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Mental Health and Homelessness
Approximately 20-25% of the single adult homeless population suffers from
some form of severe and persistent mental illness (Koegel et al., 1996).
However, only 5% of the estimated 4 million people who have a serious
mental illness are homeless at any given point in time (Federal Task Force
on Homelessness and Severe Mental Illness, 1992).
Despite
the disproportionate number of mentally ill people among the homeless
population, the growth in homelessness is not attributable to the release
of seriously mentally ill people from institutions. Most patients were
released from mental hospitals in the 1950s and 1960s, yet vast increases
in homelessness did not occur until the 1980s, when incomes and housing
options for those living on the margins began to diminish rapidly (see
"Why Are People Homeless?," NCH Fact Sheet #1). However, a new
wave of deinstitutionalization and the denial of services or premature
and unplanned discharge brought about by managed care arrangements may
be contributing to the continued presence of seriously mentally ill persons
within the homeless population.
Mental
disorders prevent people from carrying out essential aspects of daily
life, such as self-care, household management and interpersonal relationships.
Homeless people with mental disorders remain homeless for longer periods
of time and have less contact with family and friends. They encounter
more barriers to employment, tend to be in poorer physical health, and
have more contact with the legal system than homeless people who do not
suffer from mental disorder. All people with mental disorders, including
those who are homeless, require ongoing access to a full range of treatment
and rehabilitation services to lessen the impairment and disruption produced
by their condition. However, most people with mental disorder do not need
hospitalization, and even fewer require long-term institutional care.
According to the Federal Task Force on Homelessness and Severe Mental
Illness, only 5-7% of homeless persons with mental illness need to be
institutionalized; most can live in the community with the appropriate
supportive housing options (Federal Task Force on Homelessness and Severe
Mental Illness, 1992). Unfortunately, there are not enough community-based
treatment services, nor enough appropriate, affordable housing, to accommodate
the number of people disabled by mental disorders in the U.S.
Federal
demonstration programs have produced a large body of knowledge on the
service and treatment needs of homeless individuals with serious mental
illnesses. Findings indicate that homeless persons with mental disorders
are willing to use services that are easy to enter and that meet their
perceived needs (Oakley and Dennis, 1996). Findings also reveal that persons
with mental disorder and persons with addictive disorders share many of
the same treatment needs, including carefully designed client engagement
and case management, housing options, and long-term follow-up and support
services. Studies also emphasize the importance of service integration,
outreach and engagement; the use of case management to negotiate care
systems; the need for a range of supportive housing and treatment options
that are responsive to consumer preferences; and the importance of meaningful
daily activity. When combined with supportive services, meaningful daily
activity in the community (including work), and access to therapy, appropriate
housing can provide the framework necessary to end homelessness for many
individuals.
POLICY ISSUES
Low-income people with mental disorders are at increased risk of homelessness.
A variety of approaches must be employed to help them obtain and retain
stable housing to prevent homelessness.
In
addition, programs that assure access to mainstream and targeted community-based
services for homeless people with serious mental illness, such as the
Projects for Assistance in Transition from Homelessness (PATH) program,
should be expanded. At its current funding level, the PATH program is
unable to meet the needs of many people with serious mental illness who
are homeless or at risk of becoming homeless.
Supplemental
Security Income (SSI) benefit levels must be increased so that disabled
Americans are not forced to live in poverty. In 14 states and 69 metropolitan
areas, the entire maximum SSI grant does not cover the Fair Market Rent
for a one-bedroom apartment (Kaufman, 1997). In most states, even if the
SSI grant does cover the rent, only a few dollars remain for other expenses.
Benefit levels have not kept up with increases in the cost of rent and
therefore do not provide disabled individuals with adequate allowances
for housing.
Finally,
the commitment to making deinstitutionalization work as it was intended
must be renewed. People with mental illness must be able to live as independently
as possible with the help of expanded comprehensive, community-based mental
health services and other supports. It is crucial that polices be proactive
rather than reactive. Services such as crisis intervention, landlord-tenant
intervention, continuous treatment teams and appropriate discharge planning
in jails and inpatient facilities must be made available in all communities.
REFERENCES
Federal Task Force on Homelessness and Severe Mental Illness. Outcasts
on Main Street: A Report of the Federal Task Force on Homelessness and
Severe Mental Illness, 1992. Available, free, from the National Resource
Center on Homelessness and Mental Illness, 262 Delaware Ave., Delmar,
NY, 12054-1123; 800/444-7415.
Kaufman,
Tracy L. Out of Reach: Rental Housing At What Cost? 1997. Available for
$25.00 from the National Low Income Housing Coalition, 1012 14th St.,
NW, #610, Washington, DC 20005-3410, 202/662-1530.
Koegel,
Paul, et al. "The Causes of Homelessness," in Homelessness in
America, 1996, Oryx Press. Available for $43.50 from the National Coalition
for the Homeless, 1612 K Street, NW, #1004, Washington, DC, 20006; 202/775-1322.
Lezak,
Anne and Elizabeth Edgar. Preventing Homelessness Among People with Serious
Mental Illness: A Guide for States, 1998. Available, free, from the National
Resource Center on Homelessness and Mental Illness, 262 Delaware Ave.,
Delmar, NY, 12054-1123; 800/444-7415.
Oakley,
Deirdre and Deborah L. Dennis, "Responding to the Needs of Homeless
People with Alcohol, Drug, and/or Mental Disorders," in Homelessness
in America, Oryx Press, 1996. Available for $43.50 from the National Coalition
for the Homeless, 1012 14th Street, NW, Suite 600, Washington, DC 20005;
202/737-6444.
Wells,
Susan Milstrey. Projects for Assistance in Transition from Homelessness:
A Summary of Fiscal Year 1994 State Implementation Reports, 1996. Available,
free, from National Coalition for the Homeless, 1012 14th Street, NW,
Suite 600, Washington, DC 20005; 202/737-6444.
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National Resource Center on Homelessness and Mental Illness, Policy Research
Associates, Inc., 262 Delaware Ave., Delmar, NY 12054; 1-800-444-7515;
email: nrc@prainc.com.
The National Resource Center on Homelessness and Mental Illness maintains
and updates a bibliographic database on homelessness and mental illness.
The Center publishes a series of annotated bibliographies, an information
packet on financing services for homeless people with mental illness,
and an organizational referral list. These materials are available free
of charge.
Last
updated - April 1999 - National Coalition for the Homeless
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