Homelessness is a
harsh reality for many people throughout the United States and around the
globe. The homeless are a highly stereotyped and stigmatized group within
American culture. Many are feared and dehumanized because of society’s lack of
understanding. They are often associated with psychiatric disorders, alcohol
and substance abuse, and criminal activity. Why do the homeless often carry these
characteristics? The mental health of the homeless population remains not fully
understood, and adequate homeless support programs are in short supply.
There is plenty
of research that has been done on the mental health of homeless populations, but
the research has many complications. To start with, there is no generally
accepted definition of homeless. Almost all definitions include people who lack
housing of their own, but many studies use divergent definitions of
homelessness. This causes discrepancies amongst the data collected in different
studies. A cohesive definition would be beneficial for the interpretation of research
studies and for the understanding the conditions of homelessness in other
regions. Another problem with the research is that most of it is funded by
agencies that have their own agendas, which results in biased study results. On
top of that, the incidence of homelessness and its associated mental health
problems vary from one community to another and evolves over time. Research
done in a specific region is not always applicable to another, further diluting
the knowledge of the subject. Despite these discrepancies, there is still
valuable information about the mental health of homeless population that can be
used from current research (Vazquez & Munoz 2001).
People do not end
up homeless simply by coincidence or because of lack of ambition and effort;
there is a series of social reasons that have caused them to end up where they
are. There are both structural and individualistic explanations for
homelessness. Structural reasons include the lack of affordable housing,
changes in the economy, an increase in the availability of illicit drugs,
declining appeal of marriage, the prevalence of sexism and racism, and lack of
support for the disabled (Vazquez & Munoz 2001). Lack of ambition or
talent, traumatic life events, and debilitating effects of illness, including
drug and alcohol dependency, are all individualistic causes of homelessness
(Vazquez & Munoz 2001). It is also common for women and children to enter
homelessness to flee domestic violence situations, especially since the
increase in emergency housing within the U.S. (Vazquez & Munoz
2001). In other words, as emergency housing became more available, people
suffering from domestic violence became more willing to leave their homes.
However, the loss of employment and insufficient income to retain housing are
the most prevalent reasons for homelessness (CIHI
& CPHI 2007).
Homelessness cannot be fully explained by either structural or individualistic
explanations, as both are immense contributors to the problem.
Whatever the cause,
homelessness is an enormous problem in the United States; there are more than
630,000 people who are homeless every night (Burt et al. 2001). Approximately
30 percent of homeless people have serious mental disorders, and more than 80
percent, if other disorders such as anxiety and antisocial personality are
included (Vazquez & Munoz 2001). Approximately half of
homeless adults have substance dependencies, many of whom suffer from
comorbidity (PRA & CMHS 2003). Other common mental illnesses among the
homeless are PTSD (most frequently from domestic violence or war), depression,
anxiety, manic-depressive disorder, schizophrenia, alcoholism, and, frequently,
comorbidity. These are daunting statistics, but the U.S. has the information
and capability to alleviate these problems.
Some people develop mental
illness prior to losing their shelter. There is a complexity of biological,
psychological, and sociological explanations of why these people develop mental
illness. Regardless of what causes it, a person with a severe mental illness is
more likely to become homeless than a person who does not suffer from one (Toro
& Janisse 2004). Mental illness can create a burden upon family and
friends, resulting in a loss of social support. Some mentally ill people find
school difficult and lack substantial education. With many of the mentally ill
finding it difficult to maintain job security and proper self-care, they often
end up institutionalized or on the streets. Although almost half of homeless
people have a lifetime diagnosis of mental illness, it is argued that it is a
relatively uncommon cause of homelessness (CIHI & CPHI 2007; Toro & Janisse 2004).
If this is true, it is much more common for people to be diagnosed as mentally
ill after they have become homeless. Unemployment rates, household resources
(such as education and skills of workers, social support networks, financial
resources, and vulnerabilities), the presence and severity of disabilities and
illnesses, and social policy for people with disabilities, all affect income.
The combination of low household income with the poor availability and high
cost of housing often results in homelessness (Burt et al. 2001). This can be
seen in Figure 1.1 on the next page, which was taken from Helping America’s
Homeless by Martha Burt and co-authors. This cause of homelessness has become
more common since 2008 when the recession began, increasing unemployment and
lowering employment opportunities. The closing of mental institutions also accounts
for much of the rise in homelessness throughout the last several decades (Toro
& Janisse 2004). Other factors that distinguish the homeless from other
populations include more alcohol and drug dependencies, dysfunctional
backgrounds, community violence, and higher levels of stress (Toro &
Janisse 2004).
