The Homeless Mentally Ill in Germany.

In recent discussions about the health status of the homeless in Germany, there has been an increasing interest in the extent to which mental health disorders are appearing in this heterogeneous population. It has been argued that the growth in the homeless population has been paralleled by an increase in the numbers of single homeless people suffering from severe mental disorders. Consequently, several studies have been conducted in Europe and elsewhere during the last few decades to assess the mental health status of the homeless population. In Germany, however, there is still a lack of valid, epidemiologically based and representative data in this area. This paper focuses on the unique problems of homeless people with mental health problems in Germany who typically have multiple needs for adequate treatment and rehabilitation. Some have suggested that specific psychiatric education should be encouraged or expanded and that comprehensive and sensible service responses that allow for easily accessible and unrestrictive mental health services should be developed. There is an additional need to improve cooperation on a case-management basis between counseling centers for the homeless and healthcare institutions in order to deal effectively with the complex problems associated with homelessness. Efforts targeted at the prevention of homelessness should also be strengthened. Because of their deprived living conditions, homeless persons are seriously at risk of developing physical and/or psychological or mental morbidity. Studies from North America [1-3] and various European countries [e.g., 4] have reported elevated rates of severe mental health problems among this population, especially substance abuse disorders. However, it is difficult to generalize these results to Germany because of profound differences in health-care systems and the socioeconomic context. In Germany every citizen is covered by comprehensive health-insurance plans. A homeless person in need... [ABSTRACT FROM AUTHOR]