W R Breakey

Johns Hopkins Medicine, Baltimore, Maryland, United States

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Publications (11)76.61 Total impact

  • William R. Breakey, Pamela J. Fischer
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    ABSTRACT: Homelessness is a major national problem, but the exact extent of the problem is difficult to determine. The homeless are not a homogeneous category of people, but include a wide variety of types. The first problem in establishing the parameters of the homeless population is one of definitions. Different studies have focused on street people, shelter users, people applying for assistance, or those using services. Formal attempts to count the homeless have used indirect counting methods, direct counting methods, and one recent study used a capture—recapture estimation technique. Such methods have some validity in making local estimates, although each has its disadvantages. Attempting to make national estimates is much more difficult, and any national estimate must be regarded with great caution. The numbers of people in specific subgroups of the homeless may be of even greater importance for public policy and planning. While the root causes of homelessness are the scarcity of low-income housing and the inadequacy of income supports for the poor, there are specific groups of homeless people who need special services. Such groups include the homeless mentally ill, alcoholics and drug abusers, AIDS victims, and families with small children. Assessing the extent of these problems among the homeless is therefore important for planning services.
    Journal of Social Issues 04/2010; 46(4):31 - 47. · 1.96 Impact Factor
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    ABSTRACT: The frequent co-occurrence of alcoholism with serious mental illnesses ("dual diagnosis") necessitates that clinicians are able to recognize its presence in people with disabling mental illnesses. This study demonstrates that professionals often miss the diagnosis, but that their ability to detect alcoholism can be greatly enhanced by the use of a simple screening tool. Members of an urban psychosocial rehabilitation program who received psychiatric treatment in an affiliated outpatient clinic were interviewed after their clinic therapists and rehabilitation counselors had been asked questions pertaining to their general health and substance use. The members were interviewed with two screening tests, the CAGE and the SMAST, and a clinical DSM-III-R diagnosis of alcohol use disorder was established. Both the SMAST and CAGE had good sensitivity and the addition of a screener enhanced the clinicians' ability to detect alcohol use disorders.
    Community Mental Health Journal 05/1998; 34(2):165-74. · 1.03 Impact Factor
  • W R Breakey, P J Fischer
    Social Psychiatry and Psychiatric Epidemiology 08/1995; 30(4):147-51. · 2.86 Impact Factor
  • P J Fischer, W R Breakey
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    ABSTRACT: This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.
    American Psychologist 12/1991; 46(11):1115-28. · 6.87 Impact Factor
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    ABSTRACT: In Reply.— Drs Winkleby and Fischetti draw attention to potential problems in the public interpretation of scientific data. Our report presented an overview of a complex data set and was not intended to be a complete analysis. It was written for a medical audience, and it is a cause of concern to us, too, that our data can be misinterpreted in the public media, where, for example, reports may fail to distinguish major mental illnesses from the broad spectrum of Axis I disorders. In fact, although our prevalence rates of Axis I disorders as a whole are very high, those for major mental illness do not diverge substantially from rates reported by other investigators.1 Where our study differed from others was that subjects were examined by psychiatrists, so that a wider range of psychopathology was detected than is possible using structured interview instruments.
    JAMA The Journal of the American Medical Association 01/1990; 263(6):811-811. · 29.98 Impact Factor
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    ABSTRACT: A study of homeless people in Baltimore, Md, focused on their health and other characteristics, with special emphasis on their needs for services. In the first stage, 298 men and 230 women were randomly selected from the missions, shelters, and jail in Baltimore to respond to a baseline interview that provided extensive sociodemographic and health-related data. In the second stage, a subsample of 203 subjects was randomly selected from the baseline survey respondents to have systematic psychiatric and physical examinations. Data are presented from both stages. Data from the first stage demonstrate, among other things, the high levels of disaffiliation of this population and their heavy involvement in substance abuse. Data from the clinical examinations demonstrate the high prevalence of mental illnesses and other psychiatric disorders and of a wide range of physical disorders and confirm the high prevalence of alcohol abuse disorders. The high rates of comorbidity of these conditions is demonstrated and data are provided on the subjects' needs for mental health and substance abuse services.
