Gender Differences in Self-Reported Reasons for Homelessness

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1 Journal of Social Distress and the Homeless, Vol. 10, No. 3, July 2001 ( C 2001) Gender Differences in Self-Reported Reasons for Homelessness Richard Tessler, 1,5 Robert Rosenheck, 2,3 and Gail Gamache 4 The purpose of this paper is to illustrate some of the ways in which the perceived pathways into homelessness are socially structured. We do this by examining the relative frequency of 11 different reasons homeless males and females cite for being homeless. Males were more likely to cite the following as their main reasons for homelessness: loss of a job, discharge from an institution, mental health problems, and alcohol or drug problems. Women were more likely to cite the following as their main reason for homelessness: eviction, interpersonal conflict, and someone no longer able or willing to help. Self-reported reasons for being homeless are also related to age, marital status, race, and being a veteran. As expected, they are also linked to receptiveness to treatment. Gender differences in reasons for homelessness may require different approaches to building helping relationships with homeless men and women. KEY WORDS: homelessness; gender; mental illness. There is a growing consensus concerning the social forces and the individual risk factors that lead to homelessness. Studies conducted in the 1980s and 1990s suggested that the growing number of homeless adults was primarily attributable to societal factors such as the reduced availability of affordable rental housing, declining personal incomes, the loss of industrial jobs, and the reduced purchasing 1 Social and Demographic Research Institute, and Department of Sociology, University of Massachusetts at Amherst, Amherst, Massachusetts. 2 Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, Connecticut. 3 Departments of Psychiatry and Public Health, Yale University School of Medicine, New Haven, Connecticut. 4 Mental Illness Research, Education and Clinical Center, Veterans Administration Medical Center, Northampton, Massachusetts. 5 Correspondence should be directed to Richard Tessler, Social and Demographic Research Institute, Machmer, University of Massachusetts at Amherst, Massachusetts 01003; tessler@sadri. umass.edu /01/ $19.50/0 C 2001 Human Sciences Press, Inc.

2 244 Tessler, Rosenheck, and Gamache power of public support payments (Rossi, 1989). Many studies have reported a high risk of homelessness among persons who are male, who belong to a ethnic minority group, who are less than 45 years of age, unemployed, with a major psychiatric or substance use disorder, and a history of family instability in childhood (Burt, 1992). Although we have a fairly good understanding of the social forces that give rise to homelessness, and of the individual risk factors that are involved, we know surprisingly little about what homeless people with mental illness subjectively believe is the main cause of their homelessness. These self-reports are worthy of analysis because they communicate the persons own explanation of their situation and perception of the factors that precipitated their current homeless condition. Analysis of self-reports is not necessarily relevant to determining the causes of homelessness, but is relevant to better engaging clients in areas of their concern. PATHWAYS INTO HOMELESSNESS The reasons homeless people give for their homelessness may also shed light on how different pathways into homelessness are subjectively experienced. Various pathways have been hypothesized. One is that the path into homelessness involves a breakdown in the capacity for independent living (Mechanic, 1999). Often, this is associated with mental illness, substance abuse, or both, either of which threatens employability and may also result in breakdowns in interpersonal relationships (Tessler, Gamache, Rossi, Lehman, & Goldman, 1992). The unraveling of social bonds leading to withdrawal from kin, spouses, and other significant persons may arise out of conflict, for example disapproval of life style choices, or some other reason. The withdrawal of an individual on whom one was economically dependent, whether initiated by person or other, or due to illness or death, can also pose a serious problem for those without alternative sources of support. Among the possible economic reasons are loss of a job, declining income, and eviction due to failing to pay the rent. Among the possible social reasons are conflict with a significant other, and other reasons for the disruption of a relationship with someone the person depended on financially. Among the possible psychological reasons are mental health problems, and alcohol and drug dependence, which we will refer to collectively as ADM disorders. Although Economic, Interpersonal, and ADM reasons do come up in the qualitative literature about homelessness (Hopper and Hamburg, 1986; Shlay and Rossi, 1992), to the best of our knowledge, neither the relative frequency with which homeless people endorse these reasons nor their sociodemographic correlates, have been examined. A major assumption that we make is that reasons for homelessness are structured by social roles that define a person s place in the social structure. As one of the most basic of roles, gender summarizes a host of differences in how individuals are socialized, what is expected of them, and what they expect from themselves. In so far as gender roles make people differentially vulnerable to alcohol, drug

