August 9, 2019 Center for Medical Ethics and Health Policy, Dr. Fabrizia Faustinella, Homeless, Incarceration, Mental Illness
More than 550,000 people, including about 36,000 unaccompanied youth under the age of 25, are homeless in the United States on any given night and homelessness remains a widespread phenomenon. Why, despite the obvious wealth of developed western nations, is the prevalence of homelessness so high? There are many reasons: loss of income or insufficient income, lack of affordable housing, eviction, poverty, marriage breakdown, domestic violence, mental and physical illness are, among others, common causes.
Racial and ethnic minorities are disproportionately affected by this problem. When compared to the total population, those who are homeless are more likely to be adult, male, African-American, unaccompanied/alone, and disabled. More than 10% of adults living on the streets are veterans.
Once in the streets, many speak of living in a vicious cycle of losing their ID to theft, homeless camps clearing by city ordinance, eviction, and other circumstance, and then struggling to get formal identification documents. They are then denied access to support services, which creates insurmountable obstacles for those trying to come out of homelessness.
Impact of mental illness
Many people experiencing homelessness often have serious mental illness, such as major depression, bipolar disorders, schizophrenia and psychosis, and issues with drug and alcohol abuse, likely to be both the cause and consequence of their condition. While approximately up to 6% of Americans are affected by a mental health condition, more than 20% of homeless people fall under this category.
Furthermore, about 45% of the U.S. homeless population has a history of mental health diagnoses. This doesn’t consider those living with mental health problems that have not been diagnosed or addressed by healthcare professionals.
Many of those living on the streets come from abusive families and have suffered neglectful, traumatizing experiences as a child. This can have long-lasting, negative effects on their neuro-biological development. Sadly, these fractured family dynamics also mean that these individuals are less likely to have family support when they fall on hard times, again compounding their risk of homelessness.
Social isolation and risk of incarceration
Life on the streets can be a demeaning, humiliating and, at times, dehumanizing experience. Clearly, living without material comforts is only one part of the plight. The mental struggle caused by isolation and abuse is often an even more difficult burden to bear.
Often, those living on the streets talk about their daily experiences of being ignored, overlooked, or even feared, by their fellow citizens.
Studies show that people who are homeless are more likely to be victims of crime than perpetrators. Sleeping on the street with all their worldly possessions makes them extremely vulnerable to attacks. Rates of rape among homeless women stand at approximately 30%. Those with serious mental health conditions are even more likely to suffer abuse.
Unfortunately, these individuals are also at higher risk of incarceration. In fact, across the U.S., people with serious mental health issues are more likely to be jailed than to be hospitalized. 17.3% of prison inmates with severe mental illness were homeless prior to being arrested and 40% were homeless at one point in their lives, compared to 6% of undiagnosed inmates.
To complicate matters, homeless people are often targeted by a number of city ordinances, which prohibit behaviors such as obstructing sidewalks, loitering, panhandling, trespassing, camping, being in particular places after hours, sitting or lying in particular areas, wearing blankets, sleeping in public, storing belongings in public places, and so forth.
Under these laws, homeless people are regularly cycled through prisons and jails, which perpetuate abuse and discrimination. Homelessness and incarceration increase the risk of each other causing a cycle of hardship and uncertainty.
Importance of education
It’s far less expensive to prevent homelessness and help people come out of homelessness than to maintain the status quo. There will never be a shortage of homeless people, if the conditions leading to homelessness won’t be addressed and solved.
Homelessness is the end result of many social ills including poverty, unaffordable housing, unemployment, untreated mental illness, domestic violence, lack of social safety nets, incarceration and family disintegration, among others.
It is of paramount importance to educate the public and spread awareness of this problem, its causes and its solutions. This is an issue our society cannot afford to ignore.
Understanding the complexity of the problem will lead to a positive shift in attitudes and intentions toward homelessness, eventually resulting in increased support for changes in social, political and economic policies.
-By Dr. Fabrizia Faustinella, associate professor of family and community medicine at Baylor College of Medicine; writer, director and producer of ‘The Dark Side of the Moon,’ an educational film-documentary exploring homelessness
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