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Alannah Chatfield 5/1/23 English 5B Mental Health in the Homelessness community Fujinami Homelessness is a very complex issue throughout society and requires much recognition, support and intervention from federal, state and local governments, along with community and charitable foundations and organizations. This support and intervention measures must aid to reduce the number of homeless by providing avenues for individuals and families to attain consistent, sustainable housing and utilities. There are many causes of homelessness throughout first world countries and much assistance is required to address these issues. Throughout developed nations, housing affordability has continued to decrease and there have been significant costs of living increases, making groceries, utilities such as electricity and gas, along with health care far more expensive. With housing and cost of living expenses increasing, having stable well paid employment is critical to be able to meet these costs. Maintaining stable employment, having the ability to make sound financial decisions and having access to health care and support are central to having sustainable housing to live in. Much research into the cause and prevalence of homelessness has shown a significant number of individuals who are suffering from homelessness are also suffering from mental health conditions and substance addiction disorders, showing us the importance of addressing these issues.

Although solving homelessness sounds like an impossible task, as there’s not one solution due to the multiple problems that factor into homelessness. From mental health to addiction, how do we find a solution that factors in all branches of the problem? Through my research the solutions which have been put in place to protect and prevent mental health and addiction in the homeless community, are donations to help awareness, facilities and preventive foundations to help make easier access and more availability to doctors, also housing programs for short term living. Although these solutions are embedded in our community, are they really effective? Are they really making a difference? Addressing access to appropriate health care and treatment for mental illness and substance abuse, is extremely important to prevent the loss of stable housing and employment and assist people already on the streets who are suffering these conditions to find housing and long-term solutions to maintain stable homes. While there are numerous factors contributing to homelessness, mental illness and substance addiction are the most prevalent causes in developed societies and significant investment and support in treating and educating people at risk is crucial to reducing homeless rates and assisting current homeless individuals and families in finding stable housing. Housing prices play a huge part in the cause of homelessness, with many organizations assisting to use “housing first philosophy” (Fowler and Hovmand). Housing first is an organizing philosophy that “coordinates resource allocation” to people in need of somewhere to leave. With this serving as an answer to quick housing support. The program makes it easier to obtain and

maintain housing with a “shift in philosophies” (Fowler and Hovmand) moving towards “a person centered and recovery oriented approach” (Fowler and Hovmand) rather than just another organization trying to help the mass population which is ineffective and unreliable. This organization is one that provides the homeless with access to housing and support ranging from mental health awareness to addiction interventions. The organization wanted to test their approach and see if by giving homeless individuals long term housing, it will help them in the long run. This experiment first took place in the 1980s and 1990s, to see how the homeless community reacted to the “housing first philosophy” (Fowler and Hovmand). They split a range of homeless individuals into two groups, with one group put into the housing first philosophy and the other one also put into that philosophy but put through treatment and doctor support first. It was recognised and discovered rather quickly within the results that the homeless community are strongly impacted by severe mental illness which is more consistently shown to the housing first instead of treatment first services. This helped the organization realize that giving homeless people a roof over their heads isn’t enough to help them move forward into the future and support them to take a positive step forward in their life. It was strongly emphasized that putting a treatment plan in place to help achieve healthy and happy people before getting put in a house, will make for more opportunities for these homeless individuals to find employment. It is clear from all the study and research into the cause and reduction of homelessness, that mental illness and substance abuse has a strong correlation and connection with an individual’s ability to access stable housing and maintain employment, with either being the cause of the homelessness or the outcome from it. Addressing access to appropriate

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health care and treatment for mental illness and substance abuse, not just for the existing homeless but also for at risk individuals and families, is extremely important, to prevent the loss of stable housing and employment and assist people already on the streets who are suffering these conditions to find housing and long-term solutions to maintain stable homes. While there are numerous factors contributing to homelessness, mental illness and substance addiction are the most prevalent causes in developed societies and significant investment and support in treating and educating people at risk is crucial to reducing homeless rates and assisting current homeless individuals and families in finding stable housing. Mental illness can lead to homelessness when individuals don’t receive appropriate treatment or support, increasing the chances of losing their jobs and even just making it difficult to gain employment or welfare support. Often people with untreated mental illnesses use street drugs as a form of self medication, causing further issues. Mental illness is a diagnosable health disorder that affects an individual's cognitive, emotional or social abilities (DoHA 2009). Without appropriate management and or treatment mental health issues can be extremely damaging on individuals, families and have an impact on all of society. There is a strong link between mental illness and homelessness, with mounting evidence that there is a significantly higher prevalence of mental issues in people who are homeless compared to that of the general population. Homeless people may not receive adequate health care to treat mental health illness due to financial barriers, lack of transportation to treatment facilities, lack of health care or private health insurance, also with no permanent address contact details making it nearly

