在房屋的墙壁内，您有一个屋顶来保护您免受雨水的影响，一扇门可以让您感到安全，最重要的是，是一个叫回家的地方。

然而，许多人没有从Maslow的需求等级制成的基本要素。实际上，得克萨斯州在无家可归者人数最多的州中排名第四。每天晚上，大休斯顿地区有4,000多人在没有永久性住房的情况下睡觉 - 其中有39％的人生活在桥梁下或帐篷下。

While this number has ebbed and flowed over the decades, many remain chronically homeless, slipping through the holes of a tattered safety net of services and becoming high utilizers of health care.

通过美国卫生与公共服务部的药物滥用和精神卫生服务管理局的250万美元赠款，Jane Hamilton, PhD,精神病学和行为科学助理教授麦戈文医学院在休斯Beplay体育中心敦的德克萨斯大学健康科学中心（Uthealth）is leading an effort to combat behavioral disorders and homelessness.

许多长期无家可归的人一生都在精神疾病中苦苦挣扎，受到有限的资源的残废，使他们无法避免。汉密尔顿说，他们的主要诊断通常分为四类之一：精神分裂症，创伤后应激障碍，严重抑郁症或躁郁症。

汉密尔顿解释说：“有很多污名使他们更难以置信。”“在庇护所中还需要更高的功能。”

Amplifying the impact of their disorder, unsheltered individuals are reluctant to take a medication that changes the way they feel. “They tell me that they don’t have a door, a place to be safe,” explains Hamilton. “So they worry about taking something that makes them feel a little different.”

Over the past 30 years, the percentage of adults over 50 years old in the homeless population increased from 11% to approximately 50%, revealing a problem compounded by time.

“I was driving around downtown Houston one evening when I saw all these people with white hair sleeping under a warehouse overhang,” remembers Hamilton. Often, family members who were once caring for them have died, leaving behind someone with medical comorbidities who is incapable of self-care.

2019年1月18日，汉密尔顿（Hamilton）的团队在Beacon增加了基于证据的心理健康咨询和社会服务，以改善患者的访问权限，并与医疗保健为无家可归者提供的初级保健服务进行集成。在头四个月内，她的团队招收了500名500名赠款的82名患者，旨在治疗。有合格的行为健康需求的人参加了一系列服务，包括循证治疗和社会服务，以帮助具有所有必要益处的患者，包括社会保障障碍，并将患者与初级保健，住房和支持的就业服务联系起来。

她的团队治疗的患者中有百分之九十的患者报告了创伤。她说：“由于该计划中提供的疗法是专注于创伤的，因此患者受到了良好的评价。”“过去，他们无法获得这种类型的疗法，许多人甚至完成了他们的中间作业。”

But the integration of services doesn’t stop there. A common barrier for services is not having a government-issued ID. Many patients in the study grew up in the foster care system and moved around a lot, sometimes losing their ID card in the process.

“I had one patient who was born in Maine but entered the foster care system in California. She didn’t have her birth certificate to get an ID, so she’s been sleeping on the sidewalk for three years,” says Hamilton. “Our team helped her get her birth certificate, and she has received 35 therapy sessions in five months to address past trauma.”

Housing assessments must be conducted every 90 days for individuals to maintain eligibility for permanent supportive housing, which is a primary outcome of Hamilton’s work. This requirement introduces another barrier. “If they don’t get their housing assessment done every 90 days, no one follows up,” says Hamilton. “So we hired a dedicated housing assessor and have become a partner with Houston Coalition for the Homeless, the organization managing Housing and Urban Development funds for our region.” As a result, Hamilton’s team helped 23 people gain housing in less than five months—many of whom had outdated housing assessments when they enrolled in the program.

“People actually cry once we start moving them into housing because they are so scared and so frustrated with their lives. They just can’t believe it’s finally happening,” says Hamilton.

Many feel like the system has failed them. But with helping hands and research to improve services, Hamilton’s team is building relationships— and trust—to change the trajectory.

“Chronic homelessness is a sad thing that just shouldn’t happen,” says Hamilton, “especially when they have mental disabilities and cannot navigate complex and fragmented systems. By reducing chronic homelessness, we are making a positive impact on the health care system and, most importantly, the individuals.”