Most homeless
individuals have very stressful life-circumstances, lack adequate social
support, and have low levels of self-esteem. It is common for them to not have
social support because they have fled a domestic situation or have burned-out
their friendships and family support by being too much of a financial or
emotional burden. The fall into poverty causes loss of self-esteem and
self-worth. Without social support and self-esteem, which act as buffers
against the effects of stress, stress can have a great impact on an
individual’s mental health (Thoits 2010). Homelessness causes a great amount of
stress on an individual:
The absence of shelter
exposes homeless persons to the weather, violence, and other threatening
conditions. They have trouble fulfilling basic needs that most Americans take
for granted, such as finding a job, obtaining nutritionally adequate meals,
getting around town, washing clothes, storing belongings, and locating toilet
and bathing facilities. (Barrett 2001)
Because of this, many people who are biologically predisposed to
mental illness are triggered by the stress of homelessness. Many others turn to
alcohol or drugs to help alleviate their stress, which often leads to addiction
and can also act as a trigger of other mental illnesses.
Alcohol and drug
dependencies among the homeless population are huge problems, especially in the
United States. The prevalence of substance dependence, including alcohol, was
72.6 percent in a Los Angeles sample (Vazquez & Munoz
2001). This number is approximately
twice as high as the prevalence among most European regions, with the exception
of Germany where there is a high prevalence of alcohol dependency (Vazquez
& Munoz 2001). The difference in these rates can be explained by the
number and quality of treatment facilities in the region, along with the
variance in cultural norms of alcohol and drug use. Europe has healthcare
systems that are more inclusive of the lower class, and has lower rates of drug
and alcohol dependencies. Substance abuse often is paired with affective
disorders, which makes treatment more difficult (Vazquez & Munoz
2001). Substance abuse is problematic because it leads to mental and physical
complications and deviant behavior: “more social problems (e.g., effects on
work, school, or childcare), emotional problems (e.g., lack of interest,
depression), and health problems (e.g., hepatitis) related to alcohol and
drugs” (Vazquez & Munoz 2001). Drugs and alcohol
dependencies prevent the homeless from spending their money on the things that
they really need (food and shelter), which causes them to become less healthy.
Homeless support programs and shelters typically do not allow drug or alcohol
use. Because of this, many addicts choose to fulfill their substance dependency
rather than taking advantage of available shelter and services. In order to
afford both their addiction and their basic needs, they may participate in
panhandling, exploitive labor, or illegal activities such as prostitution or
drug dealing. Addictions cause people to dive deeper into homelessness and stay
homeless longer (Vazquez & Munoz 2001).
Different people
have different durations of homelessness. Some are homeless for short amounts
of time (about 80%), some are chronically homeless (about 10%), and others are
episodically homeless (about 10%) (Vazquez & Munoz 2001). The median episode of homelessness is around
5 months, which puts most of the homeless into the short-term category (Lee 2001). People who have severe mental illness and/or addictions
frequently fall into the chronic category. As individuals spend increasing
amounts of time being homeless, they become more comfortable doing what they
need in order to cope with the stresses of homelessness. Many pick up
panhandling, going to the bathroom and sleeping in public places, and
committing petty crimes. Many are banned from shelters because of alcohol or
drug problems, or because they have caused other problems for the shelter’s
administration. With more harsh exposure to the environment, they are also more
likely to pick up infections. They break an abundance of social norms, act
strangely, and do things that the non-homeless typically do not. While the
short-term homeless often blend-in or are out of sight at various shelters and
social services, it is mostly the chronically homeless that shape the public’s
view.
These negative perceptions lead people to
think that ending homelessness is a hopeless cause, as the homeless are just
too far gone. The public’s lack of understanding of the path into insanity,
addiction or poverty, causes dehumanization and leaves them as others and disenchanted individuals (Weinberg 2005:193). Americans value
individualism and the belief that we all have control over our destiny, which
leads to the view that “if one is poor, it is one’s own fault, and that poor
people are somehow less worthy, less blessed, less chosen, and also less fit
than those with money” (Burt et al. 2001).
This individualistic view causes the general public to be less proactive
in helping the homeless, as people are more willing to provide assistance to
people who are in bad situations because of an external force (Burt et al.
2001).
