Homelessness and Mental Illness - Research Paper Example

HOMELESSNESS, MENTAL ILLNESS AND DUAL DIAGNOSIS affiliation Introduction Homelessness is described as a situation where an individual lacks a permanent housing. The definition may be complex, involving the temporal (frequency of an individual lacking a home), geography (types of accommodation that the homeless have) and the topological classifications (according to the characteristics of the homeless). According to NHCH, a homeless person is one that lacks a house or one whose main residence at night is a supervised private or public facility or is in a transitional housing. Homelessness is caused by several factors including lack of an affordable care, domestic violence, addiction disorders and mental illness. Studies done show that the mentally ill and people who are dually diagnosed have a higher risk at being homeless. Mental illness Mental health be defined as the capability of an individual to think, act and feel in ways that boost their capacity to deal with challenges and enjoy life. It is the positive sense of spiritual and emotional well being that compliments the importance of equity, culture, social justice, personal dignity and interconnections ((David, Campsie, Chau, Hwang & Paradis, 2009)). Mental illness is referred to as the alteration in the behavior, mood or thinking of an individual that is associated with a substantial impaired functioning and distress. Compared to the whole population, there is a greater prevalence and incidence of serious mental illness among individuals who are homeless ((David, Campsie, Chau, Hwang & Paradis, 2009)). The pattterns of mental state and health are influenced by several factors that include perceived self’sworth, personal coping skills, the social enviroment, socio-economic and cultural characteristics and the physical enviroment ((David, Campsie, Chau, Hwang & Paradis, 2009)). All these factors are related to the risk of the individual becoming homeless. Mental health affects the physical health for ndividuals who are homeless. The illness causes people to neglect basic precautions against diseases. When combined with insufficient hygience, it may lead to physical problems like skin diseases, exposure to HIV or respiratory infections. Moreover, nearly 50% of the mentally ill people, who are homeless, suffer from substance dependance and abuse (Substance Abuse and Mental Health Administration, 2011). Some individual also tend to medicate themselves, which may lead to addictions. The combination of these factors makes it hardfor a person to get residual and employment stability. Studies on the connection in mental illness and homelessness have shown that individuals who are homeless have a higher chance of experiencing a compromised mental illness and mental health. It is approximated that around 16% of the USA population have some form of mental illness (Nationalhomeless.org, 2014). In the USA, 26.2% of sheltered people that were homelss had a mental illnesss.34.7% of the sheltered people had chronic substance abuse (Substance Abuse and Mental Health Administration, 2011). In 2008, a survey conducted in the USA by the US Conference of Mayors on the 25 cities showed that mental weakness was the biggest cause of homelesssness in their societies; with 48% citing it as the biggest cause. For families with mental cases, 12% of the sampled cities cited by the target population as one of the top three reasons of homelessness (United States Conference of Mayors). Post traumatic stress order (PTSD) is a condition that is associated with traumatic events and has various symptoms that include persistent and recurring images (Rothschild, 2000). Studies show that majority of indidviduals at a shelter in Canada have PTSD. Sexual and physical abuse happening while individuls are homeless is a risk factor for the beginning of PTSD ((David, Campsie, Chau, Hwang & Paradis, 2009)). Depression is higher in homeless people than in the non-homeless. Among the overal population, 14% of 15-24 year old females and 17% of 25-44 year olds were diagnosed with depression at some stage in their life. In Canada, homeless youth were found to be more likely to report scores for depressive symptons; 39% compared to 20%. In the USA,out of 523 homeless people that were sampled, 12% reported some cases of depression. 73% of the sampled said they had never had a depressive episode before they left their homes (Rohde et al, 2001). Stress Studies show that stress levels are unusually higher among the homeless people relative to the common population. In Ottawa, Canada, homeless male youth had an overall stress level two times higher than the value reported by non-homeless males (Votta and Manion, 2003). Studies done by Unger et al, 1998, in Los Angeles show an increase in depressive symptoms and disorders related to substance abuse. Coping Numerous studies have been undertaken to comprehend how the homeless cope with stress. General results show that the homeless have an inclination towards using coping strategies and styles that work to detach them from the stressor rather than by attempting to solve the crisis at hand. In Canada, male youths that were homeless were likely to avoid the problem, withdraw from social networks or use drugs as ways of solving their stress issue ((David, Campsie, Chau, Hwang & Paradis, 2009)). The trend was the same in Los Angeles, where youths tended to engage in alcohol and drug usage to overcome their problems (Unger et al, 1998). Suicidal behaviors Suicidal behaviors have been linked to aspects of mental health in homeless individuals qualitative studies show that