impossible for follow ups and further may have a lack of insight or understanding into their illness. There may also be a reluctance to seek any treatment due to past negative experiences or refusal to get treatment. If treatment is used, the transient lifestyle of a homeless individual may increase the likelihood that they do not continue treatment or take appropriate medicines regularly. Individuals suffering mental illness may have symptoms or behaviors that prevent or threaten housing stability. These include, disruption to neighbors, missing rent or utility payments, keeping housing in an unsanitary state or causing damage to housing and furthermore causing a threat to themselves or others. Having insecure housing and low housing stick and affordability can have further impact on mental health disorders and subsequently lead to homelessness. A 2010 review by Greenberg and Rosenheck, “estimated that between 20 and 50% of people” who are homeless have serious mental illness. The study also notes that people who experience a week of homelessness since age 18 were “significantly more likely” to develop mental illness than those who had not. Homelessness is an issue that can be provided with solutions to prevent and protect individuals. By understanding the behavioral health needs of the homeless population we can start to develop ways in which to end homelessness. “A growing body of psychological research has already contributed to knowledge in this area with reviews of risk factors for the homeless revealing that adverse childhood experiences, mental illness and substance abuse are strongly associated with homelessness.” (Susser, Moore, & Link, 1993; Tsai & Rosenheck, 2015). This means that if we protect the next generations and

give them the support and opportunity for a good future we can help get people off the streets. Recently there have been advances in the research and services provided to the homelessness and to the awareness of homelessness, “for example the U.S Interagency Council on Homelessness provided the nation’s first comprehensive strategy to prevent and end homelessness in 2010”- (O'Toole and Kearney). There needs to be prominent solutions to help build awareness about homelessness and the severe mental illness and substance abuse that comes along with the complex issue. Building this awareness will help make a change and further educate the community to invest in this cause by making donations with money, clothes, food and other necessities that could change someone's life. This awareness will help the government to invest in the issue as they will understand the importance and value of financially supporting these foundations and facilities which have been built to acknowledge the homeless and try to get them to a place where they can have a stable life, with a job and a roof over their heads. When confronted with a problem we think solving it means finding one way to make the problem go away, making it inexistent, but in reality when it comes to finding a solution for homelessness it is with the work of many solutions and many voices which will work together to manage the problem. It has been shown through research that a solution to homelessness involves having a voice and taking a stance to educate the population, this doesn’t only just bring awareness to the issue but it makes the government acknowledge the issue and help take this step forward by helping to fund these solutions. With the help of the government and the majority of society we can start really taking action.

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A Canadian study by M Hwang Et Al looked at the prevalence of mental illness in homeless individuals and found that it was extremely high, with over one third of individuals reporting diagnosis of a mental health disorder. The study found that homelessness can increase the risk of mental health disorders through the trauma, social isolation and poverty associated with homelessness, along with the inability to access health services. The Australian Institute of Health and Welfare in a 2017 study found “There were 234,033 people aged 10 years and older assisted by specialist homelessness agencies nationally in 2020-21. Of these almost 2 in 5 were clients with a current mental health issue.” The rate of individuals being assisted by homelessness agencies, conducted by the same Australian Institution in 2011, which found “20% of homeless individuals suffered a mental disorder”. “The Canadian Institute of Substance Abuse in a 2021” also report that people with poor mental health or who have a mental illness are more vulnerable to homelessness. They found that people living with mental illness experience increased stress that can impact their ability to exit from homelessness due to their economic, health and social struggles. As noted in the article that “people who do not experience mental health issues while housed can experience poor health if they become homeless. This is due to the risks and stresses inherent in the homeless situation.” A 2021 systematic review analysis conducted of previous studies into the prevalence of mental disorders among homeless people across 11 high income countries found that of 39 publications with a total of 8049 participants, the prevalence of mental disorder was