If homelessness is a primary
cause of mental illness, substance dependence, and criminal activity among the
homeless population, then it is obvious that the best solution in helping their
mental health would be to take steps towards irradiating homelessness (Burt et
al. 2001). The current programs designed
to help the homeless of the United States are scarce and insufficient. There
needs to be more funding provided to homeless services and the funds need to be
better allocated. The homeless are among the most vulnerable people in the
United States, but we are not doing a very good job at taking care of them.
The government has put a
great deal of emphasis on emergency shelters in recent years. These shelters
are costly, not expansive enough to assist entire homeless populations, have
done little to irradiate homelessness, and the homeless that are assisted still
have the stress of not knowing where they will sleep the next night. It is an
ineffective system that needs to be changed. More funds should be allocated to
transitional programs designed to get people out of homelessness, rather than
to emergency shelters. It is important that people get enough emergency
assistance to survive homelessness, but it is common for people to misuse
shelters by living in them for extended periods of time. It is more expensive
to operate and maintain emergency shelters than it is to provide subsidized
housing. In order to relieve homelessness we simply need to “make housing more
available and affordable” (Burt et al. 2001:324). If more funds were allocated
to transitional programs and rent subsidization, more people would sleep with a
roof over their head. Not only are transitional programs less expensive than
emergency shelters, but they can also relieve stress and provide consistent
social support and encouragement that most homeless individuals desperately
need. This support is necessary for many to transition. It is also necessary
for many to create and reach goals that will help them become self-sustaining, from
gaining employment to engaging them in drug or alcohol treatment (Burt et al.
2001).
The individuals
who are too mentally ill to be successful in transitional programs should be
put into permanent supportive housing. Many people have the perception that
this would be too costly, but it actually would save money. The seriously
mentally ill rack up costs for the government at emergency rooms, prisons, and
emergency shelter programs that would be prevented if they were put into
permanent supportive housing. The current lack of assistance for this
disadvantaged population of our country is unethical and more assistance needs
to be implemented (PRA & CMHS 2003).
It should be
taken into account that homeless people tend to cluster in areas that offer the
best support services. This can be seen locally in the Willamette Valley. Many
people travel from Springfield and other poorer cities in Oregon to Eugene,
where there are better services for them. Some of these facilities include The
Eugene Mission, ShelterCare, Looking Glass, First Place Family Shelter, The
Relief Nursery, Woman’s Space, Egan Warming Center, Oregon Health Plan, and a
variety of other organizations. When there are large numbers of transients they
can overwhelm the system, causing everyone longer waits for assistance and less
quality care. The police force also has a problem with the large numbers of the
homeless. They have to work extra diligently to make sure the homeless do not
commit crimes, to attempt to keep drugs away, and ensure that there are not
conflicts between homeless people and community members. It would make sense
for services to be more spread-out and community based. This would allow the
homeless to not have to abandon any social support that they have in order to
receive assistance, and spread out the homeless problem so that it would not be
such a burden on certain areas.
There are also
disproportionate groups within homeless populations. There are higher
prevalences of males and racial minorities. One explanation for the different
prevalence of sexes is the greater abundance of programs available for women,
teenagers, and children, than there are for men. Racial minorities are more
commonly homeless partially because they are more typically members of the
lower class, which is the most common class for the homeless to come from
(Duneier 2001). Teenagers frequently become homeless, and have different
patterns than homeless adults. Research shows they have lower levels of
substance abuse and mental illness than adults. This is because they typically
become homeless not out of financial or mental problems, but family problems.
It is also because many mental disorders tend to not appear until later in life
and they do not have as easy access to alcohol and drugs (Toro & Janisse 2004).
Approximately 70 percent of the homeless
population consists of single adult males. This can be seen at the Eugene
Mission, which provides 350-400 guests meals and shelter every night, with a
ratio of five single men for every single woman. There is no definite reason
why there are so many more homeless men than women. One possibility is that
they more frequently have drug and alcohol dependencies (about 70 percent). It
is possible that women do not do drugs as frequently as men in order to be better
mothers, or that their drug use is underrepresented because of denying drug use
to prevent their children from being taken away to protective custody (Toro
& Janisse 2004). It could also be argued that not as many women do drugs
because society pressures them to internalize their emotions, and that men do
drugs to externalize their emotions (Rosenfield 2000).
Even though there
are still many discrepancies in the research of the mental health of the
homeless, many important conclusions have been drawn from it. People in the
United States need to realize that homelessness is a circumstance, not a
personal characteristic. The homeless are vulnerable people who deserve proper
assistance, not disenchantment. The United States is capable of more
effectively serving the homeless but needs to evolve its homeless support
systems in order to do so. The research and understanding of how to do so
exists, it just needs to be implemented.
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