Creating a science of homelessness during the Reagan era

Milbank Q. 2015 Mar;93(1):139-78. doi: 10.1111/1468-0009.12108.

Abstract

POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net.

Context: A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda.

Methods: Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness.

Findings: Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services.

Conclusions: The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.

Keywords: health policy; homeless persons; mental health; substance-related disorders.

Publication types

  • Historical Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Behavioral Research / economics
  • Behavioral Research / history*
  • Deinstitutionalization / economics
  • Deinstitutionalization / history*
  • Deinstitutionalization / legislation & jurisprudence
  • Financing, Government / history
  • History, 20th Century
  • Humans
  • Ill-Housed Persons / history*
  • Ill-Housed Persons / legislation & jurisprudence
  • Ill-Housed Persons / statistics & numerical data
  • Interviews as Topic
  • Mentally Ill Persons / history
  • Mentally Ill Persons / psychology
  • Mentally Ill Persons / statistics & numerical data*
  • National Institute of Mental Health (U.S.) / history*
  • Needs Assessment
  • Organizational Case Studies
  • Politics*
  • Public Policy
  • Research Support as Topic / history
  • Retrospective Studies
  • Substance-Related Disorders / economics
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / history
  • United States / epidemiology
  • Urban Renewal / economics
  • Urban Renewal / history