Mental Illnesses among the Homeless
The homeless population has received much more attention in the recent past due to the increasing mental health challenges affecting the group. A dilemma is always observed when the health authorities try to cater for the mental health needs of the homeless while forgetting that the primary health concern in the individuals is homelessness. It has been long recognized that the homeless population is at high risk of mental illness than the housed people. Serious mental illnesses disrupt the people’s ability to carry out daily routines such as household management and self-care. Research has indicated that one-third of people experiencing homelessness in the United States suffer from mental illness (Perry and Craig, 2015).
Homeless people with mental health are a vulnerable group because they are neglected, or less attention is given to them when addressing mental illness. According to statistics, four percent of people suffering from severe mental illness do not receive treatment (Perry and Craig, 2015). Much attention is given to people who have relatives and friends, and those who are housed in asylums. I chose this topic because it is given less attention and due to the increasing number of homeless individuals in the streets. Statistics from the England journal indicate that the population of people sleeping in the streets has increased by 36% since 2010 (Perry and Craig, 2015).
A survey conducted in 2015 reveals that more than two-thirds of homeless people in the streets suffer from physical health problems like epilepsy, cancer, and cardiovascular diseases. Surprisingly, the population of the homeless group suffering from mental illness ranges from 25-30% (Perry and Craig, 2015). This article discusses the health concerns of the mentally ill homeless people, the risk factors associated with the problem, common mental problems facing the group and the management strategies used to eradicate the problem.
Risk Factors for Homelessness
Mental health is a problem that is mainly associated with various risk factors. The first cause of homelessness in mental health is drug use. A large population of people found in the streets is substance abuse users such as alcohol. The mental status is altered with continued substance abuse making them leave their homes. Psychiatric problems later develop leading to the increased rate of mentally ill individuals in the streets. Some homeless individuals are observed to be having home challenges such as the death of parents. The problem is common in third world countries where nobody volunteers to take care of the children. Depression is a health problem that affects many people leading to false judgments. Depression can render individuals homeless thus predisposing them to mental health illnesses.
Mentally ill individuals are subject to neglect by their family members and relatives as a result of violence or lack of cooperation. Due to the neglect, the individuals seek resort in the streets thus becoming homeless. Non-adherence to medication use is another factor that contributes to homelessness. Psychiatric medications are effective, and they help reduce the effects of psychosis, and when patients fail to adhere to the treatment regimen, they may end up becoming homeless (Perry and Craig, 2015). Lack of universal healthcare system in some nations is a risk factor for homelessness. The mentally ill are subjected to poor medication use or lack of the necessary drugs thus they become homeless. Lack of secure housing connections for inpatient people is likely to render them homeless during discharge. Research conducted in the United States revealed that 38% of the discharged individuals have no known addresses (Perry and Craig, 2015). The research indicates that many discharged patients end up in the streets.
Common Illnesses
The prevalence of mental illness in the homeless varies from one country to another because of the healthcare support systems available. However, there is a uniform pattern of the common illnesses that affect the people in the streets. Schizophrenia is a psychiatric disorder characterized by distorted behaviors, paranoid thinking, and delusional thoughts. The disorder affects individuals equally, and it has been observed that the homeless population is more affected by schizophrenia. In the United States, a third of the population receiving psychiatric treatment has been homeless at some point. The prevalence of schizophrenia in the mentally ill homeless people in the US is estimated to be at 15-20% (Spicer et al. 2015). The prevalence of the condition in the general population is at 1-2% showing how the disease is common in the streets.
The diagnostics and statistics manual (DSM-5) classifies Alcohol and Substance abuse as a psychiatric disorder. There is a global pattern with alcohol abuse among those who are homeless and according to statistics; alcohol dependency is a health problem that is difficult to control among the homeless individuals. The United States reports show that 4-86% of the homeless populations are chronic alcohol and substance abusers (Spicer et al. 2015). The condition is also observed in countries such as Canada, Australia, Germany Netherlands and Russia. The problem is rampant due to the availability of alcohol and drugs in the streets.
