Safanah T Siddiqui
Professor Oppenheimer
MCHC 2001
10 September 2012
Abstract
The rate of homelessness in this country has been on the rise, and the percentage of homeless who report mental illnesses has been increasing as well. For some, mental illness is the cause of homelessness, while for others it is the result. No matter the etiology of the mental disorders, various clinical measures must be taken to prevent and treat the issue. The most common mental disorder amongst the homeless would be substance abuse disorders, as defined by the Diagnostic and Statistical Manual for Mental Disorders (DSM). This type of disorder is very different from the other common mental illnesses in origins and treatments. The next most common mental disorders amongst the homeless are schizophrenia, major depressive disorder, and bipolar disorder, amongst others. Because each disorder is so different, treatment regimens are different for each. Helping the homeless comply with medical treatments, whether therapy or medication, has been a challenge, even more difficult than making the initial diagnoses. This paper will discuss the methodology of making diagnoses, the statistics and research behind them, and general trends along with specific cases of the homeless with mental disorders.
Annotated Bibliography
Caton, Carol L. M. Homeless in America. New York: Oxford UP, 1990. Print.
As homelessness increases, the amount of mentally ill homeless exponentially increases. Caton provides extensive data on the numbers of homeless mentally ill and the statistics of diagnoses. He writes that psychotic disorders such as schizophrenia were most noteworthy, along with mood, anxiety, and personality disorders, usually antisocial personality disorder. Substance abuse disorders are also common amongst the homeless. Those with histories of psychiatric hospitalizations are most likely to be diagnosed with a mental disorder. The recent evolution of antipsychotic medicine emphasizes social treatment rather than confinement, resulting in a deinstitutionalization movement, a process thought to be a huge contributor to the increase of homelessness, as the chronically mentally ill are not able to function on their own. Once homeless, these patients are the most difficult to manage. Some deny having disorders, while others simply do not prioritize their mental health. Because the homeless lack a support network, treatment requires significant amount of outreach and trust-building beforehand.
Lloyd, Kami. “Homelessness and Mental health.” Homelessness and Mental Health. California Psychiatric Association, 28 Mar. 2003. Web. 3 Sept. 2012. .
The most common mental disorders amongst the homeless, aside from substance abuse disorders, are schizophrenia, bipolar disorder, major depressive disorder, followed by anxiety disorders. Schizophrenia is characterized by a lack of ability to function independently and an inability to distinguish what is reality and what is not. Schizophrenia may be treated with medication, but is a chronic disorder. Bipolar disorder is characterized by periods of depression and periods of mania. Major depressive disorder, or major affective disorder, commonly known as depression, presents itself with symptoms of sadness and hopelessness. Depression may be treated with medication or therapy, depending on the underlying cause.
Robertson, Marjorie J., and Milton Greenblatt. Homelessness: A National Perspective. New York: Plenum, 1992. Print.
With a lack of community support for the cause, it is difficult to reach out to the mentally ill homeless. Robertson sites Underleider’s article on his efforts and clinical insights gained from working with the homeless in Santa Monica. He describes the adaptations a homeless person must go through, and suspects that interventions before these adaptations would be more effective. Although seeking medical help, many of the homeless psychiatric patients had negative experiences with psychiatric hospitals. These patients are difficult to have comply with medication as a treatment. Patients that are less likely to even receive treatment are substance abusers, even if they also have another serious mental illness. Working with outreach workers and more, Ungerleider and his team worked to develop treatment plans, but came into contact with a wide range of opinions that made decision-making difficult. He finds that clients develop trust after long-term outreach efforts, which allows outreach workers to keep track of their progress.
Schutt, Russell K., and Stephen M. Goldfinger. Homelessness, Housing, and Mental Illness. Cambridge, MA: Harvard UP, 2011. Print.
Mental illnesses are not as easily defined and classified as other physical illnesses—they are more complex to diagnose and treat. Simultaneously, society possesses an unhealthy stigma toward the mentally ill. Currently, clinicians follow the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and its guidelines for diagnosing. The DSM defines a mental disorder as a deviant behavior or psychology that causes dysfunction and distress, and classifies substance abuse disorders, mood disorders, anxiety disorders, psychotic disorders, and personality disorders, among others. The common disorders listed are schizophrenia, bipolar disorder, and major depressive disorder. The symptoms and cases of each are described. Lacking a support system, poor judgment, and negative side effects of medications, the homeless mentally ill have a difficult time complying with medication regimens. Schutt describes the situation of the mentally ill in homeless shelters and the complications that arise. House staff must learn to deal with these tenants, and the tenants must learn to control their behaviors in order to keep their shelter.
Wasserman, Jason A., and Jeffrey M. Clair. At Home on the Street: People, Poverty, & a Hidden Culture of Homelessness. Boulder, CO: Lynne Rienner, 2010. Web.
Wasserman discusses the various perspectives on the idea that mental health and addictions as causes of homelessness, a hypothesis that arises from the fact that a third of homeless self-report mental illness. At the same time, the causation may be in the reverse, of the stresses of homelessness causing mental illness. An equally prominent explanation is drug and alcohol addiction. While the homeless may readily admit to having such problems, they will hesitate to say that they are the cause of their homelessness. It has been seen that addiction worsens with homelessness, but mental illnesses cannot be as clearly defined. Some illnesses, such as depression, can solely arise from homelessness. On the other hand, disorders such as schizophrenia may be the cause or the result of homelessness. Homelessness creates a stressful situation that triggers mental illness, and management of these illnesses for the homeless is nearly impossible.
