Gender differences in MH/SA referral rates among chronically homeless adults with trauma histories living in permanent supportive housing

Trauma exposure rates are high among homeless populations. Access to behavioral health treatment (Tx) can help individuals cope with symptoms associated with past traumas. The Access to Wellness (ATW) project offers evidence-based, in-home behavioral health support services to chronically homeless adults recently housed in permanent supportive housing, many with histories of mental illness (MI), substance abuse (SA) or co-occurring disorders. Upon enrollment, all participants are offered a referral for Tx by their case manager, data collection administrator, or both. Utilizing client-level clinical and Tx referral data, we compared self-reported trauma and MI/SA symptoms in relation to Tx referral patterns for 80 recently housed chronically homeless adults. ATW data shows that 68-69% of men and women report experiencing a violent/traumatic event during their lifetime. Of these, 87% of men and 91% of women screened positive for symptoms of MI. Yet, men constitute only 36% of referrals for MH Tx, while women constitute over 60%. Conversely, of the 61% of men and 17% of women who experienced trauma and screened positive for symptoms of SA, men make up 86% of the referrals for SA Tx, compared to women who make up only 14%. Despite experiencing similar rates of trauma and MI, Tx referrals have maintained the traditional pattern of men more often being referred for SA Tx and women for MH Tx. Program administrators need to recognize and address this gender bias when developing service delivery models – and when monitoring referral processes and outcomes – as part of quality improvement efforts.