Homeless Veterans with Mental Illness: Predicting and Enhancing Recovery

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DESCRIPTION (provided by applicant): Homelessness in Veterans is a widespread problem and is a high priority at the national level. The 2010 Federal Strategic Plan to Prevent and End Homelessness has as one of its goals to "Prevent and end homelessness among Veterans in five years." The Supplemental Report to the 2009 Annual Homeless Assessment Report to Congress offered a bleak account of the status of homeless Veterans: On a single night in January 2009, 75,609 Veterans were homeless. Veterans are homeless at about twice the rate of non- Veteran adults in the U.S. A joint program between Housing and Urban Development (HUD) and the VA offers housing assistance and supportive services to homeless Veterans through the HUD - VA Supportive Housing (HUD-VASH) Program. This program is a tremendous accomplishment; however, housing status is a necessary, but not sufficient, condition for successful community integration. Other important facets of community integration include social connections with family and friends, participation in work and school, and activities of daily living (shopping, transportation. These aspects of community integration frequently remain unchanged after housing is achieved. For those with severe mental illness (SMI), such as psychotic disorders, rates of homelessness are 10-20 times higher than in the general population. Little is known about predictors of functional outcome within the very large group of homeless Veterans with SMI. The research aims for this project are to determine which specific factors (i.e., neurocognition, social cognition, or motivational variables) predict functional outcome in homeless Veterans with psychotic disorders. In the proposed 3-year study we will recruit 120 Veterans with a history of a psychotic disorder who are in the HUD- VASH program and assess their community integration over a 12 month period prospectively. The goal is to identify the primary determinant(s) of outcome to be included in a subsequent treatment study. The aims of the proposed project are based on previous research at the VISN 22 Mental Illness Research, Education and Clinical Center (MIRECC) at VA Greater Los Angeles Healthcare System (GLA) on predictors and determinants of functional outcome in SMI. When we complete this study we will know which factors are key determinant(s) of community integration in homeless Veterans with psychotic disorders and will have the necessary information to propose a larger intervention study. We view the current application as the start of a concentrated and systematic research program dedicated to improving the lives of homeless Veterans with SMI.