Homelessness, Health, and Human Needs (1988) / Chapter Skim
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Appendix C: The Rural Homeless
Appendix C: The Rural Homeless
Pages 183-217
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From page 183... ...
At this point, there are no answers to many questions central to the public policy debate: issues of definition, the prevalence of rural homelessness, changes in its incidence, and similarities and differences between rural and urban homeless populations. Unfortunately, this appendix cannot authoritatively resolve these questions; that will require substantial additional field research.
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From page 184... ...
· The nature of rural communities obscures the problem of homelessness as well. With the exception of larger, more urbanized cities, rural communities seldom have in place a formal social service network that would permit the transient homeless to gather or be counted.
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From page 185... ...
Compared to urban America, there are great differences in the scale, density, and resource base of rural communities that severely limit the ability of these communities to assist individuals in economic distress. That perspective is essential to keep in mind as we develop better estimates of the relative distribution of the homeless in rural and urban communities.
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From page 186... ...
Second, while poverty has left few rural counties untouched, rural poverty has always been extremely concentrated. Two-thirds of the rural poor reside in the southeastern states, as do 93 percent of rural blacks (Ghelfi, 1986; National Association of Community Health Centers, 19871.
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From page 187... ...
along from * This was one Community Action Agency director's response to a survey being conducted by the Housing Assistance Council (1984)
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From page 188... ...
The site visits conducted by committee members and the author suggested that these types of dwellings are often located on private property that is either occupied by the owner or adjacent to the owner's property. Because of the increased visibility of transients in rural communities, and the proximity of the property's owner, it was not unusual to see nominal rents imposed on those taking refuge in such dwellings.
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From page 189... ...
The rural homeless are more geographically dispersed and the shelter facilities available in rural areas tend to be small, making it difficult for even shelter operators to categorize the population definitively. We will use two approaches to answer this question: The first Is a conceptual framework for classifying the rural homeless; next, we will review the Ohio Mental Health study, which, while limited as a single-state case study, provides the only comprehensive statistical comparison of the rural and urban homeless that has been completed to date.
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From page 190... ...
For the most part, they appear to gravitate toward the larger rural communities or towns within close proximity to state mental hospitals. For example, there appeared to be a substantial chronically mentally ill homeless population in the Minnesota-North Dakota shelters, all of which were within close proximity to state mental hospitals.
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From page 191... ...
The most exhaustive and authoritative effort to date was the 1985 Ohio Mental Health Study (Ohio Department of Mental Health, 19851.* Because the researchers conducted extensive interviews with 790 urban and 189 nonurban homeless people, their survey provides the most extensive data base available on the demographics of the rural homeless and the ways in which they are both similar and different from their urban counterparts.
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From page 192... ...
Sex and Marital Status Women constitute a much higher proportion of the rural homeless population (32.3 versus 15.8 percent of the urban homeless) , a fact that is partly explained by the much higher percentage of rural homeless who are married (18.5 percent of the rural homeless versus 6.7 percent of the urban homeless)
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From page 193... ...
(8.5) No 523 66.2 142 75.1 665 67.9 No answer 3 0.4 1 0.5 4 0.4 Total 790 100.0 189 99.9 979 100.0 Ever been in jail/prison Yes 470 59.5 103 54.5 573 58.5 No 313 39.5 85 45.0 398 40.7 No answer 7 0.9 1 0.5 8 0.8 Total 790 100.0 189 100.0 979 100.0 SOURCE: Ohio Department of Mental Health (1985)
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From page 194... ...
Urban Nonurban Total Time (days)
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From page 195... ...
rural communities. In fact, only 20.4 percent of the homeless in these urbanized rural communities used shelters or missions, while none of those in more rural counties had spent a night in these facilities.
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From page 196... ...
~ rip ~ A Employment Based on self-reports by nonurban homeless individuals, the findings on employment suggest that they had a more recent attachment to the TABLE C-5 Number of Places the Homeless Stayed During the Previous Month (Ohio Data)
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From page 197... ...
? Urban homeless: 22.2 Nonurban homeless: 35.4 42.7 25.7 Mixed county: Rural county: · The last year worked for those who have not worked in the previous month (percentage)
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From page 198... ...
First, the problems of enumerating the homeless in the urban area multiply in the vast geographic expanse of rural America. As noted earlier, service providers are seldom found outside the larger rural communities (Redburn and Buss, 1987~; therefore, provider-based surveys only tap a portion of the homeless in rural communities.
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From page 199... ...
