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 Medicine
and Society Curriculum Contents
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; nbrady@prainc.com
- 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.
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References
1. Jackson MP, McSwane DZ. Homelessness as a determinant
of health. Public Health Nurs 1992;9:185-92.
2. Ross TC. Where have all the doctors gone? Compassion for
the indigent mentally ill people. PCRM Update Spring 1992;12-6.
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).
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