest forms of concerted action are open to them, since homelessness is incompatible with sustained involvement in a complex division of labor.

The observable behavior of the homeless person consists largely of activities that furnish subsistence or enjoyment without incurring responsibilities: mendicancy, petty crime, scavenging, casual conversation, and an incurious attention at spectacles. This quality of social inertness renders him both innocuous and helpless. He is unlikely to engage in major crime or political movements or to protest his own condition forcefully. A certain apathy regarding self-preservation often develops in addition to the collective helplessness. The home less in great cities and in refugee camps stand and watch their companions assaulted by strangers without offering to interfere and without taking any measures to protect themselves. The combined effect of poor nutrition, exposure of all kinds, neglect of injuries and illness, and insensitivity to emergencies leads to very high rates of morbidity and mortality among homeless persons as compared to the settled population around them.

The homeless versus the settled. For reasons not entirely understood, the presence of homeless persons often arouses a degree of hostility in the settled population that seems entirely disproportionate. Ancient ballads preserve the image of the gypsy as rapist and kidnapper. Being homeless or vagrant became a felony in England in the fourteenth century and a capital crime under the Tudors; it is still treated as a criminal offense in most American and European cities. These external attitudes and the punitive measures to which they lead further separate the homeless man from his settled neighbor. Homeless populations often occupy an underworld with a special argot, secret signs, and a conventional refusal to communicate with outsiders. Such manifestations may lead romantic observers to imagine an entire clandestine social system, such as the “kingdom of beggars” or the “hobo republic,” but on closer view, these fantasies disappear and reveal the homeless as an aggregate of unrelated individuals who share a common situation and some elements of a common culture.

A theory of homelessness. The Germanic term “home,” with its special connotations of warmth, safety, and emotional dependence, has no exact equivalent in other linguistic systems. Aside from its familiar overtones, it expresses the idea of a fixed place of residence shared with a limited number of other persons. In current usage, home does not imply a family (unrelated persons can “make a home” together), a household (a rest home may be much larger), more than moderate fixity (in any given year, more than one in five U.S. families moves to a new home), or exclusivity (a special body of tax law covers taxpayers with two or more homes). Living outside a family, with no permanent address, does not make a priest or a soldier homeless, but the man who occupies the same lodging on skid row for forty uninterrupted years is properly considered homeless. The essence of the concept goes beyond residential arrangements. Homelessness is best visualized as a relationship to society at large and best understood by examining the difference between the settled and the homeless.

A settled, active adult in any society participates simultaneously in several major types of organization. This participation anchors him in the social structure by linkages with near and distant kin, neighbors, compatriots, superiors and subordinates, co-workers, departed ancestors, sacred and supernatural personages, persons with the same special interests, and even those who like to play the same games. Each of these memberships involves duties and privileges, restraints and rights, status and roles. Each requires sustained interaction with particular other persons who enter into the subject’s life history and become part of the audience for his socially meaningful acts.

The pattern of these affiliations varies in detail from one time and place to another, but the main outlines remain unchanged. In modernized countries of the twentieth century, the individual’s at tachment to society seems to be mediated through eight major types of organization: family, school, community, state, production group, occupational union, church, and recreational associations. Taken together, these memberships define who the settled person is, how he schedules his days and his years, and the benefits he may claim from, and the duties he owes to, the social order. Above all, they identify the others who are influenced by him and define the extent of that influence.

The fully homeless man is unaffiliated in all sectors. He is not an active member of any organization and therefore has no enforceable responsibilities toward fellow members, no audience of persons influenced by his actions, no claim on social rewards beyond whatever minimum has been set to avoid the scandal of his starvation, and no duties to fulfill except those imposed as a condition of remaining in the territory. Clearly, this condition will be uncomfortable and sometimes dangerous. On the other hand, it may be attractive to those who reject the cultural goals together with the means of achieving them.

Homelessness as an ideal. The age of modernization is singularly unsympathetic to the positive values of homelessness. However, in other times and places it has been regarded as a desirable, or at least admirable, way of life.

The exaltation of homelessness as an ideal is a central, recurrent theme of Christianity, reflecting such scriptural teachings as “lay not up for your self treasures on earth.” Poverty, detachment from previous affiliations, and the abandonment of worldly aspirations are the first principles of monasticism. The Christian ethos of vagrancy was most fully developed by St. Francis of Assisi and the several orders of wandering, mendicant friars who followed the Franciscan model.

A parallel theme runs through Muslim history. The “St. Francis of Islam” is Mulai ’Abd al-Qadir al-JIlani (1078–1166), the patron of the needy and suffering. From the Muslim viewpoint, the beggar performs a kind of social service by enabling others to attain merit by almsgiving: “As long as Islam flourishes,” says one writer, “there will be beggars, for there will always be devout people who will give away all they have, and so become beggars themselves” (Edwards 1912, p. 931).

In addition to friars, hermits, and holy beggars, Christianity and Islam recognize and honor the pilgrim, who becomes a homeless wanderer temporarily, partly for the spiritual benefit of visiting the sacred shrine and partly to withdraw from settled society. In the Middle Ages pilgrims played a vital part in integrating both the Christian and Muslim worlds. The pilgrim routes to Mecca and Medina, to Rome and Santiago de Compostela, are as crowded today as ever, but the modern pilgrim is more often a religious tourist than a holy vagrant.

The ethos of vagrancy is even more conspicuous in Buddhism. Buddha and his disciples were members of an already ancient order of wandering almsmen, and Buddha charged his disciples to “go forth and wander about for the good of the Many.” The bhikshu-sangha was (and is) a community of homeless men entered by “going forth from a house to a houseless state.” A bhikshu is an almsman. “He is differentiated from an ordinary beggar by the sacramental character of his begging. His beggary is not just a means of subsistence, but an out ward token that he has renounced the world and all its goods and thrown himself for bare living on the chances of public charity” (Dutt 1962, p. 36).

Similar themes exalting homelessness and attaching a positive value to mendicancy may be discerned in Hinduism, the religion of Zoroaster, and a number of Hellenistic cults. Indeed, approval and abhorrence of religious mendicancy may occur together. One appeal of the world religions may lie precisely in their ability to combine doctrinal elements supporting the performance of status obligations with others that allow the believer to with draw from the world without penalty.

Modern forms of homelessness

Although the traditional types of homelessness may still be observed on the contemporary scene, they are overshadowed by new forms that arise directly from the dominant processes of the modern era: industrialization, urbanization, decolonization, and the redistribution of political power. The three types to be considered here are refugees, migratory workers, and skid row men.

Refugees. Involuntary migration has occurred throughout historic times, but the displacements of the twentieth century have been unprecedented in scale, scope, and duration. Refugees are persons who migrate to escape actual or threatened persecution because of their race, religion, political convictions, or for any reasons related to war (Proud-foot 1957, pp. 53, 446). A broader definition of refugees includes any persons compelled to abandon their homes because of events for which they cannot be held responsible (Vernant 1953, p. 3).

