THE HOMELESS VET AND YOU

 

 

AMERICAN PUBLIC HEALTH ASSOCIATION (APHA) CASE STUDY

Causes of death among homeless and non-homeless veterans

By  Wesley J. Kasprow, PhD, MPH and Robert A. Rosenheck, MD. Northeast Program Evaluation Center /182, Department of Veterans Affairs. In a 1998  APHA study report Kasprow & Rosenheck compared mortality rates in a cohort of homeless veterans (N=6,714) nine years following entry into a Department of Veterans Affairs specialized homeless program to mortality in a cohort of non-homeless veterans (N=1,715) treated in the Department’s specialized PTSD programs. Relative to non-homeless cohort members, higher mortality rates were observed in certain subgroups of the homeless cohort, especially those veterans aged 55 and older, even when salient influences on mortality (e.g., medical problems, employment history, minority status) werecontrolled in the analyses. The study to be reported at APHA 2000 builds on these findings by adding an analysis of cause of death. Records from the cohort were submitted to the National Death Index, and cause of death was abstracted. Differences among homeless and non-homeless cohort members with respect to cause of death will be presented. Implications for homeless services will be discussed.

BACKGROUND

Approximately 40% of homeless men are veterans, although veterans comprise only 34% of the general adult male population. The National Coalition for Homeless Veterans estimates that on any given night, 271,000 veterans are homeless per the National Coalition for Homeless Veterans, 1994. 

Despite the overrepresentation of veterans in the homeless population, homelessness among veterans is not clearly related to combat military experience. Rather, studies show that homeless veterans appear less likely to have served in combat than housed veterans (Rosenheck, 1996). 

Similarly, despite the widespread perception that Vietnam-era veterans constitute the majority of homeless veterans, research indicates that the veterans who are atgreatest risk of homelessness are those who served during the late Vietnam and post-Vietnam era (Rosenheck, 1996). These veterans had little exposure to combat, but appear to have increased rates of mental illness and addiction disorders, possibly
due to recruitment patterns. Faced with a lack of affordable housing, declining job opportunities, and stagnating wages (see "Why are People Homeless?," NCH Fact Sheet #1), people with these disabilities are more vulnerable to homelessness. 

DEMOGRAPHICS

Homeless veterans are more likely to be white, better educated, and previously or currently married than homeless nonveterans (Rosenheck, 1996). 

Female homeless veterans represent an estimated 1.6% of homeless veterans. They are more likely than male homeless veterans to be married and to suffer serious psychiatric illness, but less likely to be employed and to suffer from addiction disorders. Comparisons of homeless female veterans and other homeless women have found no differences in rates of mental illness or addictions. 

Minorities are over represented among homeless veterans, just as they are among the homeless population in general. However, there is some evidence that veteran status reduces vulnerability to homelessness among Black Americans. Black non-veterans are 2.9 times more likely to be homeless than white non-veterans; Black veterans, on the other hand, are 1.4 times more likely to be homeless than white veterans
(Rosenheck, 1996). The reduced risk of homelessness among Black veterans is most likely the result of educational and other benefits to which veterans are entitled, and thereby provides indirect evidence of the ability of government assistance to reduce homelessness. 


Special Characteristics

Veterans deal with problems in addition to homelessness. They have more health problems and physical disabilities (often service related), which may prevent them from working (Wright); a higher rate of drug and alcohol abuse than the rest of the homeless population; and a higher incidence of psychiatric disorders, most notably Post Traumatic Stress Syndrome.

Additionally, some are dually diagnosed with both substance abuse and psychiatric disorders. Rosenheck cites a study that showed both psychiatric and substance use disorders to be two to three times more common among those who served in the military. The study also cited antisocial personality disorders to be five to six times more common among veterans. Many developed substance and drug abuse habits during military service, with addictions increasing after discharge. Unemployment and extreme poverty then pushed them towards homelessness.

Veterans have more health problems and physical disabilities than the general population. One in five of these problems or disabilities is often war-related (Wright). These problems are in addition to an already difficult re-entry into mainstream society. Many veterans, particularly those from the Vietnam era, suffer from social isolation and lack of self-esteem and motivation.

JUST THE FACTS

About one-third of the adult homeless population have served their country in the Armed Services. On any given day, as many as
250,000 veterans (male and female) are living on the streets or in shelters, and perhaps twice as many experience homelessness at
some point during the course of a year. Many other veterans are considered near homeless or at risk because of their poverty, lack
of support from family and friends, and dismal living conditions in cheap hotels or in overcrowded or substandard housing.

Right now, the number of homeless male and female Vietnam era veterans is greater than the number of service persons who died
during that war -- and a small number of Desert Storm veterans are also appearing in the homeless population. At this time,
scientific studies indicate that there is no known, direct connection between military service, service in Vietnam, or exposure to
combat and any increased risk of becoming homeless. Family background, access to support from family and friends, and various
personal characteristics (rather than military service) seem to be the stronger indicators of risk of homelessness.

Almost all homeless veterans are male (about three percent are women), the vast majority are single, and most come from poor,
disadvantaged backgrounds. Homeless veterans tend to be older and more educated than homeless non-veterans. But similar to the
general population of homeless adult males, about 45% of homeless veterans suffer from mental illness and (with considerable
overlap) slightly more than 70% suffer from alcohol or other drug abuse problems. Roughly 56% are African American or
Hispanic.

Special Needs Assessment 

Homeless veterans do not fare well in programs designed for the general homeless population. Dropout and recidivism rates are high. Access to Veterans Administration benefits is also limited not null:

1. We determine through case study that The House of Grace will provide unemployment help, outpatient medical care, drug counseling, case management, and mental health counseling, primarily to veterans.

2. House of Grace Homeless shelter is partnership with Riverside County to provide  transitional shelter with case management, drug counseling, employment assistance, education and vocational training, mental health services, and meals. The proposed twenty beds will target veterans and/or substance abusers as well. 

3.In the future the House of Grace Homeless Shelter program plans to provide affordable housing and transitional housing to homeless veterans and well as our target goal of servicing families and youths. This program provides 23 beds of transitional housing to single male veterans.

4. In Riverside County, between the cities of  Temecula and Perris extending its borders to  San Bernardino there is a great need to support these fallen heroes. We appreciate  if you help us assist them with a helping hand and not a hand-out.

 

HOME