Homelessness and mental health
Depending on the age group in question and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, 25% of the American homeless—140,000 individuals—were seriously mentally ill at any given point in time.
[4] Being chronically homeless also means that people with mental illnesses are more likely to experience catastrophic health crises requiring medical intervention or resulting in institutionalization within the criminal justice system.
For example, with the proliferation of immigrants throughout industrialization, the original purpose of asylums as small facilities transformed into their actualized use as "large, custodial institutions" throughout the late 1840s.
The legislative purpose of state asylums soon met the role society had funneled them toward; they primarily became institutions for community protection, with treatment secondary.
In addition to this, the view that asylums and state hospitals exacerbated symptoms of mental illness by being "inherently dehumanizing and antitherapeutic" spread through the public consciousness.
Furthermore, economic responsibility for disabled people began to shift, as religious and non-profit organization assumed the role of supplying basic needs.
[14]: 60–61 In response to the flaws of deinstitutionalization, a reform movement reframed the context of the chronically mentally ill within the lens of public health and social welfare problems.
Policy makers intentionally circumvented state mental hospitals by allocating federal funds directly to local agencies.
Despite efforts, newly founded community centers "failed to meet the needs of acute and chronic patients discharged in increasing numbers from public hospitals".
It is argued that an over reliance on community health has "left thousands of former patients homeless or living in substandard housing, often without treatment, supervision or social support.
With the founding of the National Committee for Mental Hygiene, acute treatment centers like psychopathic hospitals, psychiatric dispensaries and child guidance clinics were created.
[19] Decades later, once the Community Mental Health Act was implemented a lot of state hospitals suffered and were on the verge of forced to close which pushed patients to the community-based facilities.
[20]: 465 [21]: 82 One explanation for homelessness states that "mental illness or alcohol and drug abuse render individuals unable to maintain permanent housing.
"[22]: 114 A 2002 study states that 10–20 percent of homeless populations have a dual diagnoses, or the co-existence of substance abuse and of another severe mental disorder.
For example, Martens emphasizes the salient dimension of familial and residential instability, as he describes the prevalence of foster-care or group home placement for homeless adolescents.
[20]: 465 In addition to family conflict and abuse, early exposure to factors like poverty, housing instability, and alcohol and drug use all increase one's vulnerability to homelessness.
[21]: 89 Lee notes that minorities have a heightened risk of the "repeated exit-and-entry pattern"[23]: 511 Shinn and Gillespie (1994) argued that although substance abuse and mental illness is a contributing factor to homelessness, the primary cause is the lack of low-income housing.
"[22]: 122 Their findings emphasize that among the analyzed correlates, "per capita expenditures on mental health care, and the supply of low-rent housing are by far the strongest predictors of homelessness rates.
"[22]: 127 Along with economic hardship, patterns of academic underachievement also undermine an individual's opportunity for reintegration into general society, which heightens their risk for homelessness.
"[23] For example, poverty is a key determinant of the relationship between debilitating mental illness and social maladjustment; it is associated with decreased self-efficacy and coping.
It is argued that persons with mental illness are more likely to be arrested, simply from a higher risk of other associated factors with incarceration, such as substance abuse, unemployment, and lack of formal education.
Furthermore, when correctional facilities lack adequate coordination with community resources upon release, the chances of recidivism increase for persons who are both homeless and have a mental illness.
Modern efforts to reduce homelessness include "housing-first models", where individuals and families are placed in permanent homes with optional wrap-around services.
[23] This effort is less expensive than the cost of institutions that serve the complex needs of people experiencing homeless, such as emergency shelters, mental hospitals and jails.
[19] Research calls for evidence based remediation practices that transform mental health care into a recovery oriented system.
Proponents of the NIMBY (not-in-my-backyard) movement have played an active role in the challenges faced by housing and mental health service interventions for the homeless.