The involuntary migration of refugees contrasts sharply with voluntary migration in search of economic opportunities. Voluntary migrants are mostly young adults usually assured of a welcome in the host country and of continued ties with the country of origin. Involuntary migration often affects entire communities, including people of all ages and conditions, uprooted without their consent and set down in a place selected at random, where their numbers increase their helplessness.

The wars and revolutions of the twentieth century have created both temporary and permanent refugees. The temporary refugee may flee from his home in the face of an invading army to return at the first opportunity. The permanent refugee leaves a country where his enemies have come to power with no real hope of eventual return. Sometimes he is resettled after an interval of hardship in a new community among people of his own persuasion. But if no such place is available, he may linger indefinitely in refugee camps, living on a dole. One observer speaks of Heimatlosenauslander as “ultimate refugees” and describes their loss of affiliations:

Here you meet men whose environment has ceased to succour them. In their former normal life they had the solace of their homes in times of weariness or perplexity, perhaps even in times of unemployment. They had the consolation of their church in times of spiritual need and of family sadness. They had their trade union and political association in times when work and politics preoccupied them. They had their village inn and folk festivals on high days and holidays. All these props and cushions in life’s pilgrimage are taken from them…. (Rees 1960, p. 37)

The large-scale refugee movements of the twentieth century began with the Balkan wars of 1912–1914. World War I displaced several million civilians, most of whom were subsequently relocated. Almost every major disturbance of the interwar period generated a refugee problem, and World War ii displaced between 20 and 50 million persons; the exact number is unknown and cannot be accurately estimated. In the postwar period, the displacement of populations continued unabated in Europe, Asia, Africa, the Near East, the islands of the Pacific, the Mediterranean, and the Caribbean. Not without reason has this been called the “cen tury of the homeless man.” Most refugees are ultimately resettled, but not without great cost in suffering and dislocation. Meanwhile, the making of refugees continues at a rate that reflects the peculiar and fanatical character of twentieth-century nationalism.

Migratory farm laborers. Large-scale agriculture often requires large amounts of hand labor for brief seasonal periods. This situation frequently occurs during the transition from a plantation or family farm system with a fixed labor force to a fully mechanized system of cultivation. The transition may extend over several decades, during which the local labor force is incapable of planting and harvesting a crop without outside help. Arranging the appearance of the required number of workers at the right time and place is a perennial problem for the planters. Protecting the workers against exploitation and the natural hazards of migration is a major problem for whatever authorities assume the responsibility.

Seasonal migratory labor is required for such diverse products as coffee, cocoa, rubber, cotton, citrus fruits, wheat, apples, potatoes, and wild rice. The seasonal movement of migratory workers is significant throughout the world, often transmitting a modernizing influence from advanced to backward areas. The preliterate tribesmen brought to the coastal banana plantations of Central America, the Italian peasants cultivating sugar beets in France, the tribal Africans who migrate to cocoa plantations of Ghana, and the Mexican braceros picking peaches in Oregon all acquire new ideas and attitudes to carry back with them.

Movements of this kind are often internal as well as international. In the United States in the middle 1960s, for example, Mexicans were admitted annually on a temporary basis under a farm labor program jointly administered by the two countries, and sizable numbers were drawn under other programs from Canada, the British West Indies, Japan, and Puerto Rico. But the stream of migrants is also fed by many internal groups: Indians, mountain whites, Spanish Americans, and southern Negroes. The annual cycle begins in the South and moves steadily northward with the advancing season; some workers follow the wheat harvest all the way from southern Texas to Manitoba.

Migratory laborers vary in degree of homeless-ness. John Steinbeck’s novel, The Grapes of Wrath, painted an unforgettable picture of migrant families displaced from their ancestral farms in Oklahoma during the depression and cut loose to drift helplessly from one temporary job to another. Even in times of prosperity, the United States has an estimated one million transients who have no fixed base (Shotwell 1961, p. 34); and there are many others who have home bases to which they return between seasons or when forced back by unemployment.

A migrant work force may be composed of single men, entire families, or both. Their living and working conditions range from adequate to wretched. Like other homeless persons, migratory workers are prevented from forming or retaining normal affiliations and are subject to disproportionate hostility from their settled neighbors.

Migrancy engenders community resentment, puts in peril such practical aspects of normal family living as regular schooling for children, housing that is sanitary and convenient and conducive to wholesome family relationships, voting privileges, stable income, health and welfare services available to residents. Migrancy reduces to zero the chance to develop the feeling of belonging to a stable community. (Shotwell 1961, pp. 36-37)

The farm laborer occupies a place at the very bottom of the socioeconomic ladder, doing the most work for the lowest wages with less security and opportunity than any other segment of the population.

Solidary organizations among migrant laborers are rare. Attempts to unionize them, when not vio lently suppressed, have usually failed. However, a loose form of crew organization often develops, whereby a group of individuals or families is represented by a leader who negotiates with employers and arranges transportation and lodging.

The impact of this form of homelessness on in dividuals is mitigated by its temporary character. The available evidence suggests that most migra tory workers return to a settled life at the first opportunity, often in an area they have discovered as migrants.

The skid row man. In proportion to their numbers, skid row men in the United States and comparable homeless men in western Europe have received disproportionate attention from both scientific and literary observers. In a study using 1950 census data, Bogue (1963) identified skid row areas in 41 American cities and estimated their combined homeless population at under 100,000. The individual settlements are correspondingly small. Careful enumerations in the New York Bowery, one of the most conspicuous skid row areas in the world, disclosed less than seven thousand homeless men in 1964 and 1965 (Baker 1965, p. 7).

The name “skid row” (or “skid road”) appar ently derives from the log skidways on which felled timber was transported in the forests of the Pacific northwest. It came to be applied to the Seattle area where lumbermen wintered and then to similar enclaves in other cities where single homeless men were housed in dormitories and lodging houses, surrounded by facilities that served their special needs. Most of these enclaves, in their present locations, can be traced back about a century. In recent decades, their populations have been declining, although irregularly; and the migratory workers identified as the principal inhabitants of “hobo-hemia” after World War i (Anderson 1923) have given way to the practically immobile pensioners, alcoholics, and disadvantaged workers who make up the bulk of the population today.

The interest aroused by skid row may be explained partly by its unique institutions, partly by its high visibility, partly by the resistance of the skid row alcoholic to ameliorative programs, and partly by a life style that deviates dramatically from the success-oriented, family-centered ethos of the surrounding society. The visible facilities are cubicle lodging houses, cheap restaurants and bars, missions, barber colleges, secondhand stores and pawnshops, newspaper reading rooms, sidewalk gatherings, all-night movies and burlesque shows, tattoo parlors, “jungles” near railroad yards, and the “revolving door” of police court and workhouse. In several major cities the original area has been cleared in the course of urban redevelopment, but substitute skid rows have invariably appeared.

