Introduction
According to the American Psychological Association, homelessness
occurs when a person lacks a safe, stable, and appropriate place to live; both
unsheltered and sheltered individuals can be considered homeless. The US
Department of Housing and Urban Development estimated that on any given night in
January 2013, approximately 610,042 people were homeless in the United States and
an estimated 109,132 people were chronically homeless. Rates of mental illness
among homeless individuals in the United States are much higher than rates for the
general population. According to 2009 data from the US Substance Abuse and Mental
Health Services Administration (SAMHSA), approximately 20 to 25 percent of the
homeless population in the United States has a severe mental illness compared to 6
percent of the general population. Individuals with schizophrenia
or bipolar
disorder are particularly vulnerable to experiencing periods
of homelessness. Serious mental illness without proper treatment and
social
support inhibits a person's ability to carry out essential
aspects of daily life, disrupting their ability to maintain employment and
housing.
One of the reasons for the high prevalence of mental illness among the homeless
is the large-scale deinstitutionalization of mental
hospital residents in the 1960s. The advent of antipsychotic
medications for treating schizophrenia and bipolar disorder
also contributed to the perceived decrease in need for continuous care; mental
hospitals started to release residents in large numbers with prescriptions for
antipsychotics and other medications. However, these individuals often stopped
taking their medications, either because of their prohibitive cost or because they
did not feel they were necessary or helpful, resulting in the reemergence or
exacerbation of their psychiatric symptoms. Community and mental health centers
were originally intended to fill the vacuum, but funding cuts rendered them
inadequate as a safety net.
Often, the psychiatric conditions and symptoms of individuals with mental
illness make it difficult for them to obtain and maintain employment. Furthermore,
the inability of many poor individuals with mental illness to support themselves
financially and to obtain adequate treatment, as well as the lack of
affordable
housing in many communities, causes many individuals with
mental illnesses to end up in shelters or on the streets. Homelessness often
causes individuals with mental illness to enter a downward spiral of ever more
desperate conditions, compounding their physical and mental health problems.
Some individuals who did not have preexisting mental diseases prior to becoming
homeless may develop psychiatric disorders or symptoms after becoming homeless,
triggered by the stress of living on the streets or in shelters. Homeless
people are often the victims of crime, particularly theft and physical assault,
with homeless women being especially vulnerable to sexual assault and
rape. The trauma of such abuse can provoke the emergence of
or exacerbate the symptoms of conditions such as depression,
posttraumatic
stress disorder, bipolar disorder, and schizophrenia,
especially in individuals with a genetic predisposition. Homeless children often
experience emotional and developmental problems; the negative effects of trauma
from physical and sexual assault most likely have a greater effect on their
psychological development than that of adults.
Psychological Causes
Mental illness interferes with individuals' ability to attend to essential aspects
of daily life, including self-care, household management, and employment, placing
individuals with mental illness at greater risk for experiencing periods of
homelessness. Furthermore, poverty prevents many individuals with mental illness
from obtaining adequate mental health care and treatment. However, although mental
illness puts individuals at a greater risk for becoming homeless, poverty and a
lack of affordable housing remain the principal causes of homelessness.
As the economic situation of individuals with mental illness becomes more
desperate, they face even more obstacles to obtaining and sustaining employment
and housing. Many individuals with mental illness have other physical illnesses or
mental conditions, including drug and alcohol addiction,
diabetes, hypertension, and asthma,
further hindering their ability to maintain employment. Mental illness can make it
difficult for individuals to adequately care for comorbid conditions and other
physical health problems. Individuals with mental disorders encounter more
barriers to accessible housing than individuals without mental disorders through
income deficits, stigma, and discrimination. Homelessness then exacerbates both
physical and mental illnesses.
Contrary to popular belief, most homeless individuals with mental illness are
willing to accept treatment services, although access to care remains difficult.
People with schizophrenia and some forms of bipolar disorder may experience
paranoia, hallucinations, and delusions,
making them suspicious of outsiders' attempts to help them. However, according to
the National Coalition for the Homeless, outreach programs have greater success
when they establish a trusting relationship through continued contact with the
people they are trying to help.
Psychological Effects
Homelessness has definite psychological effects, ranging from the detrimental
effects of disrupted sleep to the deep psychological trauma inflicted by chronic
stress, instability, and exposure to violence. Sleep problems are rampant among
homeless people living on the streets or in shelters, where there is constant
noise, crowding, and interruption of sleep. On the severe end of negative effects,
violent physical and sexual attacks are much more likely to be made on the
homeless than on the general population. For example, a sexual assault is twenty
times more likely to be made on a homeless woman than on a woman in the general
population. These violent assaults result in considerable emotional and
psychological trauma in survivors, often leading to posttraumatic stress disorder,
anxiety, depression, suicide attempts, substance abuse and addiction, and further
psychiatric symptoms. The death rate among the homeless is also three times
greater than that of the general population, with many homeless people dying from
preventable or treatable illnesses or from unprovoked violence. Homeless people
with mental illness are even more vulnerable than other homeless individuals to
violent attacks and death.
Another important consideration is the number of children and adolescents who
are homeless. Homelessness has multiple significant psychological and
developmental effects on children. Homeless preschoolers are more prone to
developmental delays in language, motor skills, and social skills. Children who
experience chronic stress due to poverty or homelessness have poorer concentration
and memory, affecting their ability to learn. They also display more aggression
and shyness, have sleep problems (often due to the noisy environment of the
streets and in shelters), are more likely to exhibit aggressive behavior, have
lower self-esteem, and
experience more disruptions to their education. Homeless children are twice as
likely to experience hunger as nonhomeless children; hunger has serious negative
effects on children's physical, emotional, and cognitive development.
Some families consisting of women and children become homeless after escaping
from child
abuse, spousal abuse, or domestic
violence. In addition to possible developmental problems,
these children also have to struggle with the psychological trauma and
aftereffects of abuse. A study of homeless and runaway adolescents suggests a link
between domestic abuse and depression in these adolescents. Homeless adolescents
are more likely to have health problems, including respiratory diseases and
sexually
transmitted diseases, as well as substance abuse problems,
than their counterparts in the general population. The combination of
developmental, psychological, and medical problems makes homeless adolescents
extremely susceptible to poverty and homelessness in adulthood.
Potential Solutions
According to the US Department of Health and Human Services, most homeless
individuals with mental illness do not require institutionalization but would
benefit from a supported housing program that offers mental health care and
treatment. However, the number of affordable housing and community treatment
services is insufficient to accommodate all the homeless who suffer from mental
diseases. Additional resources are urgently needed so that the mentally ill
homeless can have access to continuous treatment and therapy. Additionally, making
community activities and certain types of employment available to homeless
individuals with mental illness may help break the vicious cycle of homelessness
and unemployment. Programs that assist homeless individuals and individuals with
mental illness to find housing, such as the Projects for Assistance in Transition
from Homelessness (PATH) program, need to be expanded to bring the these
individuals into stable, safe housing where they can receive the adequate social
support and treatment. Supplemental Security Income checks, which are the sole
income source for some Americans with disabilities, currently fall far short of
the amount required to cover rent and other necessities. Increasing this amount to
keep up with rising living costs can help ease the situation for some of the
homeless population. The Department of Health and Human Services has initiated a
program to recruit homeless children and their families into the national
Head Start
program to provide much-needed education and other services
via community and daycare programs. Studies have shown that preschool education
and participation in the Head Start program improve preschoolers’ development of
various skills.
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