To achieve the Center's broad prevention agenda, faculty from an array of disciplines, including public health, psychiatry, social work, economics, and urban planning, will be brought together with service providers, consumers, and city and state policy makers to collaborate on the development of new and more effective approaches to enable people at risk of chronic homelessness to retain safe, adequate, and affordable housing.
"Homelessness is a social problem of enormous public health significance, " says Carol Caton, PhD, professor of clinical Sociomedical Sciences at the Mailman School, center director, principal investigator, and a research scientist at the New York State Psychiatric Institute. "It has been estimated that 25 percent of homeless adults aged 18 years and older suffer from severe mental illness." Successful efforts to create supportive housing for people with severe and persistent mental illness have enabled many to move from shelters and streets, according to Dr. Caton. However, a high rate of recidivism has been identified raising concern that people with mental illness may be vulnerable to chronic homelessness despite best efforts to date. Moreover, these initiatives have not forestalled the steady increase in the numbers of new people with mental illness falling into homelessness with each passing year. "As research on homelessness moves into its third decade, what we know about it and the causes of its widespread prevalence among different groups of America's most impoverished is overshadowed by our inability to prevent it," she observes.
About 12 million people of the U.S. adult population have experienced literal homelessness at some time in their lives. In 1996, the most recent year for which such data are available, 3.5 million Americans were homeless at least once during the year, an increase of 1.2 million over that estimated 10 years earlier. The condition of homelessness has been associated with mental illness, substance abuse, and health problems, sometimes alone, but often in combination. "There is a need to advance the knowledge base on the factors underlying chronic homelessness, accelerate the development of evidence-based preventive interventions, and disseminate effective interventions, treatments, and service models to benefit the mentally ill at greatest risk of long-term housing instability," observes Ezra Susser, MD, DrPH, Anna Cheskis Gelman and Murray Charles Gelman Professor of Epidemiology, professor of Psychiatry, chair of the Department of Epidemiology, and center co-director.
To date, most of the empirical work on homelessness has been cross-sectional or of limited duration of follow-up. Therefore, there is little understanding of the impact of homelessness over the life course or its association with access to services or participation in social and community activities. "What is now needed is an assertive, coordinated effort to thrust the science of homelessness prevention forward," says Dr. Susser.
Preliminary evidence as well as field experience suggests that homelessness experiences can exacerbate existing illnesses, impede recovery, and provoke new illnesses. "For all these reasons, we believe that our prevention program must focus on both high risk and population-level prevention," notes Dr. Caton. The strategy of the Columbia Center for Homelessness Prevention Studies is to develop an agenda for homelessness prevention studies ranging from pre-intervention research to Phase I, II, and III clinical trials and effectiveness studies.
Richard Parker, PhD, professor and chair, Department of Sociomedical Sciences, serves as associate director of the Center. Dr. Susan Barrow, research scientist at the New York State Psychiatric Institute, also serves as an associate director of the new Center.
Other partner institutions affiliated with the new center are the New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, Graduate School of Arts and Science, School of Social Work, and other academic centers in the region in collaboration with providers and stakeholders.
About the Mailman School of Public Health
The only accredited school of public health in New York City, and among the first in the nation, Columbia University 's Mailman School of Public Health provides instruction and research opportunities to more than 850 graduate students in pursuit of masters and doctoral degrees. Its students and more than 250 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences. www.mailman.hs.columbia.edu