Mental Health and Homelessness

Homelessness is quick to strip away a person’s dignity.  Homelessness makes it harder to meet your basic physical needs for food, warmth and shelter.  Homelessness also impacts a person’s psychological wellbeing, and studies have shown somewhere between 70% to 95% of homeless individuals suffer with poor Mental Health in the USA.  These figures are shocking and indicate how much need there is on the streets.  Edens’ Shift are working hard to tackle local homelessness, including supporting the homeless community to access effective mental health support.  In this blog, we’ll take a look at why it’s so important to consider the impact of poor Mental Health among the homeless community, and how quality Mental Health support is an important aspect of restoring dignity to homeless individuals in our community.

Mental Health:  Meeting our Physical and Psychological Needs

The World Health Organization are clear about what constitutes Mental Health.  The WHO definition of Mental Health is:

“a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”

This definition makes it clear why Mental Health difficulties are so prevalent in the homeless community.  Whether you’re sleeping on the streets, or making do in temporary accommodation and shelters, it is hard to realize your own abilities.  The stresses of life can be overwhelming for anyone who is homeless.  Contributing to your local community becomes increasingly difficult for anyone who must constantly focus on finding ways to stay alive and warm.  This point was outlined in the oft quoted work of psychologist, Abraham Maslow, who wrote about the needs we have as humans.  Maslow’s work is known commonly as “Maslow’s hierarchy” .  According to Maslow, it’s impossible for a person to meet their higher psychological needs for love, self-esteem and belonging if their basic needs for food, shelter, warmth and safety are neglected.  

Poor Mental Health within the homeless community presents in a variety of ways.  Depression, anger, and adjustment disorder were found to be the most common presenting Mental Health concerns for young homeless people.  Similarly, a research review found affective disorders such as depression and bipolar disorder, schizophrenia, anxiety disorders and substance abuse disorders were the most common types of mental illness in the overall homeless population^.  Just as it is harder to access services and support if you suffer from one of the many physical health conditions that impact the homeless community (including tuberculosis, asthma, bronchitis and HIV infection), so Mental Health conditions act as an additional barrier for people accessing services.  

The Homeless Chicken and Egg Question.

Which comes first, Mental Health issues or homelessness?  It’s easy to imagine how living on the streets can lead to anxiety, depression and use of drugs or alcohol as a coping mechanism.  Yet, it is also true to say that pre-existing poor Mental Health can exacerbate the chance of someone becoming homeless.  Most researchers agree that the connection between homelessness and mental illness is complicated.  Indeed, there are other factors to consider.  Poverty increases a person’s likelihood to suffer poor Mental Health and poor Mental Health, in turn, can make it challenging to secure and maintain regular, reliable employment.   Poverty is both a causal factor and a consequence of poor Mental Health.  It is also the case that certain communities within the homeless population present with higher levels of poor Mental Health.  For example, sexual and gender minorities have been shown to have greater rates of poor Mental Health, substance use disorders, and specific types of health problems compared to heterosexuals.  Prejudice and discrimination are thought to be a factor in these statistics.  

Conclusion

So, what can be done?  It’s clear that doing nothing is not an option.  Attending to people’s basic physical needs is important.  Food, shelter and safety offer some security and a base from which a person can then address other psychological needs.  That, alone, however, is not enough.  Homeless people also require access to trauma informed Mental Health care provision that is flexible and adaptable to the needs of the community it seeks to serve.  And, it makes sense to invest in supporting individuals who are at risk of homelessness due to poverty and injustice.  It’s for these reasons that Edens’ Shift take a holistic approach to working with local homeless individuals.  Mental Health support is just part of a package of care offered to the local homeless community.  Restoring dignity includes supporting both physical and psychological needs.  

Citations

•  U.S. Department of Housing and Urban Development, 2015 Annual Homelessness Assessment Report: Part 1: Point-in-Time Estimates of Homelessness in the U.S. https://www.hudexchange.info/resources/documents/2015-AHAR-Part-1.pdf
•  Martens WH.(2001). A review of physical and mental health in homeless persons. Public Health Reviews. 29(1):13-33
•  World Health Organization. (2004).  Promoting mental health: concepts, emerging evidence, practice. Geneva: WHO.
• Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.
• Winiarski, D.A., Rufa, A.K., Bounds, D.T. et al. Assessing and treating complex mental health needs among homeless youth in a shelter-based clinic. BMC Health Serv Res 20, 109 (2020).
•  Fazel, S. et al. (2008).  The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Medicine, Volume 5.  
• Mental Health Foundation, (2013). Starting Today: The Future of Mental Health Services.  London: Mental Health Foundation. 
• Flentje, A., Leon, A., Carrico, A., Zheng, D., & Dilley, J. (2016). Mental and Physical Health among Homeless Sexual and Gender Minorities in a Major Urban US City. Journal of urban health: Bulletin of the New York Academy of Medicine, 93(6), 997–1009.