Ethnic and occupational characteristics vary somewhat from one skid row to another, but the population is almost exclusively male. Their average age is much higher than that of the general popu ation; a large proportion are past the usual age of retirement (Bogue 1963, pp. 8-10). About a third of the men are heavy drinkers, frequently arrested for drunkenness and apparently addicted to alcohol, although there is some doubt about their being true alcoholics. The remainder are divided between social drinkers, whose need for liquor is apparently controllable, and moderate drinkers or abstainers (Bogue 1963, pp. 90-93). Most report themselves unmarried and without active family ties. Their histories show less than average involvement in family relationships from early childhood on (Pitt-man & Gordon 1958, pp. 10, 125-138). Their organizational affiliations have often been slight throughout adult life, reflecting a permanent state of social detachment. The typical skid row man has a background of intermittent unskilled or semiskilled employment, with minimal involvement in political, religious, and recreational organizations (Bahr & Langfur 1966).

Morbidity and mortality rates are startlingly high. The risks of contagious disease, infection, exposure, injury, and malnutrition are greater on skid row than in any other urban environment (Bogue 1963, pp. 199-230). Most men live close to the margin of bare subsistence on sporadic earnings, pensions, relief payments, begging, or some combination of these. A few depend on savings or assistance from relatives; a few enjoy regular incomes and remain on skid row by preference (Bogue 1963, pp. 13-17; 46-77).

In addition to the core population, the skid row area provides temporary accommodation for migratory workers and work seekers, eccentrics, and fugitives of various kinds. Some of these men are not strictly homeless, and some homeless men have no contact with skid row. However, the predominant type is unmistakable.

The principal current trends in the status of skid row inhabitants are decreased mobility and a decline of relative income. There is, however, a rising provision of public assistance for them, and experimental programs are being undertaken in the rehabilitation of alcoholics.

Theodore Caplow, Howard M. Bahr, and David Sternberg

[Directly related is the entryRefugees. Other relevant material may be found inDrinking and alcoholism, article onsocial aspects; Migration.]

BIBLIOGRAPHY

Anderson, Nels 1923 The Hobo: The Sociology of the Homeless Man. Univ. of Chicago Press.

Bahr, Howard M.; and Langfur, Stephen J. 1966 Social Attachment and Drinking in Skid-row Life Histories. Unpublished report, Columbia Univ., Bureau of Applied Social Research.

Baker, Michael A. 1965 An Estimate of the Population of Homeless Men in the Bowery Area, New York City, February 28, 1965. Unpublished manuscript, Columbia Univ., Bureau of Applied Social Research.

Bogue, Donald J. 1963 Skid Row in American Cities. Univ. of Chicago, Community and Family Study Center.

Caplow, Theodore 1940 Transiency as a Cultural Pattern. American Sociological Review 5:731–739.

Cirtautas, Claudius K. 1957 The Refugee: A Psycho logical Study. Boston: Meador.

Dutt, Sukumar 1962 Buddhist Monks and Monasteries of India. London: Allen & Unwin.

Edwards, Albert 1912 The Beggars of Mogador. Out look 101:929–936.

Gilmore, Harlan W. 1940 The Beggar. Chapel Hill: Univ. of North Carolina Press.

Holborn, Louise W. 1960 The World’s Refugees: Every one’s Concern. Washington: American Association of University Women, Committee on International Relations.

International Labour Review Staff 1957 Interterritorial Migrations of Africans South of the Sahara. International Labour Review 76:292–310.

Martin, Norman F. 1957 Los vagabundos en la Nueva Espana, siglo XVI. Mexico City: Editorial Jus.

O’Connor, Philip 1963 Vagrancy: Ethos and Actuality. Baltimore: Penguin.

Oregon, Bureau of labor 1959 …And Migrant Problems Demand Attention: The Final Report of the 1958-1959 Migrant Farm Labor Studies in Oregon. Salem: The Bureau.

Orwell, George (1933) 1950 Down and Out in Paris and London. New York: Harcourt. → Orwell is the pseudonym of Eric Blair.

Pittman, David J.; and Gordon, C. wayne 1958 Re volving Door: A Study of the Chronic Police Case Inebriate. Glencoe, 111.: Free Press.

Pollitt, Daniel H.; and Levine, Selma M. 1960 The Migrant Farm Worker in America: Background Data on the Migrant Worker Situation in the United States Today. Washington: Government Printing Office.

Proudfoot, Malcolm J. 1957 European Refugees, 1939-1952: A Study in Forced Population Movement. London: Faber.

Rees, Elfan 1960 Common Psychological Factors in Refugee Problems Throughout the World. Pages 31-43 in World Federation for Mental Health, Uprooting and Resettlement. London: The Federation.

Shotwell, Louisa R. 1961 The Harvesters: The Story of the Migrant People. Garden City, N.Y.: Doubleday.

Solenbergeb, Alice W. 1911 One Thousand Homeless Men: A Study of Original Records. New York: Russell Sage Foundation, Charities Publication Committee.

Stoessinger, John G. 1956 The Refugee and the World Community. Minneapolis: Univ. of Minnesota Press.

Straus, Robert 1946 Alcohol and the Homeless Man. Quarterly Journal of Studies on Alcohol 7:360–404.

Sutherland, Edwin H.; and Locke, Harvey J. 1936 Twenty Thousand Homeless Men: A Study of Unem ployed Men in the Chicago Shelters. Philadelphia: Lippincott.

Vernant, Jacques 1953 The Refugee in the Post-war World. New Haven: Yale Univ. Press.

Vexliard, Alexandre 1956 Introduction à la sociologie du vagabondage. Paris: Rivière.

Wallace, Samuel E. 1965 Skid Row as a Way of Life. Totowa, N.J.: Bedminster.

Wood, Margaret M. 1953 Paths of Loneliness: The Individual Isolated in Modern Society. New York: Columbia Univ. Press.

Homelessness

Definition

In the United States, definitions of homelessness help determine who is able to receive shelter and assistance from certain health and social service providers. The Stewart McKinney Homeless Assistance Act of 1987 defines a homeless person as any individual who lacks housing, including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations or an individual who is a resident in transitional housing. More specifically, this means an individual who lacks fixed, regular, and adequate nighttime residence, and an individual who has a primary nighttime residence that is either (i) a supervised temporary living shelter (including transitional housing for the mentally ill), (ii) an institution that provides temporary residence for individuals intended to be institutionalized, or (iii) a place not designed for or ordinarily used as a regular sleeping accommodation for human beings.

