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Home » Homeless Services » Homelessness Among the Seriously Mentally Ill: What We Can Do To Help

Homelessness Among the Seriously Mentally Ill: What We Can Do To Help


On any given night, 111,993 individuals suffering from severe mental illness are homeless in America. [1]

The US Department of Housing and Urban Development (HUD) defines severely mentally ill individuals as a “…subpopulation category of the PIT [that] includes persons with mental health problems that are expected to be of long-continued and indefinite duration and substantially impairs the person’s ability to live independently.” [2] The most common
mental health conditions that tend to lead to homelessness are schizophrenia and bipolar disorder.

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According to the HUD 2012 Point-In-Time Count report, severely mentally ill homeless persons constitute the second highest HUD-defined homeless subpopulation, closely following the HUD homeless subpopulation suffering from chronic substance abuse. [1] The situation is even more severe in Nevada, however, where the population of severely mentally ill homeless persons represents the highest percentage of among all homeless subpopulations, constituting 23.1 percent (2,290 persons) of the general homeless population in the region. [3]

With approximately 111,993 severely mentally ill homeless persons nationwide, this subpopulation composes approximately 17.7 percent of the entire homeless population. [1] This ratio is drastically different from that of the general population, where the percentage of severely mentally ill individuals hovers at a much lower level of 5 percent. [4]

WHY ARE THE SEVERELY MENTALLY ILL HOMELESS?

The disabling characteristics of mental illness lie at the heart of homelessness among the severely mentally ill homeless subpopulation. However, other causes include deinstitutionalization, as well as both self-imposed and societal barriers to assistance

Disabling Characteristics Of Severe Mental Illness: The severely mentally ill suffer immense challenges that can prohibit them from functioning in daily life, often leading to homelessness. These symptoms can be divided into three categories:

Emotional Disruption: 

  • Incapacitating and uncontrollable emotion, mood and/or anxiety

Cognitive Disruption:

  • Highly impaired concentration abilities, along with delusions, paranoia, and/or hallucinations
  • Disorganized thinking
  • Poor problem-solving skills
  • Inability to mobilize oneself for action (especially in Major Depressive Disorder)

Social Disruption:

  • Disruption in family and other personal relationships that creates severe difficulty in establishing a personal social support system, which can lead to social isolation and eventual homelessness.

These factors lead to the inability to obtain or maintain employment, and carry out the basic tasks of every day living. They also disrupt the individual’s ability to obtain food, clothing, shelter, and transportation. And substance abuse, which is common among the mentally ill, further compounds these difficulties. Overall, mental illness leads individuals (especially youth) to pursue life goals in unrealistic and irrational ways that lead to personal resource depletion and loss of social support.  [5] [6].

The Role of Deinstitutionalization in Homelessness: Deinstitutionalization is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. [7]

The common belief that deinstitutionalization is the direct cause of the high rate of homeless among the severely mentally ill is not entirely accurate.  The highest rate of deinstitutionalization occurred in the 1950’s and 1960’s, but the increases in homelessness among the severely mentally ill did not occur until the 1980’s. Experts agree that the decrease in income and affordable housing that characterized the 1980s is more to blame than the deinstitutionalization that occurred 3 decades prior. [8]

Barriers To Assistance: According to a 2003 report released by the US Department of Health and Human Service, most homeless persons who suffer from mental illness do not necessarily need to be institutionalized if they have appropriate supportive housing options. [9] The problem lies in the fact that many severely mentally ill homeless persons are unable to access supportive housing and/or treatment services for both social reasons and reasons related to their impaired conditions. [8] Therefore, there exists both societal and self-imposed barriers to individuals with severe mental illness to receive assistance.

Individuals suffering from severe mental illness face societal and self-imposed barriers to assistance. For example, the current lack of an effective system of mental healthcare represents a societal barrier to receiving mental health services. In addition to this, self-imposed barriers such as the intense paranoia that can accompany mental illness often leads severely mentally ill individuals to resist help from community services. [6]

CURRENT MOVEMENTS TO AID THE SEVERELY MENTALLY ILL

POLICY ISSUES

Better Coordination With Mental Health Service Providers: This has been cited as one of the top strategies to combat homelessness among the mentally ill and homelessness in general. The majority of severely mentally ill are willing to accept treatment, and the establishment of trusting relationships between mental health service providers and the mentally ill have statistically made outreach programs more successful.

Enhanced Supportive Housing: Even when severely mentally ill homeless individuals are provided with housing, it is difficult for them to maintain the stability necessary to stay off the streets unless they have accessed to continues treatment and services. Supportive housing has been found to be highly effective for individuals with mental illness, thus this trend must continue. It has been found that successful supportive housing involves the following:

  • Mental health treatment
  • Physical health care
  • Variety of flexible treatment options
  • Services that reintegrate mentally ill into their communities
  • Education and employment opportunities
  • Peer support
  • Daily living skills (i.e. money management skills training)
  • Implementation of outreach and engagement workers.

INTEGRATION OF MENTAL HEALTH SERVICES INTO EXISTING PROGRAMS 

A substantial effort to change the overall structure of the social service delivery system and integrate services for the mentally ill homeless population is necessary.

CityScape, a HUD publication that focuses on innovative ideas, policies, and programs that show promise in revitalizing cities and regions cites the following as necessary for successful integration: [10]

  • Assertively address mental health, substance abuse, and other problems through active outreach and services.
  • Closely monitor the need for services.
  •  Integrate mental health and substance abuse interventions.
  • Involve a comprehensive set of services for developing living, interpersonal, vocational, and social skills.
  •  Ensure a stable residential situation with a continuum of housing options that are safe and free of illegal drugs and alcohol.
  • Understand that chronic mental health and substance abuse problems need long-term treatment.
  • Commit to the belief that improved quality of life is possible for an individual, regardless of the nature and severity of his or her problems.

Conclusion

Kay Redfield Jamison, renowned author and professor at UCLA, who suffers from bipolar disorder once stated: [11]

“The horror of profound depression, and the hopelessness that usually accompanies it, are hard to imagine for those who have not experienced them. Because the despair is private, it is resistant to clear and compelling description.”

The fact that the majority of the general population cannot fathom the experiences that haunt severely mentally ill homeless persons does not mean there is no cure to homelessness among this particular subpopulation. Through increases in awareness, government assistance, the abandonment of stigma, as well as the dedication of CoCs nationwide, America can indeed quell homelessness that exists among the mentally ill.

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