hopelessness, worthlessness and loneliness are fundamental themes in the homeless individual’s experience with suicide. In Canada, 21% of homeless youths had at least a suicidal attempt. This is unusually higher compared to 4% of non-homeless youths (Votta and Manion, 2004). In British Columbia, 46% of the sampled homeless population said they had attempted suicide at least once. In his study, Belcher (1989) established that 36% of mentally-challenged patients that were discharged from state hospitals became homeless or experienced any some form of homelessness within the first six months upon discharge from hospitals. Studies done in Canada show that homeless individuals are likely to experience a compromised mental illness or health (Hwang, 2001). In Toronto, 67% of people at a shelter at the Pathways into Homelessness had a lifetime identification of mental illness in them (Goering et al, 2002). In some individuals, the issues can precede the start of homelessness. It is with no doubt that the state of homelessness can worsen an individuals condition if they are already mentally sick. Dual diagnosis Dual diagnosis is defined in several ways. It may refer to the coexistence of a wide array of mental health combined with substance use problems. It is also used to define individuals with severe mental health problems, plus alcohol or drug problems (Rethink, 2014). The mental health problem could be schizophrenia, bipolar dis-order, depression, personality disorder or manic depression. The homeless and mentally ill people are usually substance abusers with multiple impairments at different levels. Moreover, such individuals have general medical conditions, histories of trauma, skill deficits, behavioral problems and legal problems (Fischer, 1990). Dual diagnosis is hard and individuals usually may not receive diagnosis for both conditions. The state of the relationship between mental health need and substance abuse is intricate and my take several forms; hence, making its diagnosis very hard. Moreover, service users are mostly only diagnosed when both their substance abuse problem and mental health have become severe. Individuals with a mental health diagnosis tend to have a higher risk of using alcohol and other drugs. Psychiatric disorder---------------------------- Increased risk of substance misuse Manic episode ------------------------------------14.5% Major depressive episode----------------------4.1% Schizophrenia -------------------------------------0.1% Panic disorder------------------------------------ 4.3% Phobias--------------------------------------------- 2.4% Antisocial personality disorder--------------- 15.5% Obsessive-compulsive disorder-------------- 3.4% Source: (Rethink, 2014) Individuals with these disorders tend to be seen within mental health services; but once they leave the facilities, the majority of them end up among the homeless or at the criminal justice department. The symptoms of dual diagnosis involve the physical, social, psychological and spiritual sense of a person. The symptoms interfere with an individual’s capacity to function efficiently and this may affect their relationship to others and even to them. Sometimes, the symptoms may interact with each other, hence worsening the situation and increasing the chances of a relapse. Problems that are associated with dual diagnosis include abrupt changes at work or school, outbreaks of temper, withdrawal from responsibilities, deterioration of physical looks and financial problems. Others include withdrawal and isolation, family and relationship problems, increased casualty admissions and an increased risk of suicide or self-harm. All these issues usually cause an individual to feel isolated and stigmatized and might eventually lead to the individual moving out (Rethink, 2014). Other negative outcomes associated with dual diagnosis are high relapse rates, violence, homelessness, incarceration and infections like hepatitis and HIV (Drake, 2001). Homeless individual who have been dully diagnosed with simple mental diseases have disorders and they constitute a specifically susceptible sub-group that needs complex service delivery. Dully diagnosed individuals are a heterogeneous population. The heterogeneity encompasses demographics, the severity and type of non-addictive mental disorders, the pathway to homelessness and the type of substance use. The issue of heterogeneity makes the generalization of individuals that are dually-diagnosed homeless hard (Lehman and Myers, 1989). The coexistence of mental health needs and drugs dependency usually affect an individual’s ability to get suitable accommodation. Majority of the supported housing providers have policies that want service users to be free of drugs. There is no customized hotel provision for individuals with dual diagnosis; and segregations from hotels are frequent. Hostels, that are overcrowded and offer little privacy, can worsen a prevailing mental distresses or even contribute to the growth of mental requirements. People, who are undergoing residential alcohol and drug rehabilitation treatment, have difficulties in finding suitable accommodation for their transition period., Many dual diagnosis patients are thus left in unsuitable accommodation; repeatedly in locations with bad access and local infrastructure. They are left with no support, and may eventually face tenancy breakdown or eviction (Good practice: briefing Service without substance, 2007). Illness disruptive behavior and exacerbation that are related to substance abuse make the dually diagnosed people specifically difficult tenants. The situation makes them subjected to community resistance; a