The Subsistence Adaptation of Homeless Mentally Ill Women
Baldwin, Dana M., Human Organization
This paper explores the day-to-day adaptation of mentally ill women to the rigors of homelessness. The research on which it is based is unique in having collected extensive ethnographic data on the subsistence adaptation of a small yet heterogeneous sample of homeless mentally ill women over the course of more than three years. The subsistence adaptations of these women in a number of areas are described; these include shelter, food, clothing, hygiene, income and money management, safety and victimization, health and health care, social support, and social service utilization. The role of severe mental illness and the long-term effects of homelessness are also examined. Study participants employed a wide variety of strategies in dealing with their living environments, strategies which were at times both functional and adaptive and at times maladaptive and harmful. Homeless mentally ill women are shown to be a heterogeneous group whose lives are marked by recurring and unpredictable change, as are their adaptations to these changes. Key words: mental illness, homelessness, subsistence adaptation, women, service utilization; US, California, Los Angeles
he presence of the homeless mentally ill on our city streets is a visible and painful reminder of how our social "safety net" has failed some of society's most vulnerable members. While women are among the most vulnerable members of this population, we still know relatively little about their day-today adaptation to the rigors of homelessness. This article documents a wide variety of adaptive strategies among a small, heterogeneous sample of homeless mentally ill women.
Although early studies of homeless populations have suggested that homeless women are proportionately more likely than homeless men to be severely mentally disturbed (Mowbray et al. 1992), more recent studies question these findings and suggest that rates of psychiatric illness are comparable between homeless women and their male counterparts (Benda 1990). These contradictory findings are partially resolved if we distinguish two groups of homeless women: solitary women and women who have their children with them. Single women without custody of children (such as those in this study) tend to be older, are more likely to show evidence of personal disability, and are more similar to their male counterparts in terms of the length of their homeless careers (Baker 1994). Homeless women are said to have a number of special needs and concerns, such as risk of victimization, problems with physical health, upkeep of personal hygiene, and access to services (Stark 1994; Robertson and Winkleby 1996; Fisher et al. 1995). While these are the concerns of all homeless individuals, these concerns are amplified by gender and psychiatric illness (Basic 1993). Ethnographic studies, with their holistic focus and concern with the informants' point of view, are uniquely capable of highlighting the difficulties (and successes) that women with psychiatric problems have meeting their needs and addressing their concerns when they have no place to live. Of the ethnographic studies of the homeless to date, few have focused primarily on women (e.g., Liebow 1993; Golden 1992; Koegel 1987) and none have delved intensively into the subsistence activities of severely mentally disabled women. The study reported here is unique in having collected extensive ethnographic data on the day-to-day subsistence adaptation of a small yet heterogeneous sample of homeless mentally ill women, many of whom do not utilize shelters. This article poses the questions: How, and how successfully, do homeless mentally ill women meet their daily needs for food, shelter, clothing, health care, and other essentials? And how do they deal with the particular needs and concerns of all homeless women?
The next section briefly describes the research on which this paper is based and the methods used. Because environmental factors strongly influence how homeless mentally ill women adapt, the ecology of service delivery in the area where this research was conducted is also described. …