Larger Rural Communities The larger rural communities generally have a broader economic base and a more formalized social services network (Ohio Department of Mental Health, 19851; the bulk of rural shelters and community kitchens appear to be located in these communities (Redburn and Buss, 19871. While many of the poorer or more remote rural communities face serious obstacles in attracting sufficient numbers of health care providers, there
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From page 200... ...
· Tired of finding chronically mentally ill patients on his doorstep without warning, the director of one center has succeeded in enlisting the cooperation of one of the state mental hospitals in an effort to work together to plan for a patient's discharge. He is now trying to elicit the cooperation of the other major state mental hospital.
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From page 201... ...
A secondary aim of the program was to provide financial assistance to the farmers and counselors, who were well reimbursed for their time. Smaller Rural Communities Smaller rural communities seldom have a formal social services system.
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From page 202... ...
The fraying of the social support fabric in these rural communities could have important implications for the rate at which financially troubled families descend into homelessness. Farm families also singled out the food stamp program as an example of the failure of publicly funded income support programs to prevent this downward spiral.
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From page 203... ...
Homeless people served by some community health care centers, such as the one in Mound Bayou, Mississippi, are more fortunate. The health care center is able to provide bus service throughout the rural counties.
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From page 204... ...
Even when families have health insurance, financial barriers may remain. A recent survey of financially distressed rural Minnesota farm families indicated that while most farm families struggled to retain their health insurance coverage as their economic situation deteriorated, they had been forced to maintain a high deductible rate and curtail their use of discretionary preventive care, such as mammograms or Pap smears (Southern Minnesota Family Farm Fund, 19861.
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From page 205... ...
At the same time that access to health resources is constrained, the rural poor and homeless often appear to face greater health risks. As the site visit to Alabama's Black Belt demonstrated, rural poverty itself can pose a grave environmental threat to health.
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From page 206... ...
Regarding mental health services, even in the larger rural communities, access to mental health professionals is limited for indigent populations. The extremely large catchment areas for community mental health centers and the limited resources for treating a diverse rural population pose severe access barriers.
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From page 207... ...
Health Status The Ohio Mental Health Study asked the homeless to identify their physical health problems; the answers are presented in Table C-10. Overall, 30.7 percent of respondents reported a current medical problem; no striking differences emerged from the data for the urban and nonurban homeless.
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From page 208... ...
county category. Significant differences emerged in the overall rate of reported illness: In comparison with 31 percent of the urban homeless who reported a health problem, the mixed (urbanized rural)
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From page 209... ...
Very often emergency room visits are instigated by local TABLE C-10 Physical Health Problems Identified by Homeless People (Ohio Data) Urban Nonurban Total Problem No.
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From page 210... ...
Percent Community kitchens 531 67.2 64 33.8 595 60.8 Shelters 506 64.0 46 24.3 552 56.4 Welfare/general relief 319 40.4 116 61.4 435 44.4 Hospital emergency rooms 184 23.3 56 29.6 240 24.5 Shelters for battered women 21 18.6 2 4.0 23 12.4 Community mental health centers 91 11.5 28 14.8 119 12.2 SOURCE: Ohio Department of Mental Health (1985)
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From page 211... ...
. TABLE C-13 Reported Drinking by Homeless People During the Previous Month (Ohio Data)
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From page 212... ...
The chronically mentally ill often have trouble accessing the available resources; in general, farmers will not or cannot utilize the available resources because of strong conservative cultural forces (McCormick, 19871. Among teenagers, venereal disease and pregnancy are the two major health issues; little prenatal care is TABLE C-15 Self-Ratings by Homeless People of Their Nerves, Spirits, Outlook, or Mental Health at Present (Ohio Data)
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From page 213... ...
The depression, stress, and suicidal tendencies among the farm population warrant special outreach efforts in the view of most of our key informants. They strongly suggest that suicides in the farm community are deliberately misreported by the families to save face, that spouse and child abuse rates are rising in this population group, and that alcoholism is increasing.
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From page 214... ...
By contrast, routine or preventive care services are seldom sought because of significant barriers to access, shame, or hostility toward the health care system. Because of the importance of overcoming barriers to routine and preventive care, outreach efforts by community health centers would appear to be critical.
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From page 215... ...
Simple efforts at coordinating discharge planning can be of great importance, as demonstrated by the Fargo, North Dakota, shelter. In the course of site visits, a number of homeless farm families communicated their belief that income support programs in particular, food stamps used eligibility criteria that systematically disqualified farmers from receiving timely assistance that might have forestalled their descent into homelessness.
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From page 216... ...
Washington, D.C.: National Association of Community Mental Health Centers. Ohio Department of Mental Health.
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From page 217... ...
P 1 in Governing the Heartland: Can Rural Communities Survive the Farm Crisis?
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