3 Gender Differences in Self-Reported Reasons for Homelessness 245 abuse, and mental illness, and to the good will of persons who they rely on for financial support, we would expect to find differences in how men and women perceive their paths into the homeless condition. In many important ways homeless men and women share common experiences. Both genders suffer from extreme poverty, unemployment, and a shortage of housing. These common experiences not withstanding, men and women may become homeless for somewhat different reasons. One, suggested by prior research, is rooted in the high prevalence of substance use disorders among homeless men (Susser, Struening, & Conover, 1989). Accordingly, we predict that men will be more likely than women to cite alcohol and drug abuse as reasons for homelessness. By contrast, we predict that women will be more likely than men to cite interpersonal reasons for homelessness. This hypothesis is consistent with an image of homeless woman, especially those with children, as being less able to work and more dependent on family and marital resources. We make no prediction for gender differences in economic reasons for homelessness. Economic reasons would appear to be important to both men and women. We will also explore how other individual risk factors, such as age, education, race, health status, and being a veteran, are related (if at all) to the reasons homeless people give to explain their homelessness. The inclusion of veteran status, among both males and females, is part of a continuing investigation into the reasons for homelessness among veterans (Tessler, Rosenheck, & Gamache, 2000). Although it is generally agreed that veterans become homeless due to the same societal forces that lead nonveterans to become homeless, the higher than expected number of veterans in the homeless population remains a mystery (Rosenheck et al., 1994). A final research aim is to explore the implications of different reasons for homelessness for treatment. Are homeless persons with ADM disorders less receptive to treatment if they think they became homeless for interpersonal reasons than if they accept mental illness, alcohol, or drugs as the primary cause? If so, the homeless person s subjective understanding of the roots of his homelessness may influence his self-perceived need for ADM services and treatment regimens. METHODS The data for this study come from a large group of homeless persons who were deemed eligible for mental health-focused case management services by the U.S. Center for Mental Health Services Access to Community Care and Effective Services and Supports (ACCESS) program. Beginning in September 1993, a total of 18 sites in 15 cities in nine states were awarded approximately $17 million in 5-year ACCESS grants to test strategies that encourage cooperation among agencies bearing responsibility for persons who are homeless and have a serious mental illness. All sites received designated

4 246 Tessler, Rosenheck, and Gamache funds at similar levels to provide assertive outreach and case management to 100 new clients annually. Clients were eligible if they were homeless, suffered from serious mental illness, and were not involved in ongoing community mental health treatment. (Randolph, Blasingsky, Leginski, Parker, & Goldman, 1997). The current paper analyzes client data based on 4 years of enrollment into the ACCESS program. Sample Eligible clients who consented to participate in the research project completed a structured baseline interview administered by an interviewer who was not involved in the delivery of clinical services. All of the data for this paper come from these baseline interviews. With 18 sites recruiting approximately 100 clients per year beginning in 1994, the number of cases for analysis accumulated rapidly. By the end of 1998, and at the conclusion of the recruiting phase of the project, a total of 7,224 baseline interviews had been conducted. These included 4,497 homeless males and 2,727 homeless females. Measures In order to assess the main reasons for being homeless, respondents were first presented with a list of 11 possible reasons for being homeless and, for each, asked whether that reason applied. The reasons were as follows: lost a job, lost income, increased expenses, eviction, building rehabilitated or condemned or sold, discharge from institution, disaster, interpersonal conflict, mental health problems, someone no longer able or willing to help, alcohol or drug problems, or some other reason. Then, they were asked which of the reasons cited was the most important reason. Because the checklist invited multiple responses that could not be easily aggregated, the statistical analysis focuses on the main reasons cited. In order to measure whether an ACCESS client was also a veteran, each man and woman was asked if he or she had ever served in the U.S. Armed Forces. Almost 28% of the men and over 4% of the women said they had. The proportion of male veterans is on the low end of the range reported by community surveys during the 1980s (Rosenheck, Frisman, & Chung, 1994), and is slightly higher than the 3.5% reported in the only prior survey of female homeless veterans (Leda, Rosenheck, & Gallup, 1992). The measurement of age and ethnicity used standard items and response categories based on questions asked in the 1990 U.S. Census. In some of the analyses presented later, age is coded categorically, distinguishing homeless persons who are 45 years of age and older from those who are younger, and ethnicity is indicated by minority group membership (being Black or Hispanic). Other measures chosen to derive profiles of persons with different reasons for being homeless included years