situation referred to as ‘not in my backyard’ syndrome. People with dual diagnosis have a double jeopardy due to the mixture of their problems and the categorical nature of the supported housing arrangements (Psychosocial.com, 2014). The available housing programs for the mentally ill often do not include substance users; and those for substance users do not include the mentally severe people. The housing personnel are usually reluctant to cooperate with the other group that they have not planned for. This situation, in general, makes it hard for the dually diagnosed people get permanent accommodation (Psychosocial.com, 2014). Dually diagnosed people, who are homeless, are hugely estranged from their relatives and families. Their isolation makes it hard for them to access medical care and advice. Moreover, studies show that most families with dual diagnosed patients are reluctant to engage in the mental health system activities (Psychosocial.com, 2014). Epidemiology Adequate housing is the foundation of a care for homeless individuals, including those with dual diagnosis. Homeless persons, with substance-abuse difficulties and mental illness, are very likely to go back to institutional care when they are not delivered with adequate and sufficient housing. Maintaining sobriety is nearly impossible for such individuals with no adequate housing facilities. Researchers and clinicians advocate for both a continuum and rang of housing options to satisfy the needs and wants that vary with people and over time. The individual characteristics of a person such as the acceptance environment, tolerance and desire for self -determination determines one’s housing preference (Psychosocial.com, 2014). Living in shelters or on the streets gives a complex set of demands for their survival rather than their treatment. Shelters provide a chance for assessment and screening only, but they fail in offering the basic cleanliness and security that would enable engagements. Approximately a third of the homeless have a severe or disabling mental illness. 30-40% have an alcohol addiction and related problems, 10-20% have problems with any kind of drug and 10-12% of the homeless have dual diagnosis, having severe mental illness and a drug related problem (Psychosocial.com, 2014). In a study done by Fischer (1990) for the National Institute on Alcoholism, he found out that the rate of mental disorders and alcohol usage ranged between 3.6-26% in 7 out of 10 studies. The prevalence of mental disorders, plus any drug usage ranged from 1.7- 2.55 in three of his studies. 4 out of 5 studies showed that nearly 50% of people with mental disorders had a repetitive substance use disorder. Studies show that dully diagnosed people are specifically susceptible to being homeless and housing instability. Studies done by Drake et all (1989) found out that 27 percent of urban state hospital aftercare model had an unstable housing and were temporarily homeless during the 6 month evaluation period. Drug abuse, including alcohol use, was majorly linked to homelessness. More than 50% of the dully diagnosed sub-group experienced some form of homelessness during the duration of the study. Effective service delivery for dual diagnosis patients has lots of obstacles. Studies in Europe, Australia and Northern America indicate that homeless people with mental health have higher mortality rates than other people. The standardized mortality rate reported varied from 1.83-4.7. This figure is extremely high related to the general population (Beijer et al 2007). Research in Los Angeles showed that out of the 218 homeless people that attempted to get medical help, only 95 got the help that they needed. Those who didn’t make any determination to seek any help cited the following reasons: not knowing where the services were (53%), embarrassment (47%), lack of finance (36%), and fear of being contacted by their families or the police (36%) and the thought of the service being ineffective (33%). Conclusion The paths of linking homelessness and mental health are interrelated and numerous. In some individual, the pathway may be upstream; relying on issues such as income level, housing and the employment status. To others, the path is more personal and reflects on concerns such as mental illness, compromised mental health and substance abuse. Studies done show that the mentally ill and people who are dually diagnosed have a higher risk at being homeless. Understanding the relation between homelessness and mental health needs a consideration for both individual level factors and the wider social elements of health. Studies indicate that there is a value in clinical, research programs and outreach programs that target particular issue like self-worth and coping skills. With the use of this knowledge, it is possible to intervene and come up with polices that will address mental illness, dual diagnosis and homelessness References Beijer, U., Andreasson, A., Agren, G. and Fugelstad, (2007), “Mortality, mental disorders and addiction: a 5-year follow-up of 82 homeless men in Stockholm”, Nordic Journal of Psychiatry, Vol. 61, No. 5, pp. 363-68. Belcher, J. R. (1989). On becoming homeless: A study of chronically mentally ill persons. Journal of Community Psychology, 17 173-185. Breakey, W. R. (1987). Treating the homeless, Alcohol Health and Research World, 11 42-47. Caton CLM, Shrout PE, Eagle PF, et al (1994): Risk factors for homelessness among schizophrenic men: a case-control study. American Journal of Public Health 84:265–270, David, H., Campsie, P., Chau, S., Hwang, S., & Paradis, E. (2009). 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