"This is the first study to show that the level of awareness and activism, often called social capital, in a community directly affects the delivery of mental health services to homeless people," said lead investigator Robert Rosenheck, M.D., professor of psychiatry and in the Department of Epidemiology and Public Health at Yale School of Medicine.
For one year, Rosenheck and his colleagues tracked the progress of over 2,500 mentally ill homeless people from 18 towns and cities in the United States. They analyzed community voting records, participation in volunteer work or community projects, and the cohesiveness of the various agencies that help homeless people in these communities.
At the end of the study period, 40 percent of the participants were living in stable housing. Results showed that these ex-homeless people were more likely to be from areas with high levels of social capital.
"Social capital has been a subject of great interest in recent years because it has been shown to have a positive effect on many aspects of community and economic life," Rosenheck said. "In his recent book 'Bowling Alone,' Robert Putnam suggests that social capital in America may be declining. If so, this study raises the alarms that the effective delivery of human services may be in decline as well."
Rosenheck said social capital improves efforts to help the homeless because it is accompanied by greater trust and cooperation. "The more community residents vote, participate in volunteer activities and attend meetings in their communities, the more they experience trusting relationships that allow people from different agencies to work together," said Rosenheck, who is also director of the Northeast Program Evaluation Center at the VA Connecticut Healthcare System.
These trusting relationships, Rosenheck said, are especially beneficial to agencies such as mental health and public housing agencies that normally have little interaction and limited experience working together. Previous studies have found that agencies with separate funding are often not motivated to collaborate, even when they deliver overlapping services to the same population.
In this current study, Rosenheck said community activism seems to help bridge this gap.
Other researchers on the study include Joseph Morissey, Julie Lam, Michael Calloway, Marilyn Stolar, Mathew Johnson, Frances Randolph, Margaret Blasinsky and Howard Goldman, M.D.
The study was funded by the Center for Mental Health Services of the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration.
Rosenheck can be reached at 203-937-3850 or robert.rosenheck@yale.edu
Journal
Health Services Research