Chronically homeless people also experienced far less improvement in psychological stress while in treatment than those categorized as transitionally homeless or who had housing, according to researcher Stefan Kertesz and colleagues.

"Emotional distress and limitations in functioning among the chronically homeless are driven by a host of factors that go well beyond mental illness and addiction, even when addiction is part of the problem," said Kertesz, assistant professor of preventive and general internal medicine at the University of Alabama at Birmingham.

The authors drew their conclusions from a two-year survey of 274 homeless people entering public detox programs in Boston. All study participants had worse-than-average physical health and very poor mental-health status. But, "People who were housed showed a very nice improvement over the subsequent two years," Kertesz said. "People who were chronically homeless showed only a small improvement over the subsequent two years, and those who were transitionally homeless fell between these two extremes."

Kertesz recommended that treatment programs determine at intake whether clients are chronically homeless. "The chronically homeless failed to show anything like the mental state improvement shown in housed individuals," Kertesz said. "Chronically homeless people represent a distinctly vulnerable subgroup among people going into addiction treatment."

The research demonstrates that "a person who is experiencing chronic homelessness generally has a more complex set of treatment needs than other people," said Philip Mangano, executive director of the U.S. Interagency Council on Homelessness.

The study appears in the June 2005 issue of the journal Medical Care.

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