Guest column: The link between homelessness and mental illness (opinion)
December 7, 2017
There is no question that both mental illness and homelessness are often coexisting conditions and challenging for all communities to manage. I recently heard a previously homeless individual say, "Before I could accept a home, I needed help to get my dignity back first."
During the 1970s and 1980s, the country was trying to decrease the number of people placed in mental institutions to connect them with community mental health centers for outpatient care instead. The idea being that mentally ill people who were treated in an outpatient setting would cost less than an institution and help people achieve a higher level functioning in their communities.
The reality was that many mentally ill people did not have access to outpatient treatment or supportive housing. In addition, the insurance companies in the 1990s were pushing for fewer admission days during psychiatric hospitalizations. The collaboration between psychiatric hospitals and community mental health centers were not very effective due to shorter hospital stays.
Without access to care and without support from community resources, many people who would have been housed in a mental institution became homeless.
In January 2015, the Office of Community Planning and Development did an extensive survey and "point in time" count of homelessness. They found that over 500,000 people are homeless on a given night in the United States. Of those, more than 25 percent were seriously mentally ill and up to 45 percent had a diagnosable mental disorder (anxiety, depression and post traumatic disorders). Compare that to 90,000 people that are admitted to psychiatric hospital in a given point in time.
A 2006 study showed that there is a direct correlation with decreasing psychiatric facility beds and an increase in crime, arrests, and homelessness. One study found that 28 percent of homeless with a previous psychiatric hospitalization obtained their food from garbage cans. An inability to care for themselves, as well as problems with hygiene, create medical concerns since it often leads to more severe chronic physical illnesses which increased health care costs.
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Communities often bear the cost of mentally ill homeless through healthcare needs and law-enforcement involvement. This is especially true since over half of all homeless individuals also have problems with substance abuse. The most common cause of death for homeless is addiction related illnesses, followed by cancer and heart disease.
Often homeless are forced to obtain their medical care through emergency departments and have more severe medical problems since they also have lack of access to preventative health care. Death by head injury or trauma has been increasing especially in homeless youth since they are often victims of violent crimes.
Contrary to popular belief, many homeless people are willing to accept treatment and services but need a great deal of support to be committed to it. This burden often falls on family members. Dealing with substance abuse and refusal to comply with mental health care can be very taxing on families, which can also lead a mentally ill individual to move out onto the streets.
For those who have lost contact with supportive family, outreach programs that have frequent contact with mentally ill homeless people are more likely to be successful in connecting them to resources. Properly treated severely mentally ill individuals can live independently. Lack of funding is often a barrier for communities to provide effective outreach services that often include social worker and case manager personnel.
The South Lake Tahoe Warm Room benefits the community by taking homeless individuals out of the elements and off the streets at night during the winter months. It creates a safe place to build trust where people may be more likely to accept resources for treatment, accept housing options, but most importantly, start to get their dignity back.
Together, working with healthcare providers, mental health outreach workers, concerned family members, and other local resources, we can reduce rates of homelessness and mental illness in our community. This will eventually reduce rates of emergency room overuse, drug use and crime in our community.
Let's work together to treat everyone in our community with dignity and connect them with the support they need to move out of homelessness and improve their mental health.
Sonia Rupp is a psychiatrist and Tahoe Coalition for the Homeless board member.
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