On any single night in the United States, up to 600,000 people sleep on sidewalks, under bridges, in the woods, or in emergency shelters. Of those, an estimated 30 percent, or 180,000 people, live with a debilitating mental illness, such as bipolar disorder or schizophrenia.
Many factors can contribute to homelessness, including poverty and a lack of affordable housing. Studies also show mental illness can lead to homelessness by starting a cascade of problems—unemployment, social withdrawal, and changes in eating and habits. Mentally ill people also run the risk of pushing away friends, family members, and caregivers who might be able to help.
For social workers who help the homeless, the struggle to provide services is even more problematic. They must use everyday encounters, whether they’re in shelters, emergency rooms, or soup kitchens, to assess needs and learn how to help.
“While some symptoms may be readily apparent, others are more subtle and require a clinician’s keen abilities to draw out and manage sensitive material,” social workers Julie Lorenzo and Adina Barbosa wrote in “Clinical Social Work with Homeless People” for the National Association of Social Workers.
To best do their jobs, social workers must be able to interpret the complex connection between mental illness and homelessness for a deeper awareness of individual struggles and the barriers to assistance.
Understanding The Barriers To Assistance
Multiple studies have found a cyclical relationship between homelessness and mental illness. Mental health problems may lead to homelessness, and homelessness may worsen mental health problems.
The mentally ill may have a difficult time determining when they need help and where to turn, particularly if they have alienated themselves from family and friends. At the same time, many homeless people don’t have access to the medical resources that would help them most.
“Such barriers can result in homeless individuals seeking medical care only once his or her condition has worsened to the point of an emergency room visit,” researchers with Texas Department of State Health Services said.
Each subgroup of the homeless population has distinct mental health challenges and barriers to accessing assistance:
- Veterans: Veterans account for about eight percent of the total U.S. homeless population. Of that, about eighty percent suffer from mental illness or a substance-abuse disorder, the U.S. Department of Veterans Affairs (VA) said. Researchers have found many veterans live with the lingering impact of post-traumatic stress disorder (PTSD), depression, and anxiety. VA medical services are only available to veterans who have been honorably discharged or released. Even with that, there are severe shortages of healthcare providers in the VA system, which has caused long waitlists.
- Children: Studies show up to 26 percent of homeless preschoolers and 40 percent of homeless school-aged children are in need of mental-health services. Children, whether they are unaccompanied or in family groups, often do not have access to mental-health assessment services to determine problems that could include attention deficit disorders, anxiety, and depression. Stress from a lack of stability, food insecurity, and peer pressure can exacerbate mental-health disorders.
- Chronic Homeless: About 14 percent of the homeless population experiences chronic homelessness, or have been homeless for more than one year. Among them, up to 30 percent are mentally ill. Overall, the chronically homeless who are mentally ill face a multitude of challenges for services, including the lack of ongoing access to medication, the desire not to take medications, and general distrust of health and medical providers.
- Rural homeless: Up to 14 percent of the homeless population nationwide live in rural areas. Unlike the homeless population in urban areas, the rural homeless are more likely to live in transient areas, such as vehicles and wooded areas. Some studies show the homeless populations in rural areas have a higher percentage of severe mental illnesses when compared to the same population in urban areas. The rural homeless have less access to services, housing opportunities, and mental health treatment.
Despite the challenges, providers nationwide, including social workers, have been stepping forward to determine the best path for eliminating homelessness.
Pathways To Helping Homeless Populations
Across the United States, federal and local governments, faith-based groups, and charitable organizations are continuing to work tirelessly to best determine how to provide assistance.
One initiative, called Housing First, provides free housing to the homeless without requirements for mental-health or substance-abuse treatments. This approach differs from the oft-used model, called linear residential treatment, which requires homeless populations to undergo drug-treatment programs or mental-health counseling to be “ready” for housing.
Lisa Pape, MSSA, the acting chief of staff for the Veterans Health Administration (VHA) and the executive director of the VHA’s homeless programs, said Housing First provides veterans with a safe place to sleep and get services simultaneously.
“What we hear from homeless veterans is, ‘It’s really hard to focus on my health and mental health and employment situation when I don’t have a place to sleep at night,’ ” said Pape, an alumna of Case Western Reserve University’s Master of Science in Social Administration program at the Mandel School. “In the past, we used to treat their mental health first. No more. Let’s get them in a safe place to live.”
In 2015, officials in Utah said the Housing First model reduced homelessness by 72 percent.
“Housing First provides a new sense of belonging that is reinforced in every interaction with new neighbors and other community members. We operate with the belief that housing is a basic right. Everyone on the streets deserves a home. He or she should not have to earn it, or prove they are ready or worthy,” said Pape.
In addition, experts are continuing to explore other ways to provide assistance. One such program, called Partnering for Family Success (PFS), seeks to reduce the number of days children spend in out-of-home placement (OHP) in Cuyahoga County, Ohio, by connecting families with employment, housing and child welfare organizations. A two-year review of a five-year study found the PFS program helped stabilize families with the use of housing and increased levels of public assistance. Through the program, there was a decline in involvement with child welfare services, researchers found. However, other problems persist, including improving response to domestic violence and coordinating services for families.
Another program, called Assertive Community Treatment (ACT), seeks to help people with severe mental illness who are most at-risk of homelessness. The program, which is a coordinated effort between the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and the Center for Evidence-Based Practices at Case Western Reserve University, seeks to provide technical assistance to community-based mental health organizations for ACT services.
About Case Western Reserve University’s Online MSSA Program
Social workers who graduate from Case Western Reserve University’s Master of Science in Social Administration (MSSA) program are in high demand for helping careers. The degree, which is equivalent to a Master of Social Work (MSW), offers concentrations in Community Practice for Social Change and Direct Practice. The Direct Practice concentration offers specializations in Children, Youth, and Families (CYF) and Mental Health with Adults (MHA).
U.S. News and Report ranked the program at the Jack, Joseph and Morton Mandel School of Applied Social Sciences No. 9 in the United States among social work schools in the nation and No. 1 in Ohio. For more information, contact Case Western Reserve University now.
U.S. Department of Housing and Urban Development: https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf
National Coalition for the Homeless: http://www.nationalhomeless.org/factsheets/Mental_Illness.pdf
National Association of Social Work: http://www.naswnyc.org/?page=173
Barriers to assistance: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0ahUKEwjj3_inopbWAhXDOyYKHfGeD1kQFgg1MAI&url=https%3A%2F%2Fwww.dshs.texas.gov%2FConsumerandExternalAffairs%2Flegislative%2F2016Reports%2FSunsetItem11Report.pdf&usg=AFQjCNEAlgxU6dnIt-GD_bJzuEf32exWNQ
Homeless children: http://www.sciencedirect.com/science/article/pii/S0890856714007989
Chronic homeless: https://mdgolden.com/homelessness-mental-illness/
Rural homelessness: http://registerguard.com/rg/opinion/35589963-78/rural-homelessness-hard-to-tackle.html.csp
Pathways to help: http://www.motherjones.com/politics/2015/02/housing-first-solution-to-homelessness-utah/
Housing first: https://www.va.gov/homeless/nchav/models/housing-first.asp
Naval ship: http://www.sfgate.com/news/article/Floating-homeless-shelter-could-be-game-changer-9206351.php