5 Gender Differences in Self-Reported Reasons for Homelessness 247 of schooling and marital status (percent never married). The clinical consequences of different reasons for homelessness are evaluated based on measures of selfperceived need for emotional, psychiatric, and substance abuse services. Analysis In order to determine whether pathways into homelessness are linked to gender, the strategy was to use one-way analysis of variance to compare men and women in terms of their main reasons for being homeless. Next, reasons for homelessness are aggregated into three main types: (a) those related to alcohol, drugs, and mental health problems; (b) those related to problems in interpersonal relations; and (c) those related to poverty. The three types of reasons are then examined in relation to a set of sociodemographic and clinical variables. This is done first at the bivariate level and then in a series of logistic regressions which, in addition to the basic set of sociodemographic variables, also include the alcohol, drug abuse, and psychiatric subscales from the Addiction Severity Index (ASI), a summary index of antisocial traits in adolescence, and a multiitem indicator of informal social support as predictors of self-reported reasons for homelessness. RESULTS The total sample is 62% males, 19% veterans, 24% 45 years of age or older, 59% never married, 37% with less than 12 years of schooling, 47% Black, and 5% Hispanic. Males were significantly more likely than females to be veterans (28% compared to 4%), more likely to have never married (65% compared to 49%, less likely to be Black (46% compared to 49%), and more likely to be Hispanic (6% compared to 4%). There were no significant differences between males and females in percent 45 years or older, or in percent completing less than 12 years of schooling. In its sociodemographic characteristics, the sample is similar to other, previously studied, samples of homeless men and women. Gender Differences Table I shows the distribution of main reasons for homelessness cited, first in the total sample, and then for males and females separately. Mental health problems was the main reason cited overall (20.13%), followed by interpersonal conflict (17.30%), alcohol or drug problems (12.86%), and someone no longer able or willing to help (12.53%), and loss of a job (9.12%). Males were more likely to cite the following as their main reasons for homelessness: loss of a job, discharge from an institution, mental health problems, and alcohol or drug problems. Women were more likely to cite the following as their main reason for homelessness: eviction,

