Psychological Disorders in Homeless

Homelessness and its Causes

    The
causes of homelessness are complex, and mental illness and related mood
disorders add additional layers of difficulties. Approximately 25% of the
homeless population suffers from some serious mental illness (Kusmer, 2002). 

    Many homeless suffer from common mental illnesses such as depression, psychotic
disorders, substance abuse, and personality disorders. 

    In addition, the
population of homeless is very diverse including all ethnic groups, usually
ranging in age between 30 to 50 years of age, unmarried, unemployed, with the
largest segment of the population being women (Martens, 2002).

    Two
growing trends are increasingly responsible for the rise in homelessness over
the past 20 years: the growing shortage of affordable rental housing and a
simultaneous increase in poverty (National Coalition for Homeless, 2005). 

    In
1998, the US Conference of Mayor’s survey of homelessness in 30 cities found
that children under the age of 18 years accounted for 25% of the urban homeless
population. This same study found that unaccompanied minors comprised 3% of the
urban homeless. 

    Most studies of the homeless show that single adults are more
likely to be male and comprise 45%, while 14% are single women (US Conference
of Mayors, 1998). Families with children are among the fastest-growing segments
of the homeless population representing approximately 40% of people who become
homeless (Shinn & Weitzman, 1996).

Demographics of  Homelessness

    The
homeless population varies demographically according to location. The US
Conference of Mayors (1998) found that 49% are African Americans, 32% Caucasian
American, 12% Hispanic, 4% Native American, and 3% Asian American. 

    Approximately 22% of the homeless population left their last place of residence
because of domestic violence (Homes for the Homeless, 1998).

Mood Disorders and Homelessness

    The
homeless population commonly identified the usual signs of mood disorders such
as: ongoing sadness, anxiety, lack of energy, loss of interest in ordinary
activities, sleep problems, excessive weight loss or gain, physical aches and
pains, difficulty concentrating, hopelessness, and thoughts of suicide and
death (McMurray-Avila, 1997). 

    One of the identified mood disorders, depression,
is the most treatable of all mental illnesses. About 60%-80% of depressed
people can be successfully treated outside the hospital with psychotherapy
alone or with specific drugs. 

    Unfortunately, most drug therapies, if needed,
take at least 6 to 19 weeks before there are real signs of improvement. There
is a reluctance to receive drug treatment due to side effects of the drugs
(McMurray-Avila) and the continuing stigma of mental illness in our society.

Advocacy in Homelessness

    Advocacy
is critical to ending homelessness. Advocacy means working with the homeless to
bring about positive changes in policies and programs at the local, state, and
federal levels. 

    Breaking the cycle of homelessness and related mood disorders
also requires eliminating some of the obstacles to receiving medical care that
the homeless face. 

    Obstacles for the homeless include: a lack of awareness of
services available, lack of financial resources and health insurance, language
or cultural barriers, poor attitudes of some providers of services, lack of
transportation, difficulty scheduling and keeping appointments, fear and
distrust of institutions , and fragmented community services (Kusmer, 2002). 

    On
the bright side, organizations which offer information and assistance with
depression and treatment include: The National Institute of Mental Health
Depression Awareness, Recognition, and Treatment Program (2003); the National
Depressive and Manic Depressive Association (2003); the National Alliance for
the Mentally III (2003) and its branch organizations available in each state;
and the National Mental Health Association (2003) which publishes information
on a variety of mental health issues. 

    In addition, the President’s New Freedom
Commission on Mental Health (2003) clearly identified goals needed to transform
mental health care in the United States, which in turn should decrease the
number of homeless with mental illness when implemented.

Role of Nurses

    There
is a paucity of nursing research linking the role that professional nurses play
as advocates in improving the care for homeless with mental illness and related
mood disorders. 

    Because primary health care for the homeless population is
often provided by nurses, there is an excellent nursing opportunity to initiate
helpful research in this area. as well as assist those with mental illness to
get care so that they may function at a higher level in our society.

Nursing Interventions

    Interventions
are those successful actions taken to attempt to break the cycle of
homelessness. Project Achieve (www.homeless ness.net, 2003) attacked the cycle
of homelessness for families and individuals with information resources
described on their web site. 

    This web site lists access to social services and
emergency shelters to meet basic needs, services to prepare individuals for
successful independent living, and case-management services sites to provide
counseling, assistance with employment, and housing placement. 

    This kind of web
site assistance could be provided regionally throughout the country, educating
health professionals and others who lack the knowledge of available resources.
Another valuable resource is a listing of available grant money on this web
site that can be used to develop additional programs to better meet the needs
of the homeless.

Role Community Health Nursing

    The
strengthening of the family unit of individuals with chronic mental illness is
an important need revealed by community based case management programs. This
was a longitudinal study of family support among homeless mentally ill in
community based housing programs (Wood, P., Harbert, Hough, & Hostetter,
1998). 

    This study was one of the first to look at the strength of homeless
family relationships over time. As contact with family members increased, so
did their mental health as do greater satisfaction in their relationships and
housing.

    The
most useful strategies for professionals working with homeless mentally ill
individuals and families include: setting a tone of respect using
observational, listening, and interviewing skills that quickly identify
problems; locating existing resources; making timely and appropriate referrals;
and functioning as an advocate when needed (Williams, 1994).

Identification of Problems During Homelessness

    There
has been a slow increase in research targeting the problems and needs of the
homeless over the past decade. However, in the field of nursing there continues
to be a paucity of research related to the important roles that professional
nurses can play and the interventions they could use to provide care for the homeless
chronically mentally ill. 

    Research is needed on the nature of the relationship
between homelessness and related mental disorders such as depression and
related mood disorders. The etiology of homelessness needs studies which
include demographics comparing national, cultural, psychosocial, genetic, and
neurobiological determinants of specific homeless populations. 

    Other studies
might explore the impact of urban versus rural environments on person
vulnerable to homelessness. Both qualitative and quantitative nursing research
cojoined with the research done by other disciplines is essential to clearly
document the important role and interventions already used in practice by the
professional nurse in providing care to the mentally ill individuals and their
families.