Homelessness and Psychological Disorders

Homelessness and Psychological Disorders Introduction

Homelessness is a complex social issue with a myriad of causes, including economic hardship, lack of affordable housing, and various health problems. Among these health problems, mental illness and mood disorders significantly contribute to the challenges faced by homeless individuals. Approximately 25% of the homeless population suffers from some form of serious mental illness (Kusmer, 2002). This includes conditions such as depression, psychotic disorders, substance use disorders, and personality disorders. Understanding the demographics of homelessness, the intersection with mental health, and the roles of nurses and community health workers is crucial for developing effective interventions.

Homelessness and its Causes

The causes of homelessness are multifaceted and interconnected, often involving a combination of economic, social, and health-related factors. Mental illness and mood disorders are particularly prominent among the homeless population. These conditions can create barriers to employment, stable housing, and access to healthcare, ultimately increasing the risk of homelessness. Common mental illnesses among the homeless include depression, schizophrenia, bipolar disorder, and substance use disorders.

Two primary trends have driven the rise in homelessness over the past two decades: the growing shortage of affordable rental housing and a simultaneous increase in poverty (National Coalition for the Homeless, 2005). A survey by the US Conference of Mayors in 1998 across 30 cities found that children under the age of 18 made up 25% of the urban homeless population, while unaccompanied minors comprised 3%. The survey also showed that single adults were more likely to be male (45%) compared to single women (14%), and families with children represented around 40% of those who become homeless (Shinn & Weitzman, 1996).

Demographics of Homelessness

The demographics of the homeless population vary according to location and specific circumstances. For example, the US Conference of Mayors (1998) reported that 49% of the homeless population was African American, 32% Caucasian, 12% Hispanic, 4% Native American, and 3% Asian American. Additionally, approximately 22% of the homeless population left their last place of residence due to domestic violence (Homes for the Homeless, 1998).

Understanding these demographic variations is essential for developing tailored interventions that address the unique needs of different subgroups within the homeless population. Factors such as ethnicity, gender, and age influence the types of services and support required to improve health outcomes and reduce the prevalence of homelessness.

Mood Disorders and Homelessness

Mood disorders, such as depression and anxiety, are prevalent among the homeless population. These disorders manifest in various ways, including persistent sadness, anxiety, fatigue, loss of interest in daily activities, sleep disturbances, weight changes, physical pain, difficulty concentrating, feelings of hopelessness, and thoughts of suicide (McMurray-Avila, 1997). Depression, in particular, is one of the most common and treatable mental illnesses, with a 60-80% success rate when treated with psychotherapy, medication, or a combination of both.

However, barriers such as the stigma associated with mental illness, reluctance to take medication due to side effects, and delays in observing the effects of medication (which may take 6 to 19 weeks) make it challenging for homeless individuals to access and adhere to treatment (McMurray-Avila, 1997). Moreover, the instability of homelessness often exacerbates mood disorders, creating a cycle that is difficult to break.

Advocacy in Homelessness

Advocacy is essential for addressing homelessness and its associated mental health challenges. Advocacy efforts focus on working with homeless individuals to bring about positive changes in policies and programs at local, state, and federal levels. Effective advocacy involves addressing barriers that prevent homeless individuals from receiving necessary medical care, such as:

Lack of awareness of available services.
Financial constraints and lack of health insurance.
Language or cultural barriers.
Negative attitudes of some service providers.
Lack of transportation and difficulty scheduling appointments.
Fear and distrust of institutions.
Fragmented community services (Kusmer, 2002).

Organizations such as the National Institute of Mental Health, the National Depressive and Manic Depressive Association, and the National Alliance for the Mentally Ill play critical roles in providing information, support, and resources for homeless individuals with mental illnesses. The President’s New Freedom Commission on Mental Health (2003) has also identified goals to transform mental healthcare in the United States, which, if implemented, could reduce the number of homeless individuals with mental illnesses.

Role of Nurses

Nurses play a vital role in caring for homeless individuals, particularly those with mental illnesses and mood disorders. However, there is a lack of nursing research that directly links the role of professional nurses in improving care for homeless individuals with mental health needs. Nurses often serve as primary healthcare providers for the homeless population, presenting a unique opportunity to initiate research, advocate for improved care, and help individuals with mental illness achieve better functioning within society.

Nurses can also play a crucial role in:

Assessing the mental health needs of homeless individuals.
Providing direct care and support, including counseling and medication management.
Coordinating with other healthcare providers and social services to ensure comprehensive care.
Advocating for policies and programs that support the health and well-being of homeless populations.

Nursing Interventions

Nursing interventions are essential actions taken to disrupt the cycle of homelessness and address related mental health issues. Projects like “Project Achieve” provide resources to help homeless individuals and families access social services, emergency shelters, and programs that prepare them for independent living (www.homelessness.net, 2003). These initiatives include:

Case management services to provide counseling, assistance with employment, and housing placement.
Online resources that list available grants and funding opportunities for developing additional programs to meet the needs of the homeless.
Regional efforts to educate health professionals and community members about available resources and services.

These interventions highlight the importance of a coordinated approach to homelessness, involving healthcare providers, social services, community organizations, and policymakers.

Role of Community Health Nursing

Community health nurses are essential in supporting homeless individuals with mental illnesses. Longitudinal studies of family support among homeless individuals with mental illness have shown that increased contact with family members improves mental health, satisfaction with relationships, and housing stability (Wood, Harbert, Hough, & Hostetter, 1998).

Effective strategies for professionals working with homeless individuals include:

Setting a tone of respect and trust.
Using observational, listening, and interviewing skills to quickly identify problems.
Locating and utilizing existing resources.
Making timely and appropriate referrals.
Acting as advocates for the homeless when needed (Williams, 1994).

Community health nurses can help strengthen family units and support networks for homeless individuals, which is critical for improving mental health outcomes and reducing homelessness.

Identification of Problems During Homelessness

Research on the health needs of the homeless population has grown slowly over the past decade, but there remains a significant gap in nursing research related to the roles and interventions that professional nurses can provide. Further studies are needed to:

Explore the Relationship Between Homelessness and Mental Disorders: Investigate how specific mental health conditions, such as depression and other mood disorders, contribute to homelessness.
Understand the Etiology of Homelessness: Research should explore demographic factors, including national, cultural, psychosocial, genetic, and neurobiological determinants that make specific populations more vulnerable to homelessness.
Examine the Impact of Urban vs. Rural Environments: Studies should analyze how different environments affect individuals’ vulnerability to homelessness.
Integrate Qualitative and Quantitative Research: Combining qualitative and quantitative methods can help document the critical roles and interventions already employed by nurses and identify new strategies for providing care to homeless individuals with mental health needs.

Conclusion

Homelessness and its associated psychological disorders present complex challenges that require coordinated and comprehensive care approaches. Nurses play a crucial role in addressing these challenges through direct care, advocacy, and research. By identifying mental health needs, developing targeted interventions, and advocating for systemic changes, nurses can help break the cycle of homelessness and improve outcomes for this vulnerable population. Future research should focus on deepening our understanding of the interplay between homelessness and mental health and exploring innovative strategies to support homeless individuals in achieving stability and well-being.