6 248 Tessler, Rosenheck, and Gamache Table I. Main Reasons Given for Being Homeless by Males and Females Percent of total Percent of males Percent of females Probability of Main reason given (n = 7,224) (n = 4,497) (n = 2,727) difference Lost a job Lost income ns Increased expenses ns Eviction Building rehabilitated/ ns condemned/sold Discharge from institution Disaster ns Interpersonal conflict Mental health problems Someone no longer able or willing to help Alcohol or drug problems Other ns interpersonal conflict, and someone no longer able or willing to help. The relative frequency with which mental health problems was cited as the main reason for homelessness is not surprising because, as already noted, a current mental illness was a requirement for entry into the ACCESS program. When reasons for homelessness were sorted into more general categories, the following distribution was obtained: 33% cited mental problems, alcohol or drug problems, or both (ADM); 30% cited interpersonal conflict, someone no longer able or willing to help or both (Interpersonal); 21% cited loss of a job, lost income, increased expenses, or eviction (Economic); and 16% cited Other reasons. Table II, which excludes persons who cited Other reasons, shows how the first three types of reasons are related to the sociodemographic characteristics of the sample. As predicted, males were more likely than females to cite ADM reasons, whereas females were more likely than males to cite Interpersonal reasons. The proportion of males and females who cited Economic reasons was about equal. Similarly, veterans were more likely than nonveterans to cite ADM reasons and less likely to cite Interpersonal reasons. There was no difference in the proportions of veterans who cited Economic reasons for homelessness. We conducted further analyses of all 11 reasons for homelessness, probing for evidence of interaction between gender and having served in the Armed Forces of the United States. The only significant interaction involving gender and veteran status centered on eviction as the main reason for homelessness. We have already reported that females were more likely than males to cite eviction as a main reason for being homeless. The significant interaction reveals that this relationship is more pronounced among veterans (10.2% of these women cited eviction compared to 2.6% of the men) than among nonveterans (5.9% of these women cited eviction compared to 3.6% of the men).

7 Gender Differences in Self-Reported Reasons for Homelessness 249 Table II. Sociodemographic Correlates of Reasons for Homelessness (N = 6,066) Percent citing Percent citing Percent citing Probability of ADM as main INTERPERSONAL ECONOMIC as difference reason for as main reason for main reason for between Sociodemographic homelessness homelessness homelessness groups characteristics (n = 2,383) (n = 2,155) (n = 1,528) (chi square) Male Female Veteran Nonveteran Age is at least years Age is less than years Never married ns All other marital ns statuses Less than 12 years of schooling At least 12 years of schooling Black Not Black Hispanic ns Not Hispanic ns Other Correlates of Reasons for Homelessness Homeless persons over 44 years of age were much more likely than younger homeless persons to cite Economic reasons, and somewhat less likely to cite ADM and Interpersonal reasons. Although the differences are not as large, those with at least 12 years of schooling were also more likely than those with less schooling to cite Economic and less likely to cite Interpersonal reasons. Unexpectedly, Blacks were somewhat more likely than non-blacks to cite Interpersonal reasons for being homeless, and also less likely to cite Economic reasons. The proportion citing ADM reasons was unrelated to race. There were also no significant differences in main reasons cited comparing the never married to all other marital statuses, or comparing Hispanic to non-hispanic respondents. In order to test for net effects, we conducted separate logistic regressions of the three main reasons for homelessness (see Table III). Except for age and education, which were coded (in years) as continuous variables, these analyses used the same coding of independent variables as in the previous table. Although differing slightly from the bivariate results, the multivariate findings provide further evidence of the connection between social roles and paths into homelessness. For ADM reasons, the significant predictors are being male, being a veteran, being young, and being or having been married. For Interpersonal reasons, the

8 250 Tessler, Rosenheck, and Gamache Table III. Logistic Regressions of ADM, INTERPERSONAL, and ECONOMIC Reasons for Homelessness (N = 6,066) Sociodemographic Main reason cited characteristics ADM a INTERPERSONAL a ECONOMIC a Male.499 (7.98).494 ( 8.093).075 (1.07) Veteran.297 (4.04).151 ( 1.83).033 ( 0.39) Age (yrs.).017 ( 5.49).020 ( 6.15).021 (6.15) Never married.147 ( 2.44).184 ( 2.97).183 (2.66) Education (yrs.).018 ( 1.57).008 ( 0.72).046 (3.58) Black.031 (0.54).149 (2.53).069 ( 1.30) Hispanic.113 ( 0.880).041 (0.31).401 (2.96) Pseudo R a Logit coefficient (z score). p <.05. p <.01. p <.001. significant predictors are being female, being young, being or having been married, and being Black. For Economic reasons, the significant predictors are being older, being never married, being better educated, and being Hispanic. Table IV includes additional independent variables in the model. The results indicate that the gender differences in ADM and Interpersonal reasons for homelessness are quite robust. They do not disappear even when antisocial traits in adolescence and addiction severity at the time of the interviews (which are positively associated with ADM, but negatively associated with Interpersonal and Economic reasons for homelessness) are included in the equation. Nor do the gender effects disappear as a result of the addition of current social support. Table IV. Logistic Regressions of ADM, INTERPERSONAL, and ECONOMIC Reasons for Homelessness (N = 5,847) Main reason cited Variables ADM a INTERPERSONAL a ECONOMIC a Male Veteran Age (yrs.) Never married Education (yrs.) Black Hispanic ASI-drugs ASI-alcohol ASI-psych Antisocial traits in adolescence Social support Pseudo R a Logit coefficients. p <.05. p <.01. p <.001.