Personality disorders form the third group of mental illnesses that affect the homeless population. The condition is associated with perception changes and behavioral alterations in the affected individuals. One study in the UK suggested that personality disorders affect 66% of the homeless population and it has been found to be the leading cause of homelessness in the African countries. Suicidal ideations and self-harm are complications associated with the personality disorders. A London- based study found that 15% of the homeless people get treatment as a result of self-harm. Support evidence is also provided from Australia showing that more than 36% of the homeless people seek medical attention as a result of self-harm (Spicer et al. 2015). Suicidal ideations among the homeless are not common as compared to those in the hospital care centers.
Depression and mood disorders are more than ten times likely to occur in homeless individuals as compared to people with safe housing. Research conducted in the United States indicates that 36% of the homeless are likely to suffer from depression as compared to 3% in the safe housing (Aubry et al. 2015). Bipolar disorders affect the homeless at a rate of 6% as compared to 3% of the safe housing populations. Anxiety disorders are no exception in the homeless population, but statistics reveal that fewer populations are affected by the condition.
Barriers to Help-Seeking
The bureaucratic system forms one of the core barriers to health seeking for the homeless psychiatric patients. As observed, many people are forced to go back to the hospitals they received care first for continuity of treatment. The homeless people have a challenge of tracing the health centers that they received care from thus they fail to get the required treatment. Stigmatization is another challenge facing health care access in the mentally ill individuals (Rector, 2018). The people fail to seek medical attention because they are treated with disrespect.
Negative experience during earlier sessions is found to be a cause of non-adherence to treatment. Many homeless individuals fail to return to care centers if they were mishandled or if they did not receive the care they initially wanted. Dual diagnosis is also found to cause lack of medication adherence in homeless individuals.
Solutions
The problem of mental health among the homeless individuals can be managed using interdisciplinary measures. Integration of social housing and mental health care systems is likely to be beneficial to the homeless individuals (Rector, 2018). If housing is provided, monitoring and adherence to medication are made easier. Another approach that can be used is following- up programmes after the discharge of individuals from the hospital. As seen earlier, more than 36% of the discharged patients in the United States have unknown addresses which put them later in the streets (Aubry et al. 2015). The community can also be advised to take care of the mentally ill so that they do not run from their homes. Research indicates that 85% of housing concerns reduce psychiatric symptoms and improves stability in the mentally ill individuals.
Conclusion
Homeless people are at risk of suffering from mental illness, and a majority of the conditions are manageable if proper actions are taken. The paper shows that homelessness in mental health is a condition that is rampant in the world. Among the mental conditions that homeless people suffer include schizophrenia, depression and bipolar disorder, personality disorders and anxiety disorders. Management of the problem in the society starts with the control of the risk factors such as substance abuse, family rejection, and poor parenting. More research is required on this topic to address areas such as legislative policies to curb the problem.
References
Perry, J., & Craig, T. K. (2015). Homelessness and mental health. Trends in Urology & Men’s Health, 6(2), 19-21. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1002/tre.445/full
Spicer, B., Smith, D. I., Conroy, E., Flatau, P. R., & Burns, L. (2015). Mental illness and housing outcomes among a sample of homeless men in an Australian urban centre. Australian & New Zealand Journal of Psychiatry, 49(5), 471-480. Retrieved from
http://journals.sagepub.com/doi/abs/10.1177/0004867414563187
Rector, C., (2018). Community & Public Health Nursing: Promoting the Public’s Health (9th Ed.) Philadelphia,PA:Wolters Kluwer
Aubry, T., Nelson, G., & Tsemberis, S. (2015). Housing first for people with severe mental illness who are homeless: a review of the research and findings from the at home—chez soi demonstration project. The Canadian Journal of Psychiatry, 60(11), 467-474.