Difficulties in estimating numbers of people who experience homelessness

Methods for estimating the size of the homeless population are evolving and sometimes contested, and are complicated by varying definitions of homelessness. The U.S. Census, while attempting to identify the number of people who are homeless and who use particular types of homeless services, has complex and service-based definitions of homelessness. It also has recognized its limited abilities to define and enumerate the homeless (it is after all a national household survey). In 2000, the Census Bureau defined the Emergency and Transitional Shelter (E&TS) population by surveying people who use a sample of homeless services. They counted homeless people in emergency shelters for adults, runaway youth shelters, shelters for abused women and their children, soup kitchens, and certain outdoor locations. Technically, however, homeless people may reside in "E&TS," in foster care, in jails and prisons, in group homes , in worker dorms, non-sheltered in the outdoors, doubled up with families or friends, or temporarily in Census-recognized households. According to the National Coalition for the Homeless, while counting the number of people who use services such as shelters and soup kitchens can yield important information about services, applying these numbers toward estimating numbers of homeless people can result in underestimates of homelessness.

Further complicating the issue of counting homeless people is the fact that, in many cases, homelessness is a temporary condition. Because of this fact, some researchers advocate a method of counting all the people who are homeless in a given week or, alternatively, over a given period of time. However, the numbers of people who find housing and the number of people who newly find themselves homeless fluctuates over time periods. In contrast, people with mental illness or substance abuse problems tend to be chronically without homes—it is difficult for many of these people to find permanent housing. Thus, while these two time-oriented methods of counting homeless can be useful, they too have statistical problems—they can overestimate the numbers of homeless people.

Homelessness is an acute version of residential instability, which can be compared or contrasted with definitions of poverty. Thus the term homeless may also be extended to include people who have nowhere to go and are at imminent risk of losing housing through eviction or institutional discharge. Some definitions of homelessness further specify the duration of time without regular and adequate residence, or the types of temporary living shelter or institutions that are not fixed residences. People who live without alternatives in overcrowded or unhealthy housing conditions may be at risk of homelessness. Worldwide, national and cultural groups may have variable and often different definitions of homelessness, different terms for the condition of being without housing, and different definitions of adequate housing. For all of these reasons related both to methods of counting and varying definitions, estimating the size of the homeless population is extremely difficult.

Demographics

Census estimates of the size and composition of the homeless population are difficult to create, for reasons described above. The Emergency and Transitional Shelter (ET&S) Population count in the U.S. in 1990 was 178,638. It remained relatively stable in 2000 at 170,706. However, this figure does not include homeless adults not using ET&S services, sampling error, or some groups of homeless people not enumerated in the ET&S count. The ET&S population in 2000 was 61% male and 74% adult. Among the 26% who were youth, 51% were male. For adults, the population was 65% male, 41% were white, 40% were African-American, 20% were Latino of any race, 2% were Asian, 2% were Native American, and 9% were one other race alone.

Another estimate of homelessness is a 1988 count of homeless people that occurred over one week, counting homeless people congregated on the street, in soup kitchens, and in shelters. That estimate was 500,000 to 600,000 people.

The large variation between these estimates illustrates that, as the National Coalition for the Homeless states, "By its very nature, homelessness is impossible to measure with 100% accuracy."

Incidence of homelessness and associated diseases and conditions

Homeless adults are poor and have high rates of unmet need for health care. This is in part because poverty is associated with higher risk and rates of illness, particularly mental illnesses including substance abuse. Homeless people experience disproportionate rates and symptoms of mental health disorders, including substance abuse disorders and dual diagnoses. For these reasons, large portions of federally funded homeless services are medical services, and homeless people are often viewed according to their present or past medical classifications.

Studies researching the incidence, distribution, and control of a disease in a population (known as epidemiological studies) find that between one-third and one-half of homeless people have mental health disorders and approximately two-thirds have either a mental health or substance use disorder. People with severe mental illness are likewise more likely to become homeless, particularly when the disorder is co-morbid (co-occurs) with substance abuse. For this reason, changes in rates of homelessness are often associated with changes in mental health care and hospitalization policies.

Mental illnesses compound the vulnerability and needs of homeless adults, as reported by the Surgeon General. Psychiatric disorders exacerbate many types of problems, including housing instability, morbidity (disease), and mortality (death). Psychiatric disorders and lack of stable living conditions complicate general health care for homeless adults.

History

The history of homelessness is intertwined with the history of poverty in the United States. Poverty has always been problematic for humanitarian reasons and because it conflicts with the ideal of prosperity for all. Social welfare, based on individualistic ideas of deserving and undeserving poor, has improved society but not eliminated persistent poverty or homelessness. The 1960s war on poverty was a widely shared value, but in the 1980s concern about homelessness was confounded by moral evaluations of individual behaviors. While many in the U.S. have been poor or come from poor families, fewer have experienced homelessness. Therefore, the collective understanding of homelessness in the U.S. is limited in ways that the understanding of poverty is not.

Causes and consequences

Causes

People with mental illness are at higher risk for becoming homeless due to challenges associated with deinstitutionalization and transition planning, and both poverty and disability associated with mental illness.

Social research has studied the causes and consequences of homelessness, surveying homeless people, examining entrances into homelessness, exits from homelessness, and effects of homelessness on health and well-being. Promising explanations for increasing rates of homelessness in the 1980s have included mental disability and illness, lack of social support through jobs and marriage, increased use of drugs and alcohol, and the erosion of low-income housing in urban areas. These explanations mirror the processes of deinstitutionalization in mental health policy, unemployment, addiction and abuse, and urban decay. In other words, a direct correlation can be demonstrated between policies and trends and the rates of homelessness. As deinstitutionalization occurred, for example, the number of mentally ill people without homes increased.

Consequences

Consequences of homelessness include the exacerbation of problems which may have caused homelessness. Homeless people have less access to housing, jobs, health care, and basic needs like food and clothing. Isolation and lack of social support are well-documented aspects of homelessness, particularly for homeless people living with mental health or substance abuse disorders. Homeless women and men have been found to have significantly less family support than never-homeless women and men. Disaffiliation from family often limits opportunities for recovery and prevention.

Homeless service agencies

Services for homeless people can be divided into those providing medical care, those providing housing, and those providing other basic needs. Publicly funded agencies provide the majority of medical care, especially primary and mental health care. Public and private organizations share the responsibilities of providing shelter and housing services, through both large federal programs and smaller need and faith-based programs. Private agencies deliver most other daily needs to homeless people, through food pantries, soup kitchens, and other charities. Limited data exists on vocational services for homeless adults.

