Resources Provided for Homelessness and Severe Mental Illness
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On any given night, approximately 560,000 people experience homelessness in the United States, and approximately 250,000 suffer from severe mental health (Cisneros 155). Unfortunately, these figures no longer surprise most of the Americans as they are accustomed to the gaze of toothless older women muttering themselves and dirty, covered men with many layers of clothes even on warm weather conditions. People are no longer shocked as they were a decade ago by the sight of juveniles crouched beside their parentage, panhandling most of the busiest streets. This essay explores the contemporary condition faced by homeless people with severe mental illness, the origin of the homelessness problem, recent efforts relating to homelessness and mental health, as well as the resources provided on what is now a serious national challenge. It is impossible to imagine anything more distressing or any dangerous combination of challenges befalling anyone other than suffering from severe mental illness and homelessness, and thus there is a need to address this issue.
In the United States, mass homelessness appeared in the early 70s as there are few homelessness in skid rows mostly hidden from public view. Generally, they were white, older men staying in cheap hotels near railroads and other workplaces with most mentally or physically disabled (Gray 2). However, in the late 70s, the skid rows disappeared, and the homeless individuals grew into big numbers. They were socially isolated, extremely poor, and often mentally disabled. Unlike the skid row inhabitants, the residents on streets had no jobs, and they could hardly be ignored as they scattered all over the streets. Moreover, they were much younger, consisting of both families and juveniles, and with an overrepresentation of African Americans. In 1987, the McKinney Act was passed in reaction to the phenomenon and created programs to fight homelessness and signing.
The currently available infrastructure and resources to serve homelessness are spread thin as the issues of capacity, lack of individualized management plan and adequate funding create limited opportunities for homeless people to escape the current condition (Springer 1). As a result, various individuals find themselves in continuous interaction with the physical, behavioral health system, and justice system. According to Gray (5), the United States Interagency Council on Homelessness (ICH) (2017) approximates the cost of the chronic homelessness anywhere between $40,000 and $50,000 per year per individual with crisis system interaction taken into account. Besides, the council estimates over 70 percent beneficiaries as individuals with severe mental illness, including severe depression, bipolar disorder, schizoaffective disorder, schizophrenia, and anxiety.
According to various studies, diversion is the most commonly used method of turning chronically homeless people with severe mental illness away from correctional services, emergency room utilization, and unnecessary hospitalization (Gray 13; Springer 2). It is used as an individualized micro-interaction level and which may lead to macro-level change. Therefore, a higher utilizer or a super utilizer is anyone who often suffers from recurring chronic social, medical, behavioral, and other long term health conditions. Such individuals have large numbers of emergency division visits, criminal justice interaction, and hospital interactions, which can easily be avoided by early diversion and intervention strategies. Moreover, communities look for innovative, evidence-based models that can combat the revolving door of super-utilizers who repeatedly shuffle crisis service systems. The purpose of such models is to improve outcomes, use bottom-up services, and contain costs to achieve the unique requirements and the problems posed by homelessness.
In a community-based approach, diversion to mental health care involves the interaction of multiple systems such as local and government institutions, the criminal justice system, executive agencies, mental health and behavioral health authorities, law enforcement, homeless service providers as well as hospitals and emergency departments (Springer 2). Therefore, providing or constructing a unified unit of care across a multidisciplinary network of providers’ poses a unique challenge. Moreover, different financing streams that formulate expectations and standards and database used to track clients’ progress hardens local efforts coordination. Consequently, diversion may appear differently depending on who is executing it and the context of utilization to solve the homelessness paradox.
Besides division, housing for individuals with severe mental illness also includes supportive services such as laundry, housekeeping, and personal care services. It is a combination of housing and cost-effectively intended services to enable those individuals to have a stable and more productive life besides their mental illness (springer 6). According to Public Housing Authorities (2008), supportive housing is generally believed to perform well on those individuals diagnosed with complex health challenges. This initiative was first employed in the mid-1970s when States realized that individuals with severe mental illness were having difficulties in obtaining and maintaining their health. They introduced transition group apartments and home programs, and residents in these programs were required to attend service programs, and their movement was made in response to their progress in rehabilitation.
The incarceration of homeless individuals diagnosed with mental illness is a common phenomenon. According to Morrissey et al. (2007), nearly a million people with severe mental illness get into jails annually, and most of them have homeless history. Moreover, among the homeless individuals incarcerated, over two-thirds of them show symptoms indicating the presence of severe mental illness. Studies conducted indicate that the incarceration of homeless individuals with chronic mental illness are mostly short-term and involves crimes loitering and disturbing the peace. Additionally, in most cases, improper medication and psychiatric care increase psychiatric symptoms, which causes people to do things they will not do under normal circumstances, thereby increasing their chances of incarceration.
However, health benefits from supportive housing are more dependent on individuals. A study conducted by (Gray) using the homeless management information system and survey on local supportive housing programs in Birmingham found that with supportive housing, mental health is improved by greater access to psychiatric and medical care(pg. 12-18). Moreover, it increases stability in the lives of individuals involved through improved relationships, improved coping skills, increased incomes, and an increase in obtaining identification documents. Besides, these benefits did not accrue individuals with criminal records related to medical and physical health. Moreover, the study associate history of incarceration with other incidences and not hospitalizations. Individuals with criminal records achieved little positive outcomes from supportive housing, unlike those without.
Institutionalizations or incarceration on homeless individuals diagnosed with mental illness have a negative effect on relationships. Various studies conclude that when individuals are institutionalized for a long time, they lose the bond with their friends and families since they have their challenges and cannot afford to maintain relationships (Gray 4). Furthermore, these studies claim that most of the homeless individuals with mental illness have a tense relationship with their friends and families due to mental illness, poor parenting, and stigma related to rejection and stealing to support drug habits.
Springer claims that the Interconnection between severe mental illness and homelessness provides various social determinants of health perspective (4). For example, the criminality of homelessness is not in its commission but in the context in which it is committed. In most cases, individuals without homes are arrested for minor crimes that directly relates to their housing status, with actions described as an attempt to acquire food, shelter, or medical help. Studies conducted on both state and federal prisons reveal that incarcerated individuals flagged as homeless experience unemployment, financial security, housing, and medical treatment upon release, all of which affect their mental health. These challenges lead to stigmatization and therefore such individual receive employment, housing, financial help, and medical treatment to overcome such problems
Conclusively, services to homeless individuals with chronic mental illness are primarily divergent in the contemporary word compared to several decades ago. While there is still much to accomplish on local, state, and federal levels, contemporary outreach is more aggressive, there is a vast increase in funding, the outlook is comprehensive, and efforts are highly paying off. Today, many communities have mental health centers, and residential programs perform aggressive and intensive outreach to reach homeless individuals. However, the federal government needs to step up its effort in the federal housing policies by emphasizing on devolution, decentralizing designs of the program, implementing, and funding of State mental health programs and affordable housing agencies to the homeless individuals. This is because homeless people are facing a new challenge, which will have much impact on the provision of housing and support services to those who have a severe mental illness.
Works Cited
Cisneros, Henry G. “Searching for Home: Mentally Ill Homeless People in America.” Cityscape (1996): 155-172.
Gray, Bailey Douglas. Breaking the cycle: evidence-based diversion for homeless individuals with mental illness. Diss. 2019.
Springer, Kayla. “Housing Homeless Who are Diagnosed with Mental Illness: Social Service Professionals’ Perspectives.” (2015).