Mental Illness and Homelessness

Introduction

Homelessness is one of the indirect costs associated with mental illness (National Institute of Mental Health, 2008). National Coalition for the Homeless (2012) suggests that 633,782 people were homeless for a single night in US in January 2012. The number of people living under chronic homelessness in January 2012 was 7,254. Poverty is considered to be one of the most common contributors of homelessness. National Coalition for the Homeless (2012) suggests that people who are at high risks of experiencing poverty are also at a high risk of becoming homeless.

NHS Confederation (2012) indicates that 70% of the homeless people in USA have mental problems. Specifically, mental illnesses are the major contributing factors to homelessness. National Coalition for the Homeless (2013) also suggests that 700 people in US die of hypothermia caused by sleeping out in the cold due to homelessness. These problems of homelessness are mainly caused by mental illnesses and poverty.

The relationship between mental health and homelessness has experienced an evolution in the history of psychiatric care for mentally ill people. The first incident linking homelessness and mental health in USA was documented by Karl Wilmanns in 1906. Since then, the patterns of mental health psychiatric care have evolved in three cycles of reform beginning with the emergence of moral treatment and asylums in the early 19th century. Asylums were developed to treat people with mental illnesses. State mental hospitals were then started in the early 20th century to offer psychiatric treatments for patients. This was followed by deinstitutionalization of mentally ill people. Deinstitutionalization took place after World War II due to nationwide incitement that state hospitals and accelerated the state of mental illnesses.

Community mental health centres were then established in 1963 due to the problems caused by deinstitutionalization. However, community health centres failed to meet the needs of mental illness patients as they were discharged from public hospitals. Community centres could not be able to provide key benefits and programs for mentally ill patients. This caused homelessness and lack of access to social amenities and infrastructure. Goldman and Morrisey (1985) suggest that overreliance on community health led to homelessness among thousands of patients.

The purpose of this paper is to provide the relationship between homelessness and mental illness. Mental illness is a prevalent health condition in United States and all other parts of the world. It refers to a type of disorder that influences the thinking, behavior and mood of an individual. It is a mental anomaly that affects the normal functioning of a human being. The National Institute of Mental Health defines mental health as any behavioral, emotional or mental disorder except substance abuse and developmental disorders.

Mental illness has different levels of impact on the patient. It may be a mild impairment, or a significantly disabling one. Individuals with a serious mental illness (SMI) face serious impairment which disables the normal functioning and interferes with the ability of the patient to perform certain activities. Some of the known mental illnesses include anxiety disorders, depression, eating disorders, additive disorders, and schizophrenia.

Connection between homelessness and mental illness on a national level

Literature from USA shows a linkage between de-institutionalization of mentally ill patients and the increased rates of homelessness. Due to the closure of asylums that previously offered institutional treatments to people with mental illness in US, Britain and other countries of Europe in 1950s, the social problems of homelessness increased.

Sociologists suggest that the rise of feminism, postmodernism, and anti-psychiatry led to the shift of national policy to de-institutionalization which caused changes in the national-level state of homelessness. The decline of institutional care for people with mental illnesses is attributed to three factors. First, the decline of care for mentally ill people was caused by the changing views on the need for detention of mental illness patients after the Second World War. The second factor is the introduction of drugs that could be used to control mental disorders. Thirdly, institutionalization of mental illnesses declined due to the increasing incidences of inhumane treatment mechanisms.

As a result of community health services, there is a significant number of people with mental disorders who cycle between homelessness, boarding rooms, emergency rooms, acute psychiatric community health centre, and then back into homelessness (Homelessness Australia, 2011). In this case, the effect of mental illness on homelessness in the national level is mainly caused by the changes in policies concerned with mental illness.

Mathieu (1993) also observes that the shift in economic and social policies in United States during the 20th century led to homelessness and poverty in the national level. Mathieu considered the linkage between mental illness and homelessness as the medicalization of social problems. Therefore, Mathieu (1993) considers that there is no connection between mental illness and homelessness on a national level. He argued that medicalization of homelessness was an attempt of policy makers and politicians to delegitimize the predicaments of homeless people in the country and to draw the focus of the nation away from structural causes of homelessness including poverty.

