In recent years, a distinct subgroup of homeless persons, the dually diagnosed, has emerged. This group evidences both severe mental health problems and drug and alcohol abuse. According to the experience of a large mental health agency, the engagement phase is the critical phase for the provision and acceptance of care. This article utilizes the symbolic-interaction approach as a framework to explain and guide encounters of outreach workers with dually diagnosed homeless persons. Case examples are presented and practice recommendations are discussed.
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References
1.
AxelrodS. E., & ToffG. E. (1987). Outreach services for homeless mentally ill people.Washington, DC: Intergovernmental Health Policy Project.
2.
BakerF., & WeissR. S. (1984). The nature of case manager support. Hospital and Community Psychiatry, 35, 925–928.
3.
BarrowS.StruthenE.PlapingerJ.HemlammF., & LovellA. (1986). Effectiveness of services for the mentally ill homeless.New York: New York State Psychiatric Institute.
4.
BaxterE., & HopperK. (1982). The new mendicancy: Homeless in New York City. American Journal of Orthopsychiatry, 52, 343–408.
5.
BelcherJ. R. (1988a). Are jails replacing the mental health system?Community and Mental Health Journal, 24, 185–195.
6.
BelcherJ. R. (1988b). Rights versus needs of homeless mentally ill persons. Social Work, 33, 398–402.
7.
BelcherJ. R., & EphrossP. H. (1989). Toward an effective practice model for the homeless mentally ill. Social Casework, 70, 421–427.
BreakeyW. R. (1987). Recent empirical research on the homeless mentally ill. In DennisD. (Ed.), Research methodologies concerning homeless persons with serious mental illness and/or substance abuse disorders (pp. 27–38). Washington, DC: U.S. Government Printing Office.
10.
CohenM. B. (1989). Social work practice with homeless mentally ill people: Engaging the client. Social Work, 34, 505–509.
11.
CooleyC. H. (1902). Human nature and the social order.New York: Scribner.
12.
CrystalS.LadnerS., & TowberR. (1986). Multiple impairment patterns in the mentally ill homeless. International Journal of Mental Health, 14(4), 61–73.
13.
DennisD. (1987). Research methodologies concerning homeless persons with serious mental illness and/or substance abuse disorders.Washington, DC: U.S. Government Printing Office.
14.
DockettK. H. (1989). Street homeless people in the District of Columbia: Characteristics and service needs.Washington, DC: University of the District of Columbia.
15.
DrakeR., & AdlerD. (1984). Shelter is not enough: Clinical work with homeless mentally ill. In LambH. R. (Ed.), The homeless mentally ill (pp. 141–152). Washington, DC: American Psychiatric Association.
16.
EstroffS. E. (1989, June 13–17). In search of missing persons: Listening to narratives of self and mental illness. Paper presented at the 14th International Association of Psychosocial Rehabilitation Services Conference, Miami.
17.
GalanterM., & CastanedaR. (1988). Substance abuse among general psychiatric patients: Place of presentation, diagnosis and treatment. American Journal of Drug and Alcohol Abuse, 14, 211–235.
18.
GardnerJ. (1984). The homeless. Psychosocial Rehabilitation Journal, 8(1), 17–20.
19.
GelbergL.LinnL., & LeakeB. (1988). Mental health, alcohol and drug use, and criminal history among homeless adults. American Journal of Psychiatry, 145(2), 510–516.
20.
HagenJ. L. (1987). The heterogeneity of homelessness. Social Casework, 68, 451–457.
21.
HellersteinD., & MeehanB. (1987). Outpatient group therapy for schizophrenic substance abusers. American Journal of Psychiatry, 144, 1337–1339.
22.
HopperK. (1984). Whose lives are these, anyway?Urban and Social Change Review, 17, 12–13.
23.
KoegelP., & BurnamM. A. (1987, October 18–22). Subsistence patterns among homeless adults in the inner-city of Los Angeles. Paper presented at the annual meeting of the American Public Health Association, New Orleans.
24.
KofoedL.KaniaJ.WalshT., & AtkinsonR. M. (1986). Outpatient treatment of patients with substance abuse and coexisting psychiatric disorders. American Journal of Psychiatry, 143, 867–872.
25.
