Much of the work on homelessness being done by NKI began as part of a portfolio of projects directed at understanding the plight of "special populations" (homeless individuals involved with the legal system, and those with co-occurring substance abuse problems) in the mental health system. We focused on these groups because they constituted "sentinel conditions:" indicators of trouble at the mental health system's interface with such groups were seen as early warnings suggestive of pending difficulties in the larger public mental health system.

Substantial work in all three areas continues, but with a notable shift. The early studies tended to be population-based; the later ones explore more fully the cross-system dynamics of institutional ecologies. This shift occurred because it became increasingly evident that the defining labels attached to these groups often had as much to do with transient circumstances of livelihood, custody or care as they did with enduring personal traits. The description of an "institutional circuit" of subsistence among homeless persons with severe mental disorders in Westchester County (Hopper et al. 1997) is illustrative of the shift. The current and planned research portfolio extends this work to track the lives and map the institutional ecology of supportive housing residents, long-term shelter users, "invisible mothers" in single homeless facilities, subjects of a pilot outpatient commitment program, and persons with severe mental illness held for "low-level offenses" in city jails. Two other studies will extend a pilot study of targeted attempts to improve employment prospects for persons with severe mental disorder.

In addition to our own fieldworkers and collaborators at NKI, we work closely with Dr. Sue Barrow (New York State Psychiatric Institute), Dr. Colleen Gillepsie (Wagner School of Public Service, NYU), Dr. Kostas Gounis (Policy Research Associates, Albany), Dr. Jim Baumohl (Bryn Mawr Graduate School of Social Work and Social Research).

Earlier historical and ethnographic work on homelessness by Dr. Hopper and colleagues has been instrumental in bringing an anthropological perspective to bear on mental health services research at the Institute. Such an approach seeks to determine how institutional resources are actually deployed in the support of disabled and dependent persons. Congruent with the notion of a "de facto mental health system" (Regier et al., 1978), it seeks to learn how dilemmas of livelihood and housing for marginal populations (compounded, for the population in question, by individual disability) are solved in everyday practice. Accordingly, ethnographic methods (at times in modified or abbreviated form) figure prominently in the homelessness research program. Such methods have been used extensively by anthropologists in studies of formal and de facto mental health systems – to describe the workings of model programs, the frenetic work of an emergency psychiatric unit, the survival strategies of homeless persons with severe mental illness. Their distinctive strength is their capacity to ferret out how social actors ("natives") read, evaluate, and negotiate local conventions, institutions and practices ("culture"). Hence their special utility here in mapping "de facto" systems of care and subsistence – in shelters, jails, supportive housing, the workplace. The expected yield is twofold: shedding light on the underlying dynamics of sometimes long-standing puzzles and identifying problems in need of more rigorous quantitative work.

Hopper, K, Hay, T, Jost, J, Welber, S. "Homelessness, severe mental illness, and the institutional circuit," Psychiatric Services 5:659-665, 1997.

Regier, D, Goldberg, ID, & Taube, CA. "The de facto mental health services system," Archives of General Psychiatry 33:685-693, 1978.

Further information: Kim Hopper