    JAMA The Journal of the American Medical Association 10/1989; 262(10):1352-7. · 29.98 Impact Factor
  • R P Roca, W R Breakey, P J Fischer
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    ABSTRACT: Chronic psychiatric patients often fail to receive adequate general medical care. In a study of 42 outpatients in a psychosocial rehabilitation program, 93 percent were found to have at least one problem warranting assessment, treatment, or follow-up. Minor gynecologic disease was the most common problem among women and gross dental disease among men. Only 11 percent of the men's and 26 percent of the women's problems were receiving appropriate care. Seventy-seven percent of the previously unrecognized problems were found just by routine physical examination and hematocrit determination. Medical care for chronic psychiatric patients would improve if psychiatric clinics provided simple medical screening and if therapists were aware of their patients' general health needs.
    Hospital & community psychiatry 08/1987; 38(7):741-5.
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    ABSTRACT: Selected mental health and social characteristics of 51 homeless persons drawn as a probability sample from missions are compared to those of 1,338 men aged 18-64 years living in households from the NIMH Epidemiologic Catchment Area survey conducted in Eastern Baltimore. Differences between the two groups were small with respect to age, race, education, and military service but the differences in mental health status, utilization patterns, and social dysfunction were large. About one-third of the homeless scored high on the General Health Questionnaire which measures distress. A similar proportion had a current psychiatric disorder as ascertained by the Diagnostic Interview Schedule (DIS), with the homeless exhibiting higher prevalence rates in every DIS/DSM III diagnostic category compared to domiciled men. Homeless persons reported higher rates of hospitalization than household men for both mental (33 per cent vs 5 per cent) and physical (20 per cent vs 10 per cent) problems but a lower proportion received ambulatory care (41 per cent vs 50 per cent). Social dysfunction among the homeless was indicated by fewer social contacts and higher rates of arrests as adults than domiciled men (58 per cent vs 24 per cent), including multiple arrests (38 per cent vs 9 per cent) and felony convictions (16 per cent vs 5 per cent). Implications of these findings are discussed in terms of research and health policy.
    American Journal of Public Health 06/1986; 76(5):519-24. · 3.93 Impact Factor
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    ABSTRACT: Selected health and social characteristics of 51 homeless people drawn as a probability sample from missions are compared to those of 1,338 men aged 18–64 years living in households from the NIMH Epidemiologic Catchment Area Survey conducted in Eastern Baltimore. No important differences were found in age, race, education, or military service between the homeless and domiciled men, but significant differences were apparent in mental health status, social dysfunction, and employment. Around one third of the homeless had a current mental disorder according to DIS or GHQ criteria. Indicators of social dysfunction among the homeless were fewer social contacts and higher rates of arrests. Less than one fifth of the homeless were employed compared to nearly three quarters of household men. Implications of different occupational patterns of the homeless for psychosocial rehabilitation are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
    International Journal of Psychosocial Rehabilitation 01/1986; 9(4):51.
  • Pamela J. Fischer, William R. Breakey
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    ABSTRACT: Reviews literature on the homeless in the US concerning subgroups of homeless persons in whom the prevalence of psychopathology is not randomly distributed. Two aspects of homelessness are recognized (lack of adequate shelter and disaffiliation), and 4 subgroups of the homeless are indicated in the literature. Significant numbers of the homeless have mental disorders, but the size of the homeless population and the prevalence of mental illness have not been clarified. Distinct categories include: the chronically mentally ill, street people who choose isolation, alcoholics, and the situationally distressed. The health status of and the prevalence of mental disorders in the homeless have been studied. The contribution of the deinstitutionalization of the mentally ill to homelessness remains unanswered. Psychosocial characteristics must be documented in order for appropriate services to be determined. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    International Journal of Mental Health 01/1970;
  • Source
    Charles D Cowan, William R Breakey, Pamela J Fischer

Publication Stats

615 Citations
76.61 Total Impact Points

Institutions

  • 2010
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
  • 1989–1998
    • Johns Hopkins University
      • • Department of Psychiatry and Behavioral Sciences
      • • Department of Medicine
      Baltimore, MD, United States