HOMELESSNESS

For some, homelessness is a temporary condition; but for others, homelessness is a more permanent situation. The National Law Center on Homelessness and Poverty estimates that about 1% of the U.S. population experiences homelessness in any year. Homeless people may be living on the streets, in shelters, or with relatives or friends. Most homeless people live in urban areas. VA reports that about one-third of the adult homeless population in the United States served in the armed forces at some point. That means that on any given day, 200,000 men (and women) veterans are in need of shelter, food, medical care, and other essentials. Many homeless veterans are Vietnam-era veterans, although veterans of other periods are also homeless or at risk of being homeless. It is estimated that almost half the homeless veterans have some form of mental disorder, almost 70% have a substance-use disorder, and over half are black or Hispanic (VHA 2006).

The committee reviewed 10 studies regarding deployment and homelessness. Three were designated as primary and seven secondary. The primary studies are summarized in Table 7-2.

Primary Studies

The three studies that were designated as primary used data from the NVVRS (Rosenheck and Fontana 1994) or from community surveys (Gamache et al. 2001; Rosenheck et al. 1994). Subjects were viewed as more representative of U.S. veterans than subjects in the secondary studies. The secondary studies—Gamache et al. (2000, 2003), Mares and Rosenheck (2004), Rosenheck et al. (1991, 1992), Tessler et al. (2002), and Wenzel et al. (1993)—relied primarily on homeless subjects who were mentally ill.

Rosenheck and Fontana (1994) reanalyzed data from the NVVRS on 1460 male Vietnam veterans to model the risk of homelessness on the basis of premilitary personal experiences, exposure to war-zone stress, current PTSD, other psychiatric disorders, and substance abuse. Veterans surveyed in the NVVRS who had never been homeless served as a control group for comparison with the 8.4% of the sample who did report homelessness since the war. Structural-equation modeling was used to determine the influence of 18 hypothesized risk factors. Risk ratios ranged from a low of 1.0 (95% CI 0.7-1.4) for being a member of a minority racial or ethnic group to the three highest risk ratios: 5.0 (95% CI 3.5-7.2) for PTSD, 5.3 (95% CI 2.0-14.2) for being in foster care when young, and 6.5 (95% CI 1.9-22.5) for having psychiatric treatment before age 18. The modeling showed that four postmilitary factors—psychiatric disorder other than PTSD, not being married, substance abuse, and low levels of support—were directly related to homelessness, but PTSD was not; its effect was mediated through other psychiatric disorders. Combat exposure and participation in atrocities were associated with increased risk of homelessness—risk ratios were 2.1 (95% CI 1.5-3.0) and 2.7 (95% CI 1.9-3.8), respectively—but their effects on homelessness were also mediated through psychiatric disorders. Social support during the year after discharge was the most important variable in risk of homelessness in the model.

Rosenheck et al. (1994) used data from four community surveys to determine whether male veterans, in general, were disproportionately represented among homeless people or whether vulnerability to homelessness was peculiar to one age or race cohort of veterans. Secondary analyses were performed on data from the Urban Institute’s 1987 national survey of homeless-service users (n = 1140) and from single-city surveys conducted in Los Angeles (n =



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