Mental Illness and Homelessness When most people hear the term, "homeless" they more than likely initially think of the physical hardships of being without a home. If you're homeless, where do you sleep? What do you do without a bathroom, or a shower? How do you live without all of the everyday possessions most people take for granted, like a toothbrush or a comb or a child's beloved stuffed animal?
Most People, however, do not consider the effects being homeless can have on a person's mental health. The stress that they endure and the depression that can overwhelm become secondary to their physical and material trials and tribulations. However, the mental effects are just as important, affecting the mind that is ultimately the powerhouse and control center for the body.
Being mentally ill does not occur as a result of being homeless. Mental illness may just be more prominent among the homeless. Most people are mentally ill before they become homeless and are affected by their respective symptoms before they're out on the streets. Oftentimes as a result of their mental illness they are unable to keep up with their bills or take care of themselves. This is what leads to their being homeless. If someone was living in a home and seeing a doctor, then their symptoms could be under control. After becoming homeless, since they can't afford to see a doctor, their mental illness could surface more readily.
Over 40 years have passed since many psychiatric institutions in the United States were closed in response to civil rights concerns of the political left and cost-containment imperatives from the right, with the advent of improved therapeutic alternatives for many individuals with severe mental illness. But the promise of creating adequate community-based, outpatient mental health services has not been kept, particularly for many of the sickest and poorest of the mentally ill whose only refuge is the streets.
The past 20 years have seen incremental advances in mental health policy, the development of targeted health care and housing programs, and extensive research confirming the capacity of seriously mentally ill homeless persons to become productive members of the community, with access to comprehensive and integrated health and social services.
Forty percent of individuals who suffer from severe mental illness in the United States don’t receive the treatment they need, according to Dr. Christine Yuodelis Flores, specialist in adult psychiatry with the Health Care for the Homeless (HCH) project at Harborview Medical Center in Seattle, Washington. “There are now twice as many mentally ill persons in jails and prisons than in psychiatric institutions,” she says. “The Los Angeles County jail has been reported to have more mentally ill inmates than the largest inpatient psychiatric unit in the United States.”
Today, few people with serious mental ill- nesses, homeless or not, require institutionalization. “Advances in the treatment of mental illness have allowed the restoration of health and productivity to almost all who access good care,” writes Fred Osher, MD, HCH, Baltimore. “Unfortunately, the vast majority of people with mental illness experiencing homelessness do not have access to that care.
Observers from other industrialized nations call the American system “savage capitalism for relegating public health to a lower priority than private profit. Perhaps this suggests a thought disorder far more insidious than the mental illnesses of these “outcasts on Main Street.
Clinicians, report that among the most difficult challenges they face in caring for severely mentally ill homeless people are the cognitive difficulties intrinsic to their illnesses. “The most serious barrier to treatment is lack of insight,” according to Dr. Yuodelis Flores, persons with serious mental illness may not understand that they are ill and need care. Severe and persistent mental illnesses (SPMI) — including schizophrenia, bipolar disorder,