Title VI of the McKinney Homeless Assistance Act of 1987 created the Health Care for the Homeless (HCH) program, authorizing federal funds for primary and mental health care to homeless people. Title VI authorizes several programs to provide a HCH program, a Community Mental Health Services block grant program, and two demonstration programs providing mental health and alcohol and drug abuse treatment services to homeless people. HCH funds support providers who offer mental health, case management , and health education services, as well as substance abuse treatment. In 1987, 109 grants were made for homeless health services with $46 million; 1996: $66 million were spent for this purpose. Now there are 122 McKinney grants in 48 states. In 1992, the Act was amended to include homeless and at-risk children, creating a medical home and source of health insurance for young people. The HCH program is the largest single effort to address the medical needs of the homeless. Each year, the HCH Program serves almost 500,000 clients in the U.S. To be a HCH service agency requires cultural and linguistic competencies, compassionate community outreach, and providers who reflect the community they serve.

The federal Center for Mental Health Services oversees Projects for Assistance in Transition from Homelessness (PATH) grant program. PATH provides state funds in support services to individuals who are homeless or at risk of becoming homeless and have serious mental illnesses. These funds amounted to $22 million allocated to 365 providers in 1998. States contract with local agencies and nonprofit organizations to provide an array of services, including outreach, support services, a limited set of housing services, and mental health treatment.

There are several obstacles or barriers in providing health care to homeless people. First, homeless or persistently poor people may be concerned about their work and sustenance, devaluing their own medical needs. Alienation and depression among the homeless can also be an obstacle to providing care. There can be mutual communication problems between providers and patients. Providers may lack cultural understanding that eases work with homeless clients. Finally, lack of preventive maintenance of medical care by the homeless may result in expensive and extensive needs for care, including hospital care, which may stress the capacities of certain service providers.

Homelessness in context

Homelessness is both a form of poverty and an acute condition of residential instability. Homelessness is compounded by behavioral problems, mental health policy changes, disparities in health and health care, racial inequalities, fluctuations in affordable housing, and lack of social support. Overly individualistic views and explanations of homelessness do not reflect its multiple causes and effects. Like all groups, homeless people are diverse, experiencing and exiting homelessness for a myriad of reasons. Services for homeless adults likewise reflect a variety of needs and experiences. Nonetheless, homelessness remains a national and international concern, particularly in urban areas, for the twenty-first century.

How to help the homeless mentally ill

There are many ways that Americans can support community and federal efforts to help homeless people living with mental illness. Some strategies include:

• • Support collective public and private efforts to build homes and provide health care for people with unmet medical needs.
• • Become educated about the challenges faced by homeless and mentally ill people in American society.
• • Stop the practice of equating people in poverty and with illness with their medical conditions, instead of recognizing them as human beings. Succeeding in this step could open doors for recovery of health and housing without demeaning the humanity of people in need.

See also Community mental health; Deinstitutionalization; Hospitalization; Vocational rehabilitation

Resources

BOOKS

Burt, M., L. Aron, and others. Homelessness: Programs and the People They Serve. Washington, D.C., U.S. Department of Housing and Urban Development, 1999.

Hombs, Mary E. American Homelessness. Santa Barbara CA, ABC-CLIO, 2001.

Jencks, Christopher. The Homeless. Cambridge, MA, Harvard University Press, 1994.

U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD, SAMHSA, CMHS, 1999.

PERIODICALS

Smith, Annetta, and Denise Smith, "US Census Bureau, CENSR/01-2." Emergency, and Transitional Shelter Population: 2000. USGPO, Washington DC, 2001.

Susser, E., S. Conover, and others. "Mental illness in the homeless: Problems of epidemiological method in surveys of the 1980s. Special Issue: The homeless mentally ill." Community Mental Health Journal 26, no. 5 (1990): 391-414.

ORGANIZATIONS

The Center for Mental Health Services Knowledge Exchange Network (KEN). U.S. Department of Health and Human Services. (800) 789-2647. <http://www.mentalhealth.org>.

Habitat for Humanity International. 121 Habitat St., Americus, GA 31709-3498. (800) 422-4828. <http://www.habitat.org/>.

Health Care for the Homeless Information Resource Center. 262 Delaware Avenue, Delmar, NY 12054-1123. (888) 439-3300 ext. 246. <http://www.pra.inc/hch>.

National Alliance for the Mentally Ill (NAMI). Colonial Place 3, 2107 Wilson Blvd, Suite 300, Arlington VA, 22201-3042. (703) 524-7600 or (800) 950-6264. <http://www.nami.org>.

National Coalition for the Homeless. 1012 Fourteenth Street, NW, #600, Washington, DC 20005. (202) 737-6444. <http://www.nationalhomeless.org/>.

National Coalition for Homeless Veterans. 333 1/2 Pennsylvania Ave., SE, Washington, DC 20003. (800) 838-4357. <http://www.nchv.org>.

National Health Care for the Homeless Council, P.O.Box 60427, Nashville, TN 37206-0427. (615) 226-2292. <http://www.nhchc.org/>.

National Institute of Mental Health. 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. <http://www.nimh.nih.gov>.

Substance Abuse and Mental Health Services Administration (SAMHSA). Center for Mental Health Services (CMHS), Department of Health and Human Services, 5600 Fishers Lane, Rockville MD 20857. <http://www.samhsa.org>.

U.S. Department of Housing and Urban Development. 451 7th Street S.W., Washington, DC 20410. (202) 708-1112. <http://www.hud.gov>.

OTHER

National Coalition for the Homeless. NCH Fact Sheet #2. February, 1999.

Michael Polgar, Ph.D.

Homelessness

In the late twentieth century, homelessness became a serious issue in the United States. Increased numbers of men and women were living in shelters or on the street. Many viewed homelessness as a condition caused by excessive drinking and drug abuse. Although this view has a long history in American life, the picture is in fact more complicated. Other factors besides alcohol and drug abuse have contributed to the problem of homelessness in modern society.

A Historical Background of Homelessness

The word "homeless" can be understood in two ways. In its most literal meaning, "houseless," the word has been used to describe people who sleep outdoors or who live in temporary housing. In earlier generations, a homeless person was often a hobo, and the local police station was the most likely place to find temporary housing. In the second meaning of the word, "homeless" describes someone who lacks a sense of belonging to a particular place and who has little or no connection to a community.

In the rural- and small-town society of the nineteenth century, family was strongly linked with place. Home was the basis for community and social order, and traditions of people helping each other and joining together to control troublesome behavior grew out of this sense of place. To be homeless was to be unattached, outside this web of support and control. It was also to be without the resources necessary for living. Many of the young men and women who moved from farm to city, or those who emigrated during the nineteenth and early twentieth centuries, were unattached in this respect. In fact, such groups as the YWCA, YMCA, and various ethnic organizations were established both to help and oversee these "homeless" people.

By the 1840s, it was common for Americans to link homelessness with a habit of drunkenness. In the popular view, drunkards, usually men, drank up their wages and impoverished their families; they lost their jobs and their houses, and drove off their wives and children by cruel treatment. They became outcasts and drifters, and their wives entered poorhouses while their children became inmates of orphanages. By the 1890s, the public held the same ideas about people who abused drugs such as opium, morphine, and cocaine and the unhappy circumstances of their families.