estimated at 76.2%, with the most common being alcohol and drug addictions. The study found the burden of mental health disorders on the homeless was substantia and needed to be addressed as a major public health challenge. The study also found that there was a high prevalence of mental health disorders among homeless people significantly higher compared to the average societal. Substance abuse can either be the initial cause of homelessness or also can occur as a result of homelessness and individuals seek out substances due to their situations they are facing. In an article ‘Why we should not help the homeless’, Kyle Cassaday discusses the many “good reasons” that “exist for why we shouldn't help the homeless.” - (Cassaday) It is stated in the article that helping the homeless teaches dependency, financially our money could be spent elsewhere, often these individuals are drug addicts/alcoholics, they refuse to work and overall creates more homeless leading to the ultimate conclusion that they don’t need our help. By putting all our resources and money into the homeless community, we aren’t teaching them how to help themselves and this is leading to them knowing they can turn to the public and the government causing them to depend on us. “Give a man a fish and he’ll be hungry by the evening. But teach a man to fish, and awe… he’ll never be hungry again” - (Cassaday) This quote is referring to the fact that instead of just giving to the homeless we should actually educate them on how to help themselves, which will help them better in the long run. Over of the homeless population are drug addicts or and alcoholics, with research ⅓

showing that addictions are “entirely reversible.” - (Cassaday). With it being completely up to the individual to overcome an addiction, it is clear that many homeless don’t have the willingness to find services to help them give up their addictions. Many people in society think that homeless can’t find work because of their appearance yet it's because of their solvable drug/alcohol problems. When you see a drunk homeless person, our society today thinks that by drinking the homeless are using it as a coping mechanism, yet they are using the little money they have on alcohol over a warm place to stay, furthering the point of is there a point to helping these individuals if they can’t even manage to take positive steps forward. This naysayer makes great points yet overall Kyle Cassaday was saying that we need to teach the homeless to start helping themselves yet this would be done by making a solution or a help line to educate the homeless community in ways to not depend on the public for money or a warm shelter. Ultimately this is a rebuttal against himself in the fact that he doesn’t think we should help the homeless yet found a solution to help the homeless… Not every homeless person is an alcoholic or drug addict and it's unfair to categorize these individuals into the same position just because they live on the street, giving the government a reason not to fund or share resources just because you want to try say that a drunk man is in the conditions as a little child or a family who lost their jobs. Many of the homeless community as I have mentioned are facing long term mental health issues that can’t be fixed on their own, so by giving them opportunities to get better through giving them access to health care will ultimately help them get off the streets.

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If you were going through a mental health problem, you would go see a doctor and that's not because you rely on other people, it's because there are professionals out there to help you and it's the best way to achieve your health goals. So why is it different for a homeless person? We are all the same and we all deserve the same opportunities to be healthy and safe. Kyle Cassaday stated that addictions are “entirely reversible.” yet you would seek help if you needed to, the homeless don’t have the easy access to health care that we don’t, so them not seeking help is not because they are choosing to drugs instead of find a job or a home it's because they don’t have the resources we do to seek medical help from professionals. Overall it is very obvious that by helping the homeless, is something that needs to be done as the homeless community are humans like us and deserve the opportunities to turn their lives around. In conclusion, we need to find a solution for the homeless that can help to solve homelessness, with the solutions that I have mentioned above I believe we can really help get individuals and families not only get off the streets but be in a healthy state of mind that can enable them to be mentally stable leading to job opportunities and a happier lifestyle.

Work cited: Cassaday, Kyle J. “Why We Should Not Help the Homeless - 9 compelling reasons.” CAUF Society , 7 December 2022, https://caufsociety.com/why-should-we-not-help-the-homeless/. Accessed 1 May 2023. B, Kamlager C. “California's failures to treat addiction and mental health drive homelessness.” The Desert Sun , 2 August 2021,

Fowler, Patrick J., and Peter S. Hovmand. “Solving Homelessness from a Complex Systems Perspective: Insights for Prevention Responses.” NCBI , 2 January 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445694/. Accessed 19 March 2023. RA;, G. G. A. R. (2023, February 8). Mental health correlates of past homelessness in the National Comorbidity Study Replication . Journal of health care for the poor and underserved. Retrieved February 8, 2023, from https://pubmed.ncbi.nlm.nih.gov/21099075/ National Coalition for the Homeless. (2018, February 21). Substance abuse and homelessness. Retrieved February 9, 2023, from http://www.nationalhomeless.org/factsheets/addiction.pdf Gazzar, B. (2022, April 25). Substance use disorder . National Health Care for the Homeless Council. Retrieved February 10, 2023, from https://nhchc.org/clinical-practice/diseases-and- conditions/substance-use-disorder/

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