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Analysis of a Mental Health Needs Assessment to Improve Targeted Care for Chicago’s Unsheltered Homeless Population

Megan Beulke MS, Drishti Jain MS, Alexis Hisey MS, Jazmin Garcia BS, Marina Feffer MPH, Theodote Pontikes MD/MBA, Theresa Nguyen MD

Loyola University Chicago Stritch School of Medicine

Society of Student Run Free Clinics Conference

Chicago, IL 10/5/25

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Introduction

https://www.loyolastreetmedicine.com/

https://www.chicagostreetmedicine.org/

https://www.thenightministry.org/

CCGH – Center for Community & Global Health – part of the honors program as part of this organization; my focus within this program is street medicine, specifically working with Loyola Street Medicine
LSM – Loyola Street Medicine –within this program, which is under the larger organization of Chicago Street Medicine, we have several community partners, one of which is The Night Ministry
The Night Ministry is a Chicago-based organization whose mission is to provide human connection, housing support, and healthcare to individuals experiencing homelessness in our greater Chicago community
In partnership with The Night Ministry, LSM helps fulfill the healthcare aspect of their mission by providing free medical care at the Forest Park CTA Blue Line every Thursday evening from 8pm-midnight
Now, what you might notice here, is there is something missing from our list of services provided: that would be mental healthcare… which is where our project comes in

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Background

Widespread existence of homelessness in the greater Chicago area
Known connection between lack of sustainable housing & significant health burden [1]
Complex relationship between homelessness & mental health

Mental well-being among this population is multifaceted in nature [2]

Increased utilization of emergency psychiatric services [3]
Study Aim: to utilize a mental health needs assessment to evaluate the baseline needs of this population & to identify areas for improved intervention within our community street outreach programs

Our Goal: to better address mental well-being and prevent acute emergency department mental health (EDMH) visits and inpatient psychiatric hospitalizations within Chicago’s unsheltered homeless community

So, before getting into the details of our project, I wanted to provide some background
First, I need to acknowledge the widespread existence of homelessness in the greater Chicago area
We also know that there is a firmly established connection between the lack of sustainable housing & a significant burden on one’s overall health

It has been cited that unstable housing leads to a shortened lifespan, increased disease prevalence, morbidity, and mortality [1]

Now, it is also known that there is a particular connection, or rather, complex relationship, between homelessness & mental health

This relationship is rather multifaceted nature
Many studies report specific factors in which negatively impact mental health among this population, namely, the lack of ontological security, autonomy, hope & purpose, empowerment, social connection & belonging, and access to services [2]

All these things, as you can imagine, may play a role in worsened health outcomes among your local community of unhoused individuals

Ultimately, there is an increased utilization of emergency psychiatric services among this population [3], which is what we homed in on for our project
Study aim: utilize a self-created, mental health needs assessment to evaluate the baseline needs of this particular population & to identify specific areas for improved intervention within our community street outreach programs

Ultimate goal: to better address mental well-being and prevent acute emergency department mental health (EDMH) visits as well as inpatient psychiatric hospitalizations within Chicago’s unsheltered homeless community

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Methods

IRB-approved, survey-based study
68 unsheltered adults ages 19-76 years participated

Many considered “continuous riders” on the Chicago Transit Authority trains

All individuals recruited in partnership with The Night Ministry
Surveys completed alongside previously established joint outreach sites:

https://www.transitchicago.com/maps/

68 unsheltered adults ages 19-76 years participated in this IRB-approved, survey-based study, many of whom are considered “continuous riders” on the Chicago Transit Authority trains

A “continuous rider” is an individual that spends the majority, if not all, of their evenings on the CTA Blue or CTA Red Line trains, as these trains are the only two within Chicago’s transit system that operate overnight

All individuals were recruited in partnership with The Night Ministry

Many of which we already had a relationship with due to our medical work at the CTA Blue Line Forest Park station

All surveys were completed alongside previously established joint outreach sites

Including train stations (37% on the CTA Blue Line and 47% on the CTA Red Line), a youth shelter (12%), and a public library (4%).

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Methods

Required an initial capacity assessment & verbal informed consent
52-question survey, featuring questions regarding:

Demographics
Homelessness history
Self-reported mental health status
Healthcare utilization + access to care
Community intervention utilization

Three standardized questionnaires:

PHQ-9 (depression assessment)
GAD-7 (anxiety assessment)
TSQ (trauma screening questionnaire)

All assessors underwent formal training prior to administering the survey

If suicidal ideation was identified, a standardized protocol for reporting & referral to professional care was followed

Once an initial capacity assessment and informed consent were obtained, trained assessors administered a 52-question survey which featured questions regarding demographics, homelessness history, self-reported mental health status (including psychiatric diagnoses), healthcare utilization & access to care (or rather barriers to care), and community intervention utilization
At the core of the survey were three standardized questionnaires: the PHQ-9 (depression assessment), GAD-7 (anxiety assessment), and a TSQ (Trauma Screening Questionnaire)
If evidence of danger to self or others was identified, trained professionals followed a standardized protocol for reporting & referral to care

With the assistance of a board-certified psychiatrist, we created a thorough suicidal ideation protocol and ensured that all assessors completed formal training prior to administering the survey
Should an event arise, a trained professional would be consulted & an incident report be completed

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Results

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Results

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Results

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Discussion

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Conclusion

Non-predictive nature of these potential predisposing factors

Highlight key areas where targeted interventions may be applied within community street outreach programs

Implement more focused changes to our local outreach efforts

Better address the unique mental health needs of our community
Improve upon the allocation of resources to optimize their impact

Future Goals: incorporate tailored psychiatric services through The Night Ministry & Loyola Street Medicine

Use these data as a foundation for future growth & development of our street medicine program
Grow in our understanding of the evolving field of street psychiatry

scan for more information about street psych

Although these specific factors are not entirely predictive of increased healthcare utilization, they highlight key areas where targeted interventions may be applied within community street outreach programs in the city of Chicago and beyond
These study findings can be used to implement more focused changes to our local outreach efforts to ultimately better address the unique mental health needs of individuals experiencing unsheltered homelessness

Improvement upon the allocation of present resources to optimize their impact on their local community

So, what are our future goals? We hope to and plan to incorporate tailored psychiatric services through The Night Ministry & Loyola Street Medicine

In fact, beginning this October, we have a street psychiatrist coming out to CTA Blue 2x/mo!
Ultimately, we hope to use these data as a foundation or a starting point for further growth & development of our current street medicine program AND to assist other programs in their own growth

In the end, we would love to have a firmly established mental healthcare team to add to the already comprehensive physical health services already, so that we may take the “cura personalis” approach and truly provide care for the whole person
However, in order to do so, we must keep learning & grow in our understanding of the ever-evolving field of street psychiatry
If you would personally like to learn more about street psychiatry, please scan the QR code!

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References

[1] Reeves WC, Strine TW, Pratt LA, et al. Mental illness surveillance among adults in the United States. MMWR Suppl 2011;60(3):1-29.

[2] Diduck B, Rawleigh M, Pilapil A, Geeraert E, Mah A, Chen SP. Mental health needs of homeless and recently housed individuals in Canada: A meta-ethnography. Health Soc Care Community. 2022 Nov;30(6):e3579-e3592. doi: 10.1111/hsc.13996. Epub 2022 Sep 4. PMID: 36057960.

[3] Pascual JC, Malagon A, Arcega JM, et al. Utilization of psychiatric emergency services by homeless persons in Spain. Gen Hosp Psychiatry 2008;30(1):14-9 doi: 10.1016/j.genhosppsych.2007.08.006.

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Thank you for listening!

Any questions?

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