Connection between homelessness and mental illness among individual adults

On an individual level, homelessness also seems to be a result of mental illnesses among other factors. As suggested by the National Institute of Mental Health (2013), there were about 9.6 million adults (over 18 years of age) in the US who suffered from serious mental illness. This represents 4.1% of the total US adults. This can be illustrated in the figure below.

The figure indicates that people between 26 and 49 years of age are most affected by mental illnesses, and females are also affected more than males. In this case, mental illness is a serious problem among adults. This might affect homelessness in an individual level.

Adults who are mentally ill face problems of homelessness develop psychopathology and substance abuse before they become abuse. This leads their caregivers and relatives to push them away for lack of tolerance. Eliot and Krivo (1991) suggest that substance abuse and mental illness prevents individual adults from maintaining a permanent home.

Furthermore, mentally ill adults are always unable to get children because they cannot maintain an intimate relationship. As a result, mentally ill remain alone; hence they may not find a reason to have a home. They will choose to stay alone out of their homes.

Homelessness and mental illness in California

California’s Public Mental Health System conducted a research on adults with serious mental illnesses in California and established that 15% of the surveyed people with mental illness were homeless at least once in a year (Folsom et al, 2005). Those who suffer from bipolar disorder and schizophrenia were found out by the study to be the most affected. At least one among five people has serious mental illness in their lifetime in California.

Hoffman (2013) suggests that mentally ill people become homeless in California because they do not get funding from the government. The State of California cut $4.35 billion from the previous figures of money allocated to mental health in the budget of the state. Psychiatric hospitals in some parts of California are closing down. 64% of the homeless people in San Luis, California, in 2012 were mentally ill.

San Francisco

There are many mentally ill people in San Francisco’s the neighborhoods of Embarcadero, North Beach, South Market, and others (Linde, 2010). Due to deinstitutionalization, there are no intentions of the state to provide psychiatric and physical treatment of the many patients in San Francisco (Linde, 2000). Therefore, mentally ill people have gone out into the street in large numbers. The case study below drawn from San Francisco helps people to understand the relationship between mental illness and homelessness.

“Sick of the sickest” case study

There was a law in 2010 in San Francisco called “sick of the sickest” which intended to provide outpatient treatment to the mentally ill. This law was proposed due to killing of Laura Wilcox by a mentally ill person in the streets of Nevada County. However, this did not succeed. This law was discussed by San Francisco Board of Supervisors twice, but has never passed.

Los Angeles

There are 90,000 homeless people in Los Angeles, amounting for the largest number of the homeless people than any other county in USA. About 25% of these homeless people in Los Angeles are mentally ill. Most of these homeless people are found in Metro Los Angeles and South Los Angeles. There are about 82,291 homeless people in the city of Los Angeles. About 42% of them suffer from one or more illnesses, including mental illness.

Skid Row is the largest host of homeless people who are mentally ill in Los Angeles. Valle (2005) suggests that mental illness people are dumped on the streets of this area, near social service organizations. For instance, Valle suggests that there was a reported incident in 2005 when police officers from other areas of Los Angeles dumped an unwanted mentally ill person on the streets of Skid Row, making him homeless.

Conditions faced by mentally ill people in California

People who are mentally ill and homeless suffer various conditions. Some of the disorders associated with mental illness include anxiety disorders, autism disorders, depression, panic disorder, bipolar disorder, eating disorders, schizophrenia and many others. These disorders cause stigma, trauma and sometimes lead to psychopathology and substance abuse.

When people are mentally ill and they become homeless, they gain biographical experiences such feeling unloved, adverse childhood experiences, and unhappiness. Mentally ill and homeless people also face rejection and abuse by other people. These experiences cause stigma and trauma among the homeless mentally ill people. Homelessness and mental illness is also juxtaposed by members of the society, causing stigma among homeless mental patients.

Recommendations

Due to the serious effects that homeless brings, it is necessary to develop mechanisms through which mental illnesses can be controlled in the national and individual level so that they do not cause homelessness and more physical problems. The recommendations of this paper are provided in terms of two different systematic approaches. One approach addresses the problem in the national level while the other approach addresses the problem in adult individual level.

