The study of service use among homeless persons with mental illness: a methodological review

Abstract

The objective of this paper is to critically review the methods used to study service use by homeless persons with mental illness, and discuss gaps in the evidence base and research implications. Searches were conducted of PsycINFO, MEDLINE, and PubMed to identify service use studies published between 2000 and 2014. Data were extracted on the types of services studied, quantification of service use, assessment tools, period of service use assessment, and analytic design. The review identified 27 studies described in 46 publications. The majority of the studies had observational designs that measured service use quantitatively as an outcome variable. Receipt or non-receipt and volume of use were the most common methods of quantifying service use. The types of services that have been examined primarily consist of formal mental health, primary health care, substance use, homelessness, and housing services. There is a considerable gap in the understanding of personal outcomes associated with use of services, as well as people’s experiences of using services. Specific to the homeless mentally ill population, there is an urgent need to better understand the role of service use in the attainment of stable housing and recovery from mental illness. In addition, less formal health and related services, such as peer support, have been largely excluded in service use research.