In 1987, in response to reports of large numbers of veterans among America's homeless, the Department of Veterans Affairs established two new national health care initiatives, which have seen over 40,000 homeless veterans since their inception. We present here evaluation and treatment data on a sample of 14,000 of them. Because of differences in their design, the two programs vary in the degree to which they emphasize community outreach, homelessness prevention, and the provision of aftercare services to patients discharged from other VA programs. In spite of these differences, veterans treated in the two programs have similar health care problems and show similar degrees of improvement at the conclusion of residential treatment. About one third of those admitted complete residential treatment successfully; one third are known to be in stable community housing at the time of discharge; and more than one third are employed. These modest success rates reflect both the severity of psychiatric disorder and social dysfunction in this population, and the limited ability of health care programs to address the full range of problems faced by the homeless mentally ill, even when services are specifically tailored to meet their needs. In designing programs for the homeless, it is particularly important to link health care efforts directly with sustained vocational rehabilitation services, housing subsidies, and income supports. New VA initiatives in all three of these areas have been undertaken and are described.



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