9 Gender Differences in Self-Reported Reasons for Homelessness 251 Self-Perceived Need for ADM Services Because the ACCESS program emphasized ADM services, we wanted to evaluate how clients reporting different reasons for homelessness would perceive their own need for such services. Almost 93% of the persons who cited ADM as their main reason for being homeless also reported that they needed services for emotional and psychiatric problems or detoxification from substances or other treatment for substance abuse. Self-perceived need for ADM services was somewhat lower for persons citing Interpersonal and Economic reasons for homelessness, although most of them (82% among those with Interpersonal reasons and 77% among those with Economic reasons) also accepted their need for ADM treatment. The basic pattern remained when examined for subgroups defined by sex, age, veteran, marital status, education, and race. As expected, self-perceived need for ADM services at the time of enrolling in the program was also strongly related to self-reported use of services at both the 3- and the 12-month follow-up interviews. Thus, the general pattern is for reasons for homelessness to be directly related to self-perceived need, and indirectly related to the propensity to utilize relevant services once offered. DISCUSSION The subjective understanding of the origins of their homeless conditions, and the pathways that are involved, appear to be very different for men and women. Many women find themselves in interpersonal relationships in which they are dependent on another person or persons for their (and their children s) survival. When there occurs a major disruption in a dependency relationship, it is often their home that is in jeopardy. Thus, women are more likely than men to attribute their homelessness to interpersonal factors. This finding is consistent with their disadvantaged position in American society that, relative to men in the general population, is associated with less educational attainment, fewer occupational opportunities, and lower earned income, as well as with their greater responsibility for dependent children. In contrast to the very large disparities in the general population, the homeless women in this study were not more disadvantaged than the homeless men. Constituting roughly one-third of the sample, these women had significantly greater educational attainment than the men. There was also no significant difference in total income between men and women, and only a trend for earned income favoring the men. However, it is only in comparison with homeless men that homeless women appear advantaged. Their appearance of advantage has more to do with the extremely poor condition of homeless men. In the general population, it is rare to find American men who are dependent on others for survival. In contrast with females, the major thrust of male

10 252 Tessler, Rosenheck, and Gamache socialization is to attain independence. However, the pressure to be independent, the high expectations that surround it, and the competitive environment in which American men must strive for success, also makes them vulnerable to failure. Whether alcohol, drug abuse, and mental illness are contributing causes or consequences of such failures is unknown. But, there is little doubt about the tendency for ADM and homelessness among males to go hand in hand. Results from this study show that many homeless men believe that ADM problems have contributed to their present condition. Although it was not a focal point of the analysis, it is interesting that people with antisocial traits in adolescence (who were mainly males) were less likely to cite Interpersonal and Economic reasons. Presumably, these persons have withdrawn from relationships and from the economy, and are reduced to seeing themselves as mentally impaired. Implications In seeking to engage homeless persons in treatment for ADM problems, clinicians need to pay close attention to what their clients believe caused their homelessness. When a homeless man perceives his homelessness as stemming from problems associated with alcohol, drugs, and mental illness, then ADM services can be offered unabashedly. But, when a homeless man (or woman) views his homeless condition in some other way, the process of engagement around ADM concerns may be more complex. It would be prudent to acknowledge the other factors that the client believes to be involved, while still seeking to engage the client in ADM services. In general, when homeless people feel understood they are more receptive to professionals and the services they broker. The finding that many clients, and especially women, view homelessness as arising out of breakdowns in interpersonal relations points to family therapy as one option to restore former networks. In other cases, clients need the chance to build new relationships, with support and encouragement from their case manager. It is very challenging to help someone to build or to rebuild a natural support network. As expected, males and females do not differ in the proportions who attribute their homelessness to Economic reasons. For both males and females, the general picture is one of economic vulnerability created by age, minority status (Hispanic), and being never married. The one inconsistency in this interpretation is that high school graduates were also more likely to cite Economic reasons. The specific rank order of reasons for homelessness reported in this study may not generalize to all homeless persons. Further research is needed to determine whether the relatively high percentage of persons who cited ADM reasons for homelessness was due to self (or other) selection into the ACCESS program, or whether the finding is more broadly representative of how about one out of five