Policy formulation implementation

Mental illness and in the national level can be controlled mainly through policy implementation. The policies that need to be implemented should address both mental illness and homelessness. In terms of mental illness control, it is important to develop healthcare policies that enhance the physical and psychiatric treatment of people with mental illnesses. This role of policy formulation should be given to the state. The state should also coordinate with healthcare providers in order to ensure that such policies are implemented effectively. This will reduce the impact of mental illness on homelessness.

Outreach programs

In terms of homelessness, outreach programs should be enhanced in order to establish a strong contact between healthcare providers and the homeless individuals with mental illness in order to provide constant treatment and services for the homeless individuals who suffer from mental illnesses. Flexible treatment options for adults should be provided in order to reach the needs of each individual. This needs sufficient funding and support by the state.

Limitations of the studies

The studies consulted in this paper have their own sets of limitations. First, they rely mainly on statistics provided by organizations which are concerned with the wellbeing of people who suffer mental illnesses and those who are homeless. Therefore, they are likely to be biased in their findings.

Another limitation of the studies is that they do not provide a clear method of measuring the social variables of the problem: homelessness and mental illness. For instance, mentioning someone who lacked a room for only one night or someone who has a house but opted to stay out for mental problems seems to be unrealistic.

Conclusion

This research has found out that homelessness and mental illness are two interconnected and interlinked social problems. In the national level, the increased numbers of homeless people who are mentally ill have been caused by policy changes. Reduction of treatments for people with mental illness due to deinstitutionalization has led them to homelessness in the national level. Furthermore, individual adults have been rendered homeless by the reluctance of caregivers to support them due to their situation.

This problem can be solved by developing and implementing healthcare policies that will involve the collaboration between the state and the healthcare providers. The problem can also be addressed by developing outreach programs that can meet the needs of each individual homeless adult with mental disorder.

References list

Homelessness Australia (2011). States of being: Exploring the links between homelessness, mental illness and psychological distress. Sydney: Homelessness Australia.

Elliott, M., Krivo, L.J. (1991). Structural Determinants of Homelessness in the United States.  Social Problems, 38 (1).

Folsom, D.P., Hawthorne, W., Lindamer, L., Gilmer, T., Bailey, A., Golshan, S., Garcia, P., Unützer, J., Hough, R., and Jeste, D.V. (2005). Prevalence and Risk Factors for Homelessness and Utilization of Mental Health Services Among 10,340 Patients With Serious Mental Illness in a Large Public Mental Health System. American Journal of Psychiatry, 162, 370-376.

Goldman, H. and Morrissey, J. (1985). The Alchemy of Mental Health Policy: Homelessness and  the Fourth Cycle of Reform. American Journal of Public Health, 75 (7).

Hoffman, P. (2013). More Mentally Ill Becoming Homeless Because States Won’t Help. Accessed May 2, 2014 from http://www.truth-out.org/opinion/item/16193-more-mentally-ill-becoming-homeless-because-states-wont-help

Mathieu, A. (1993). The Medicalization of Homelessness and the Theater of Repression. Medical Anthropology Quarterly, 7(2), 170-184.

National Coalition for the Homeless (2013). Homelessness in America. Accessed   April 30, 2014 from http://nationalhomeless.org/about-homelessness/.

National Coalition for the Homeless (2009). Mental Illness and Homelessness. Washington: National Coalition for the Homeless

National Institute of Mental Health (2013). Serious Mental Illness (SMI among Adults. Accessed April 30, 2014 from http://www.nimh.nih.gov/statistics/SMI_AASR.shtml.

National Institute of Mental Health (2008). Mental Disorders Cost Society Billions in Unearned Income. Accessed April 30, 2014 from http://www.nimh.nih.gov/news/science-news/2008/mental-disorders-cost-society-billions-in-unearned-income.shtml

NHS Confederation (2012). Mental health and homelessness: Planning and delivering mental health services for homeless people.  London: NHS Confederation.

Valle, R. (2005). Los Angeles: city of the stars becomes US homeless capital. Accessed May 1,  2014 from https://www.wsws.org/en/articles/2005/10/home-o17.html

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