Section Five: Effectively Treating the Homeless Population
Homeless persons have higher rates of mental illness, substance abuse, and other medical conditions than the general population. A lack of social support, along with little or no insurance, often makes it harder for them to follow medical recommendations for treatment and recovery.
The following article1 presents the major medical issues faced by the homeless population and subsequent treatment considerations. This article is written for health care providers of all levels, and is particularly relevant for physicians who will encounter indigent patients in the emergency room or clinic.
Along with the medical concerns of the homeless population, physicians may be confronted with the dilemma of whether to treat the uninsured. Most homeless people do not have Medicaid or any other health insurance. E. Fuller Torrey, M.D., of Washington, D.C., states that “as physicians, we have a responsibility to work with people who can’t afford our services.” He suggests that, as a condition of licensure, physicians should be required to volunteer one hour per week at local clinics that treat homeless persons.2 Others, however, point out the risks of being overwhelmed by non-paying clients.
Health Care for the Homeless (HCH) is the only federally-funded health care program for the homeless population. HCH health and social service workers provide care at local clinics in 48 states, the District of Columbia, and Puerto Rico. Despite its effectiveness in treating homeless individuals, the project is too small to reach the large numbers of homeless in need of medical services. Currently, the program serves fewer than 500,000 homeless Americans.
The National Coalition for the Homeless (NCH) holds that universal health care coverage is the answer to the medical problems of the homeless population.3 But for now, at least, physicians will continue to encounter indigent patients and must determine how patient treatment should proceed, giving particular attention to the special needs of this population.
For more information on homelessness in the United States, contact:
- Health Care for the Homeless Information Resource Center, c/o Policy Research Associates, 262 Delaware Ave., Delmar, NY 12054-1123; 888-439-3300, ext. 246; firstname.lastname@example.org
- National Health Care for the Homeless Council, P.O. Box 68019, Nashville, TN 37206-8019; 615-226-2292.
- National Coalition for the Homeless, 1612 K St., N.W., Suite 1004, Washington, DC 20006-2802; 202-775-1322.
1. Jackson MP, McSwane DZ. Homelessness as a determinant of health. Public Health Nurs. 1992;9:185-192.
2. Ross TC. Where have all the doctors gone? Compassion for the indigent mentally ill people. PCRM Update Spring 1992;12-16.
3. National Coalition for the Homeless. “Health Care and Homelessness: NCH Fact Sheet #8.” October 1997. http://www2.ari.net/home/nch/health.html (19 Nov. 1997).