11 Gender Differences in Self-Reported Reasons for Homelessness 253 homeless persons, and almost one in four homeless men, view their pathways into homelessness. Further research is also needed to replicate and interpret the finding that veteran women are more likely than women who have never served in the Armed Forces to cite eviction as the main reason for their homelessness. The reason female veterans cite eviction more frequently may be that they are older and more independent than women who have not served in the armed forces, and thus more likely to have had their own apartments. Nonveteran women who always lived with their families or husbands would not have been evicted because they never had responsibility for a place of their own. Gender and other sociodemographic differences observed in reasons for homelessness indicate that the perceived pathways into the homeless condition are socially structured. Reasons for homelessness are tied to social roles that create different points of vulnerability. These differences are readily apparent in the way homeless men and women explain their current plight. ACKNOWLEDGMENTS This study was funded under interagency agreement AM A between the Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and the VA s Northeast Program Evaluation Center; as well as a grant from the Department of Veterans Affairs in support of a Mental Illness, Research, Education, & Clinical Center (MIRECC) at the VA Medical Center in Northampton, Massachusetts. The authors gratefully acknowledge the assistance of the late Julie Lam in the early stages of the data analysis. REFERENCES Burt, M. A. (1992). Over the edge: The growth of homelessness in the 1980s. New York and Washington, DC: Russell Sage Foundation and Urban Institute Press. Hopper, K., & Hamburg, J. (1986). The making of America s homeless: From skid row to new poor, In R. G. Bratt, C. Hartman, & A. Meyerson (Eds.), Critical perspectives on housing. Philadelphia, Temple University Press. Leda, C., Rosenheck, R., & Gallup, P. (1992). Mental illness among homeless female veterans. Hospital and Community Psychiatry, 43(1), Mechanic, D. (1999). Mental health and social policy: The emergence of managed care. Englewood Cliffs, NJ: Prentice Hall. Randolph, F. L., Blasingsky, M., Leginski, W., Parker, L. B., & Goldman, H. H. (1997). Creating integrated service systems for homeless persons with mental illness: The ACCESS program. Psychiatric Services, 48(3), Rosenheck, R., Frisman, L., & Chung, A. (1994). The proportion of veterans among homeless men. American Journal of Public Health, 84, Rossi, P. H. (1989). Down and out in America: The origins of homelessness. Chicago: University of Chicago.

12 254 Tessler, Rosenheck, and Gamache Shlay, A. B., & Rossi, P. H. (1992). Social science research and contemporary studies of homelessness. Annual Review of Sociology, 18, Susser, E., Struening, E., & Conover, S. (1989). Psychiatric problems of homeless men. Archives of General Psychiatry, 46, Tessler, R., Gamache, G., Rossi, P. H., Lehman, A. F., & Goldman, H. H. (1992). The kindred bonds of mentally ill homeless persons. New England Journal of Public Policy, 8, Tessler, R., Rosenheck, R., & Gamache, G. Comparison of homeless veterans with other homeless men in a large clinical outreach program. Psychiatric Quarterly, in press.

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