PTSD: The Cause of Homelessness or The Effect?

The Question:

Post-Traumatic Stress Disorder (PTSD) is common within homeless populations: 91% of people on the streets have experienced at least 1 traumatic event, and 99% have abusive childhoods (Bennett, 2022). But an ongoing debate amongst public officials and media commentators remains:

Does being homeless cause PTSD, or are people with PTSD more susceptible to becoming homeless?

Martha Sullivan – with the San Diego Housing Emergency Alliance - argues for the previous. For her, the conditions of being homeless - facing food scarcity, sleep deprivation, and constant exposure to violence - are what causes PTSD. Sullivan sees shelter as the solution to this trauma: “The mental health issue is an easy way to deflect from the core problem, and that is the lack of housing” (Smolens, 2019).

But is the lack of housing the “core issue?” What about people who had PTSD before becoming homeless?

PTSD: Fight Responses

Many individuals with PTSD become homeless: veterans returning from duty, youths from abusive homes, and everyday people suffering from personal trauma.

The most known case is “fight responses” leading to unemployment. Angry outbursts brought on by external triggers are often seen by employers as personal failings rather than mental illness. This is because PTSD is not as visible as conditions like schizophrenia. In some situations, shelters and support systems will reject those with PTSD due to a perceived threat of violence. Such negative perceptions of PTSD are further exacerbated by secondary behaviours like substance abuse (Vantol, 2022).

PTSD: Flight Responses

What is less discussed is “flight responses.” These PTSD symptoms are more inward: inducing memory loss, depression, and an overall need to escape reminders of trauma. These issues are typically overlooked, as they are often perceived as symptoms of social anxiety or general discontentment. Losing jobs and relationships is therefore a common occurrence, as there isn’t a true understanding of the mental disorder at play (Vantol, 2022).

Youths fleeing abusive homes often exhibit these flight behaviours. This is because their developing minds aren’t able to process trauma: leading to low self-esteem, low motivation, and a distorted sense of the world (Gawds, 2007). As youths are constantly revictimized on the streets, however, an avoidant approach is difficult. For them, relief is found in drugs and risk-taking behaviour (Manus, 2008).

The Solution:

Sullivan’s push towards housing sounds ideal on paper. But, in reality, getting vulnerable people off the street is a more involved process. Individuals with PTSD need to trust care providers before they can reintegrate into society. Traumatized youths especially need to feel like they’re exercising control over their own experiences rather than being thrown into shelters. They need therapy that decreases shame and increases self-esteem. Extensive research has found that “the greatest need of any traumatized individual is to feel safe, and this often requires attention to various practical dimensions” (McManus, 2008).

PTSD is the cause and the effect of homelessness. When it comes to addressing PTSD in homeless populations, mental health must be considered alongside housing and methods of therapy.

Works Cited

Bennet, A. (2022,March 9). Interventions to treat post-traumatic stress disorder (PTSD) in vulnerably housed populations and trauma-informed care: a scoping review. BMJ Open. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915369/#:~:text=It%20is%20estimated%20that%20as,99%25%20have%20experienced%20childhood%20trauma

Gwadz, M. (2007, February). Gender differences in traumatic events and rates of post-traumatic stress disorder among homeless youth. ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S0140197106000054

McManus, H. (2008, April 1). Trauma Among Unaccompanied Homeless Youth: The Integration of Street Culture into a Model of Intervention. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860307/

Smolens, M. (2019, December 6). Column: Does homelessness cause PTSD? The San Diego Union Tribune. https://www.sandiegouniontribune.com/columnists/story/2019-12-06/column-does-homelessness-cause-ptsd

Vantol, V. (2022, December 20). Homelessness and PTSD: Why They Go Hand-in-Hand. Invisible People. https://invisiblepeople.tv/homelessness-and-ptsd-why-they-go-hand-in-hand/