Homeless and mentally ill - A review of recent research on a double disadvantaged minority

There are about 200 000 homeless persons in Germany, 35 000 of them living on the streets. They suffer from unemployment, poverty, social isolation an d physical impairments. More than two-thirds of them suffer from mental ill ness as well. Substance abuse predominates, but also schizophrenic and affe ctive disorders and personality disorders show a higher prevalence than amo ng the general population. Comorbidity is found frequently. However, mental disorders are just one of several factors contributing to the process of b ecoming homeless. Due to the complex combination of mental, physical, socia l and economic problems of the homeless mentally ill psychiatric care is no t sufficient. Yet recent US studies show that a combination of multimodal c linical measures and a network of outpatient assistance can improve both ph ysical and mental health and the social situation. Having established relia ble epidemiological data, future research should concentrate on analysing t he influence of homelessness on mental health, and on planning and evaluati ng specific programmes for the homeless mentally ill.