The Effect of Homelessness on the Economy

Homelessness in the United States has often been the result of conditions beyond the control of the individuals themselves. Studies of homelessness prior to the Great Depression noted that the numbers of homeless people went up and down depending on economic conditions. Severe problems with the United States economy in the late- nineteenth and early-twentieth century caused large numbers of people to lose their jobs and thus their financial security.

Scholars investigating the problem of homelessness before the depression also noted the importance of employers' decisions about hiring and firing. When the economy soured, workers without families to support and workers seen as the least productive were the first

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to be fired. For example, employers assumed that single young women would be supported by their families and that married women did not really need a second income. Older men, single men known to drink heavily, and members of ethnic or racial minorities were more often marked for layoff. By contrast, in boom times employers relaxed their standards for hiring and job performance. All but the most seriously disabled, and the most unreliable heavy drinkers and drug users, could find some kind of work. As a result, when the economy was good, the numbers of the homeless shrank.

Working Conditions and Health Care

Pre-depression observers also emphasized the impact of other factors on homelessness, including working conditions, the health and strength of the worker, and the lack of government support for people who lost their income. Working conditions were often dangerous, and diseases such as tuberculosis affected large numbers of people. Many men became disabled by disease or workplace accidents, often at a young age. There was not much in the way of welfare to support people when they had lost their jobs. In addition, medical treatment at the time was often ineffective. As a result, these men rapidly sank into terrible poverty. They were forced to beg, find a meal at soup kitchens, and sleep in shelters or the cheapest lodgings infested with vermin. (These lodgings came to be called "flophouses.") Some of these men were heavy drinkers, and some were drug users. But these problems often grew out of the conditions of poverty and rootlessness.

Scholars of homelessness also realized that the urban areas where homeless people clustered, as well as the businesses—both legal and illegal—they were involved in, reinforced a homeless way of life. In these areas, called "hobohemias" before the depression and later "skid row," the poor and the homeless could find cheap restaurants, saloons, residential hotels and lodging houses, private and eventually public welfare agencies, and agencies that listed opportunities for "day" work. They could also find a flourishing drug trade in many corners of skid row.

By the 1940s, skid row was where poor single men disabled by age, injury, and/or chronic illness wound up. They survived on private charity, small allowances from public welfare, modest pensions, and a bit of income from odd jobs. It is important to note that these men were not homeless in the sense of having no place to live. However, they were homeless in the sense of remaining outside the bounds of society. Contrary to popular belief, only a minority—perhaps one-third—were heavy drinkers and drug users.

New Government Programs and Policies

The period from 1941 to 1973 was a time of prosperity in the United States. During the same period, the government increased welfare programs, such as Medicare, affordable housing, and benefits for the disabled. New programs to help heavy drinkers and drug users were created, and local governments began investing in projects to clean up urban areas and give new life to cities. Many observers believed that skid row would disappear.

One important result of these changes was to improve the economic circumstances of the elderly. Today, very few of the homeless are elderly. Other results were not as people had hoped. Some cities bulldozed their skid-row area. But the people driven out of skid row did not go on to find other, better housing or better lives. In fact, homelessness became a literal condition: the poor had no houses to live in.

In the early 1980s the media began to report on a new generation of younger homeless people. These people appeared to have high rates of mental illness, heavy drinking, and drug use. As a result, many observers explained the new homelessness as a result of policies that concerned mental hospitals and imprisonment for public drunkenness and minor drug offenses. During the 1960s and 1970s many states "deinstitutionalized" both mentally ill people and alcoholics and addicts. In other words, large numbers of state hospital patients were released. New laws made it much harder to commit a person involuntarily to a mental institution.

Many states also "decriminalized" public drunkenness. People who were drunk in public were sent to places where they could sober up rather than to jail. Similarly, many minor drug offenders were kept out of jails. Homelessness was described by many as a condition in which troubled and troublesome people found themselves. They were not only houseless, they were barred from institutions that had once sheltered them.

Current Situation

Some recent studies of homelessness continue to claim that perhaps 85 percent of homeless people are substance abusers and/or mentally ill. However, these studies have a serious flaw. Their estimates of substance abuse and mental illness rely on measurements of lifetime substance abuse, rather than measurements of current substance abuse. A measure of whether a person has ever had a severe mental illness or substance abuse disorder will always produce much higher rates than a measure of a current disorder (defined as occurring within the previous six months or one year of the study).

Probably a more accurate estimate, provided by the Substance Abuse and Mental Health Services Administration, is that about a third of the homeless people in the United States have serious mental illness, and more than half also have an alcohol and/or drug problem. The proportion is much higher among single men and much lower among adults who are homeless in family groups, most often single women with children.

Heavy drinking, drug use, and mental illness are certainly risk factors that make it more likely that some people will become homeless. Yet clearly most people with such problems never become homeless. To explain homelessness, then, other risk factors must be considered as well. These factors were first discussed a century ago, and still apply to the modern problem of homelessness. These factors include changes in the economy, the supply of available and affordable housing, the availability of support systems such as welfare and medical care, and whether a person has the support of his or her family.

An additional factor contributing to homelessness in the late- twentieth century was the size of the baby-boom generation. The risk for developing mental-health, alcohol, and drug problems is greatest between the ages of 18 and 25. The huge baby-boom generation reached this age at the same time as the supply of jobs, housing, and other material goods was becoming scarce.

Changes in the Economy. Changes in the economy have increased the number of highly skilled, well-paid technical jobs (such as those in the field of computers) and low-skilled, poorly paid service jobs (such as those in the fast-food industry). At the same time, these changes have reduced the number of semiskilled, well-paid jobs in the field of manufacturing. This shift from a manufacturing to a service economy is known as deindustrialization. Hardest hit by this shift are the younger members of the huge baby-boom generation (born between 1946 and 1964), especially Hispanics and African Americans. People in this group may lack the advantage of higher education or advanced technical training when they try to find work. They are not qualified for highly skilled work but cannot make a decent living in service jobs. People who work for low hourly wages are sometimes called the "working poor." Although many of these people work very hard, they remain poor and vulnerable to losing their housing.

Housing. Along with changes in the job market, the cost of rental housing rose sharply in the 1980s. The amounts of aid given by federal and state welfare programs and unemployment insurance did not rise enough to meet these costs. As a result, it became increasingly difficult for poor families to establish and maintain households.

The 1990s were a time of economic growth. However, this prosperity did not lessen the problem of homelessness. The general prosperity of the decade had little effect on the poorest members of society. In addition, economic expansion usually has the effect of increasing rents. The number of low-rent apartments decreased by 13 percent from 1996 to 1998. At the same time, the Department of Housing and Urban Development provided assistance to fewer households. The crisis in affordable housing became worse during the great boom.