KnisleyM. (1989, June). A multi-organizational view of systems issues, barriers to effective service delivery, and strategies for creating workable, integrated treatment models. Paper presented at Eastern Pennsylvania Psychiatric Institute of the Medical College of Pennsylvania.
26.
LehmanA. F.MyersC. P., & CortyE. (1989). Assessment and classification of patients with psychiatric and substance abuse syndromes. Hospital and Community Psychiatry, 40, 1019–1025.
27.
LevineI. S. (1984). Service programs for the homeless mentally ill. In LambH. R. (Ed.), The homeless mentally ill (pp. 173–200). Washington, DC: American Psychiatric Association.
28.
LindsmithA., & StraussA. (1968). Social psychology.New York: Holt Rinehart.
29.
LinkB. (1987). Understanding labeling effects in the area of the mental disorders: An empirical assessment of the effects of expectations of rejection. American Sociological Review, 52, 96–112.
30.
McClellanA. T.LuborskyL.WoodyG.O'BrienC. P., & DruleyK. A. (1983). Predicting response to alcohol and drug abuse treatment. Archives of General Psychiatry, 40, 620–625.
31.
MartinM. A., & NeyowithS. A. (1988). Creating community: Groupwork to develop social support networks with homeless mentally ill. Social Work with Groups, 11(4), 79–93.
32.
MilburnN. G., & BoothJ. (1988, November 13–17). Drug abuse among sheltered homeless people: Preliminary findings from Washington, DC sample. Paper presented at the 116th Annual Meeting of the American Public Health Association, Boston.
33.
OsherF. (1989). The dually diagnosed: Patient characteristics and treatment strategies. Community Support Network News, 5(4), 1, 10–11.
PlapingerJ. D. (1988). Program service goals: Service needs, service feasibility, and obstacles to providing services to the mentally ill homeless.New York: New York State Psychiatric Institute.
36.
RidgelyM. S.GoldmanH. H., & TalbottJ. A. (1986). Chronic mentally ill young adults with substance abuse problems.' A review of relevant literature and creation of a research agenda.Baltimore: University of Maryland.
37.
RidgelyM. S.OsherF., & TalbottJ. (1987). Chronic mentally ill with substance abuse problems: Treatment and training.Baltimore: University of Maryland.
38.
RogD. J. (1988). Engaging homeless persons with mental illness into treatment.Alexandria, VA: National Mental Health Association.
39.
RossiP.WrightJ.FisherB., & WillisG. (1987). The urban homeless: Estimating composition and size. Science, 234, 1336–1371.
40.
SaferD. (1987). Substance abuse by young adult chronic patients. Hospital and Community Psychiatry, 38, 511–514.
41.
SchuttR., & GarrettG. (1988). Social background, residential experience and health problems of the homeless. Psychosocial Rehabilitation Journal, 12(3), 67–70.
42.
SegalS. P., & BaumohlJ. (1980). Engaging the disengaged: Proposals on madness and vagrancy. Social Work, 25(5), 358–364.
43.
SheetsJ. (1982). Young adult chronic patients: Three hypothesized subtypes. Hospital and Community Psychiatry, 33, 197–203.
44.
SnowD. A., & AndersonL. (1987). Identity work among the homeless: The verbal construction and avowal of personal identities. American Journal of Sociology, 92, 1336–1371.
45.
StineO. C.FischerP. J., & BreakeyW. R. (1988, November 13–17). Co-morbid physical problems of homeless mentally ill persons in Baltimore. Paper presented at the 116th Annual Meeting of the American Public Health Association, Boston.
46.
StraussJ. S. (1989). Subjective experiences of schizophrenia: Toward a new dynamic psychiatry. Schizophrenia Bulletin, 15, 179–187.
47.
TesslerR. C., & DennisD. (1989). A synthesis of NIMH funded research concerning persons who are homeless and mentally ill.Washington, DC: National Institute of Mental Health, Division of Educational and System Liaison.
48.
TurnerR. H. (1976). Ambiguity and interchangeability in role attribution. American Sociological Review, 41, 468–477.
49.
WhiteK. K., & WhiteD. E. (1989). Dual mental health and substance use problems: A model of four subtypes. Psychosocial Rehabilitation Journal, 13, 93–98.
