Homelessness and Mental Health: Unraveling the Connection

Homelessness and mental health are two deeply intertwined issues that plague societies across the globe. While they may seem like separate challenges, a closer examination reveals a complex web of causation and correlation. Understanding the connection between homelessness and mental health is essential for crafting practical solutions to address these pressing concerns.

The Prevalence of Mental Illness among the Homeless

One striking aspect of the homelessness and mental health nexus is the disproportionately high prevalence of mental health disorders among homeless individuals. Numerous studies have consistently shown that this population faces a significantly elevated risk of mental illness compared to the general community. Conditions such as schizophrenia, bipolar disorder, depression, and anxiety disorders are alarmingly prevalent among homeless individuals. [GUTWINSKI, S., SCHREITER, S., DEUTSCHER, K., & FAZEL, S. The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS medicine, 18(8), e1003750. (2021). DOI: 10.1371/journal.pmed.1003750]

This prevalence stems from a variety of factors, including a lack of access to mental health care, substance abuse, and the traumatic experiences often associated with life on the streets. These factors create a vicious cycle, where mental health issues can contribute to homelessness, and homelessness can, in turn, exacerbate mental health problems.

Causal Factors and Complex Dynamics

Homelessness and mental health issues are not just concurrent; they can also be causal factors for one another. It is crucial to recognize that mental health problems can be both a cause and a consequence of homelessness. [Mental Health, The Homeless Hub. www.homelesshub.ca]

In some cases, individuals become homeless because of pre-existing mental health issues. Managing a mental illness without a support system and the stigma associated with mental illness can further isolate these individuals, pushing them into homelessness.

Conversely, the experience of homelessness itself can lead to the development or exacerbation of mental health problems. Life on the streets is characterised by extreme stress, constant exposure to the elements, and a lack of security or safety. Such conditions can trigger or worsen mental health issues, contributing to a downward spiral where homelessness becomes a breeding ground for psychological distress. [Housing and Mental Health, Canadian Mental Health Association. https://ontario.cmha.ca/documents/housing-and-mental-health/]

The Role of Trauma in Homelessness and Mental Health

One of the most significant contributors to the connection between homelessness and mental health is trauma. Homelessness often entails exposure to traumatic experiences, including violence, sexual assault, or substance abuse. The constant threat to personal safety, coupled with the loss of social support networks, can lead to severe psychological trauma. [Turning the Key: Assessing Housing and Related Supports for Persons Living with Mental Health Problems and Illnesses, Mental Health Commission of Canada. http://www.mentalhealthcommission.ca/]

Post-traumatic stress disorder (PTSD) is not uncommon among homeless individuals who have faced such harrowing experiences. The symptoms of PTSD, including flashbacks, hypervigilance, and emotional numbing, can further impede an individual's ability to escape homelessness or seek mental health support. [DAVIS, J. P., DIGUISEPPI, G., DE LEON, J., PRINDLE, J., SEDANO, A., RIVERA, D., HENWOOD, B., & RICE, E. (2019). Understanding Pathways between PTSD, Homelessness, and Substance Use among Adolescents. Psychology of Addictive Behaviours: Journal of the Society of Psychologists in Addictive Behaviors, 33(5), 467–476. (2019). DOI: 10.1037/adb0000488]

The Role of Substance Abuse

Substance abuse is another crucial aspect of the homelessness and mental health connection. Many homeless individuals turn to drugs or alcohol as a means of coping with the harsh realities of their lives. Substance abuse can be both a cause and a consequence of mental health issues. [PADGETT D. K. Homelessness, Housing Instability and Mental Health: Making the Connections. BJPsych Bulletin, 44(5), 197–201. (2020). DOI: 10.1192/bjb.2020.49]

On one hand, individuals with pre-existing mental health disorders may self-medicate with drugs or alcohol to alleviate their symptoms, which can lead to addiction and eventual homelessness. On the other hand, substance abuse can exacerbate mental health problems, making it even more challenging for individuals to break free from the cycle of homelessness.

The Vicious Cycle and Barriers to Care

The connection between homelessness and mental health is further compounded by the numerous barriers homeless individuals face in accessing mental health care. Stigma, lack of insurance, and a shortage of mental health services tailored to the needs of this population can prevent many from seeking help. [WONG, C. F., CLARK, L. F., & MARLOTTE, L. The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth. Journal of Interpersonal Violence, 31(5), 831–854. (2016). DOI: 10.1177/0886260514556770]

Moreover, even if homeless individuals do attempt to access mental health services, the transient nature of their lives can make it challenging to adhere to treatment plans that often require consistent engagement. The lack of stable housing can make it challenging for individuals to receive the ongoing support they need to manage their mental health effectively. [EDIDIN, J. P., GANIM, Z., HUNTER, S. J., & KARNIK, N. S. The Mental and Physical Health of Homeless Youth: a Literature Review. Child Psychiatry and Human Development, 43(3), 354–375. (2012). DOI: 10.1007/s10578-011-0270-1]

Understanding the intricate relationship between homelessness and mental health is a vital step in addressing these interlinked issues. Effective solutions must adopt a holistic approach that acknowledges the dual causality between homelessness and mental health problems. By recognizing and addressing the connection between homelessness and mental health, societies can take significant steps toward breaking the cycle of despair and providing vulnerable individuals with the support and care they need to regain stability and hope in their lives.

References

DAVIS, J. P., DIGUISEPPI, G., DE LEON, J., PRINDLE, J., SEDANO, A., RIVERA, D., HENWOOD, B., & RICE, E. (2019). Understanding Pathways between PTSD, Homelessness, and Substance Use among Adolescents. Psychology of Addictive Behaviours: Journal of the Society of Psychologists in Addictive Behaviors, 33(5), 467–476. (2019). DOI: 10.1037/adb0000488

EDIDIN, J. P., GANIM, Z., HUNTER, S. J., & KARNIK, N. S. The Mental and Physical Health of Homeless Youth: a Literature Review. Child Psychiatry and Human Development, 43(3), 354–375. (2012). DOI: 10.1007/s10578-011-0270-1

GUTWINSKI, S., SCHREITER, S., DEUTSCHER, K., & FAZEL, S. The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS medicine, 18(8), e1003750. (2021). DOI: 10.1371/journal.pmed.1003750

Housing and Mental Health, Canadian Mental Health Association. https://ontario.cmha.ca/documents/housing-and-mental-health/

Mental Health, The Homeless Hub. www.homelesshub.ca

PADGETT D. K. Homelessness, Housing Instability and Mental Health: Making the Connections. BJPsych Bulletin, 44(5), 197–201. (2020). DOI: 10.1192/bjb.2020.49

Turning the Key: Assessing Housing and Related Supports for Persons Living with Mental Health Problems and Illnesses, Mental Health Commission of Canada. http://www.mentalhealthcommission.ca/

WONG, C. F., CLARK, L. F., & MARLOTTE, L. The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth. Journal of Interpersonal Violence, 31(5), 831–854. (2016). DOI: 10.1177/0886260514556770