People with serious mental illness are overrepresented among the homeless population. While only 4 percent of the U.S. population has serious mental illness, five to six times as many people who are homeless (20–25%) have serious mental illness, and many more have milder forms of mental health problems. The reasons for this over- representation are complex. Some mentally ill people are homeless because they were released from institutions or hospitals, or have not been hospitalized despite a need. Moreover, since they have trouble keeping a job, they are often poor or financially unstable, and they receive little or no health care. Thus, their symptoms are often active and untreated, making it very difficult for them to negotiate meeting basic needs for food, shelter, and safety. Up to half of the mentally ill homeless also have substance use problems, which can make it harder to obtain a stable living situation. Also, according to the National Resource Center on Homelessness and Mental Illness, people with serious mental illnesses have greater difficulty exiting homelessness than other people. They are homeless more often and for longer periods of time than other homeless subgroups. Many have been on the streets for years. Numerous government and private agencies have proposed plans to reduce and eventually prevent the problem of homelessness among the mentally ill, but progress will likely be slow.

Conclusion

Every night in the United States, about 750,000 people are homeless. In a year, between 2.5 million and 3.5 million people experience homelessness for some period of time (days to months). Among people who remain homeless for long periods, rates of heavy drinking and drug use are very high. It is not the case, however, that drinking and drugs directly cause homelessness. Drinking and drug use may cause health problems and troublesome behavior, such as criminal activity. These health and behavior problems contribute to job loss, loss of family support, or loss of housing. Problems in the economy worsen these circumstances. In addition, far fewer people who need care and treatment for mental-health and addiction problems can turn to institutions as a place to live during recovery. As a result of many factors other than drinking and drugs, the homeless became a visible problem on the streets of American cities.

see also Alcohol: History of Drinking; Alcohol- and Drug-Free Housing; Poverty and Drug Use; Risk Factors for Drug Abuse; Treatment: History of, in the United States.

Homelessness

Definition

Description

Demographics

Causes and consequences

Homeless service agencies

Homelessness in context

How to help the homeless mentally ill

Resources

Definition

In the United States, definitions of homelessness help determine who is able to receive shelter and assistance from certain health and social service providers.

The Stewart McKinney Homeless Assistance Act of 1987 defines a homeless person as any individual who lacks housing, including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations or an individual who is a resident in transitional housing. More specifically, this means an individual who lacks fixed, regular, and adequate nighttime residence, and an individual who has a primary nighttime residence that is either (i) a supervised temporary living shelter (including transitional housing for the mentally ill), (ii) an institution that provides temporary residence for individuals intended to be institutionalized, or (iii) a place not designed for or ordinarily used as a regular sleeping accommodation for human beings.

Description

Homelessness is an acute version of residential instability, which can be compared or contrasted with definitions of poverty. Thus the term “homeless” may also be extended to include people who have nowhere to go and are at imminent risk of losing housing through eviction or institutional discharge. Some definitions of homelessness further specify the duration of time without regular and adequate residence, or the types of temporary living shelter or institutions that are not fixed residences. People who live without alternatives in overcrowded or unhealthy housing conditions may be at risk of homelessness. Worldwide, national and cultural groups may have variable and often different definitions of homelessness, different terms for the condition of being without housing, and different definitions of adequate housing. For all of these reasons related both to methods of counting and varying definitions, estimating the size of the homeless population is extremely difficult.

The history of homelessness is intertwined with the history of poverty in the United States. Poverty has always been problematic for humanitarian reasons and because it conflicts with the ideal of prosperity for all. Social welfare, based on individualistic ideas of deserving and undeserving poor, has improved society but not eliminated persistent poverty or homelessness. The 1960s war on poverty was a widely shared value, but in the 1980s concern about homelessness was confounded by moral evaluations of individual behaviors. While many in the United States have been poor or come from poor families, fewer have experienced homelessness. Therefore, the collective understanding of homelessness in the United States is limited in ways that the understanding of poverty is not.

Homeless adults are poor and have high rates of unmet need for health care. This is in part because poverty is associated with higher risk and rates of illness, particularly mental illnesses including substance abuse. Homeless people experience disproportionate rates and symptoms of mental health disorders, including substance abuse disorders and dual diagnoses. For these reasons, large portions of federally funded homeless services are medical services, and homeless people are often viewed according to their present or past medical classifications.

Studies researching the incidence, distribution, and control of a disease in a population (known as epidemio-logical studies) find that between one-third and one-half of homeless people have mental health disorders and approximately two-thirds have either a mental health or substance use disorder. People with severe mental illness are likewise more likely to become homeless, particularly when the disorder is co-morbid (co-occurs) with substance abuse. For this reason, changes in rates of homelessness are often associated with changes in mental health care and hospitalization policies.

Mental illnesses compound the vulnerability and needs of homeless adults, as reported by the Surgeon General. Psychiatric disorders exacerbate many types of problems, including housing instability, morbidity (disease), and mortality (death). Psychiatric disorders and lack of stable living conditions complicate general health care for homeless adults.

Demographics

Methods for estimating the size of the homeless population are evolving and sometimes contested, and are complicated by varying definitions of homelessness. The U.S. Census, while attempting to identify the number of people who are homeless and who use particular types of homeless services, has complex and service-based definitions of homelessness. It also has recognized its limited abilities to define and enumerate the homeless (it is after all a national household survey). In 2000, the Census Bureau defined the Emergency and Transitional Shelter (E&TS) population by surveying people who use a sample of homeless services. They counted homeless people in emergency shelters for adults, runaway youth shelters, shelters for abused women and their children, soup kitchens, and certain outdoor locations. Technically, however, homeless people may reside in “E&TS,” in foster care, in jails and prisons, in group homes , in worker dorms, non-sheltered in the outdoors, doubled up with families or friends, or temporarily in Census-recognized households. According to the National Coalition for the Homeless, while counting the number of people who use services such as shelters and soup kitchens can yield important information about services, applying these numbers toward estimating numbers of homeless people can result in underestimates of homelessness.

Further complicating the issue of counting homeless people is the fact that, in many cases, homelessness is a temporary condition. Because of this fact, some researchers advocate a method of counting all the people who are homeless in a given week or, alternatively, over a given period of time. However, the numbers of people who find housing and the number of people who newly find themselves homeless fluctuates over time periods. In contrast, people with mental illness or substance abuse problems tend to be chronically without homes—it is difficult for many of these people to find permanent housing. Thus, while these two time-oriented methods of counting homeless can be useful, they too have statistical problems—they can overestimate the numbers of homeless people.

Census estimates of the size and composition of the homeless population are difficult to create, for reasons described above. The Emergency and Transitional Shelter (ET&S) Population count in the United States in 2000 was 170,706. However, this figure does not include homeless adults not using ET&S services, sampling error, or some groups of homeless people not enumerated in the ET&S count. The ET&S population in 2000 was 61% male and 74% adult. Among the 26% who were youth, 51% were male. For adults, the population was 65% male, 41% were white, 40% were African American, 20% were Latino of any race, 2% were Asian, 2% were Native American, and 9% were one other race alone.

