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To our knowledge, no published report has compared the prevalence of, risk factors for, and Elsa of mental health services among homeless and not-homeless persons treated for serious mental illnesses in a large public mental health system. In the present study, we used data from San Diego County's Adult Mental Health Services to evaluate the prevalence of homelessness, factors associated with homelessness, and effect of homelessness on mental health service utilization among patients treated for serious mental illness in county mental health services. We sought to test the following hypotheses: 1) Homelessness would be associated with younger age, male gender, minority ethnic group status, substance use disorder, lack of Medi-Cal (Medicaid in California) insurance, diagnosis of I Love You Lock charm necklace, and lower levels of functioning; and 2) homeless persons with serious mental illness would use more emergency-type and less outpatient-type mental health treatment, compared to not-homeless patients. We employed multivariate regression analyses to control for potentially confounding variables. We hoped to provide information that could be used by public policy makers and administrators of public mental health systems as they design, implement, and evaluate interventions to reduce or prevent homelessness among persons with serious mental illness treated in public mental health systems.

MethodSan Diego County is the sixth largest county in the United States and has a diverse ethnic composition. It is located on the United States-Mexico border, and the largest ethnic minority group is Latinos, who make up 23% of the adult population. Caucasians constitute 60% of adults, and African Americans and Asians Tiffany 1837 pendant account for 5% of adults (28). The San Diego Regional Task Force on Homelessness estimates that there are 15,000 homeless persons in San Diego on any given night, but only 4,200 shelter beds. Although the physical environment for homeless persons in San Diego is probably more benign in the winter, compared to colder areas of the country, it is fairly similar to that in other large sunbelt cities in the southern and southwestern United States, in which increasingly greater portions of the homeless persons in the United States live. A prior investigation of homeless individuals in San Diego found that 80% of the homeless people with mental illness had lived in San Diego for Paloma Picasso Loving Heart pendant than 5 years, with little seasonal migration in this group (29). Similar to other American cities, San Diego has an array of homeless shelters operated by religion-based and nonprofit groups (30).

The data used for this study were extracted from the county's Adult Mental Health Services database, which included demographic information (age, gender, ethnicity, and presence of Medi-Cal coverage) and clinical information, including psychiatric diagnosis, presence of substance use disorders, and Global Assessment of Paloma Picasso Loving Heart Pendant Scale (GAF) score. We used data from fiscal year 1999-2000, the latest year for which complete data were available.We included adults with a diagnosis of schizophrenia, bipolar disorder, or major depression who received treatment at least once during the year and had data recorded for ethnicity, living situation, and GAF score. We excluded persons in jails or in locked psychiatric facilities. Substance use disorder was categorized as present if any substance use diagnosis was assigned during the year. We used the average of the intake GAF scores across all Adult Mental Health Services encounters as a measure of patient functioning.