Another estimate of homelessness is a 2007 report by the National Alliance to End Homelessness, which estimated that 744,313 people were homeless in 2005. Forty-four percent of those people were unsheltered, and 56% were sheltered. Forty-one percent of the homeless were families.

The large variation between these estimates illustrates that, as the National Coalition for the Homeless states, “By its very nature, homelessness is impossible to measure with 100% accuracy.”

Causes and consequences

Causes

People with mental illness are at higher risk for becoming homeless due to challenges associated with deinstitutionalization and transition planning, and both poverty and disability associated with mental illness.

Social research has studied the causes and consequences of homelessness, surveying homeless people, examining entrances into homelessness, exits from homelessness, and effects of homelessness on health and well-being. Promising explanations for increasing rates of homelessness in the 1980s have included mental disability and illness, lack of social support through jobs and marriage, increased use of drugs and alcohol, and the erosion of low-income housing in urban areas. These explanations mirror the processes of deinstitutionalization in mental health policy, unemployment, addiction and abuse, and urban decay. In other words, a direct correlation can be demonstrated between policies and trends and the rates of homelessness. As deinstitutionalization occurred, for example, the number of mentally ill people without homes increased.

Consequences

Consequences of homelessness include the exacerbation of problems that may have caused homelessness. Homeless people have reduced access to housing, jobs, health care, and basic needs like food and clothing. Isolation and lack of social support are well-documented aspects of homelessness, particularly for homeless people living with mental health or substance abuse disorders. Homeless women and men have been found to have significantly less family support than never-homeless women and men. Disaffiliation from family often limits opportunities for recovery and prevention.

Homeless service agencies

Services for homeless people can be divided into those providing medical care, those providing housing, and those providing other basic needs. Publicly funded agencies provide the majority of medical care, especially primary and mental health care. Public and private organizations share the responsibilities of providing shelter and housing services, through both large federal programs and smaller need and faith-based programs. Private agencies deliver most other daily needs to homeless people, through food pantries, soup kitchens, and other charities. Limited data exists on vocational services for homeless adults.

Title VI of the McKinney Homeless Assistance Act of 1987 created the Health Care for the Homeless (HCH) program, authorizing federal funds for primary and mental health care to homeless people. Title VI authorizes several programs to provide a HCH program, a Community Mental Health Services block grant program, and two demonstration programs providing mental health and alcohol and drug abuse treatment services to homeless people. HCH funds support providers who offer mental health, case management , and health education services, as well as substance abuse treatment. In 1987, 109 grants were made for homeless health services with $46 million. In 1992, the Act was amended to include homeless and at-risk children, creating a medical home and source of health insurance for young people. In 2005, Congress appropriated $145 million for health care for the homeless grants. The HCH program is the largest single effort to address the medical needs of the homeless. Each year, the HCH Program serves almost 600,000 clients in the United States To be a HCH service agency requires cultural and linguistic competencies, compassionate community outreach, and providers who reflect the community they serve.

The federal Center for Mental Health Services oversees Projects for Assistance in Transition from Homelessness (PATH) grant program. PATH provides state funds in support services to individuals who are homeless or at risk of becoming homeless and have serious mental illnesses. These funds amounted to more than $52 million allocated to 463 providers in 2005. States contract with local agencies and nonprofit organizations to provide an array of services, including outreach, support services, a limited set of housing services, and mental health treatment.

There are several obstacles or barriers in providing health care to homeless people. First, homeless or persistently poor people may be concerned about their work and sustenance, devaluing their own medical needs. Alienation and depression among the homeless can also be an obstacle to providing care. There can be mutual communication problems between providers and patients. Providers may lack cultural understanding that eases work with homeless clients. Finally, lack of preventive maintenance of medical care by the homeless may result in expensive and extensive needs for care, including hospital care, which may stress the capacities of certain service providers.

Homelessness in context

Homelessness is both a form of poverty and an acute condition of residential instability. Homelessness is compounded by behavioral problems, mental health policy changes, disparities in health and health care, racial inequalities, fluctuations in affordable housing, and lack of social support. Overly individualistic views and explanations of homelessness do not reflect its multiple causes and effects. Like all groups, homeless people are diverse, experiencing and exiting homelessness for a myriad of reasons. Services for homeless adults likewise reflect a variety of needs and experiences. Nonetheless, homelessness remains a national and international concern, particularly in urban areas, for the twenty-first century.

KEY TERMS

Deinstitutionalization — The process of moving people out of mental hospitals into treatment programs or halfway houses in local communities. With this movement, the responsibility for care shifted from large (often governmental) agencies to families and community organizations.

How to help the homeless mentally ill

There are many ways that Americans can support community and federal efforts to help homeless people living with mental illness. Some strategies include:

• support collective public and private efforts to build homes and provide health care for people with unmet medical needs.
• become educated about the challenges faced by homeless and mentally ill people in American society.
• stop the practice of equating people in poverty and with illness with their medical conditions, instead of recognizing them as human beings. Succeeding in this step could open doors for recovery of health and housing without demeaning the humanity of people in need.

Resources

BOOKS

Burt, M., L. Aron, and others. Homelessness: Programs and the People They Serve. Washington, D.C.: U.S. Department of Housing and Urban Development, 1999.

Daly, Gerald. Homeless. New York: Routledge, 2005.

Hombs, Mary E. American Homelessness. Santa Barbara, CA: ABC-CLIO, 2001.

ORGANIZATIONS

National Alliance for the Mentally Ill (NAMI). Colonial Place 3, 2107 Wilson Blvd., Suite 300, Arlington VA, 22201-3042. Telephone: (703) 524-7600 or (800) 950-6264. <http://www.nami.org>.

National Coalition for the Homeless. 2201 P Street, NW, Washington, DC 20037. Telephone: (202) 462-4822. <http://www.nationalhomeless.org/>.

National Coalition for Homeless Veterans. 333 1/2 Pennsylvania Ave., SE, Washington, DC 20003-1148. Telephone: (800) 838-4357. <http://www.nchv.org>.

National Health Care for the Homeless Council. P.O.Box 60427, Nashville, TN 37206-0427. Telephone: (615) 226-2292. <http://www.nhchc.org/>.

National Institute of Mental Health. 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 20892-9663. Telephone: (301) 443-4513. <http://www.nimh.nih.gov>.

Substance Abuse and Mental Health Services Administration (SAMHSA). 1 Choke Cherry Road, Rockville MD 20857. <http://www.samhsa.gov>.

U.S. Department of Housing and Urban Development. 451 7th Street S.W., Washington, DC 20410. Telephone: (202) 708-1112. <http://www.hud.gov>.

Michael Polgar, PhD
Stephanie N. Watson