Research Matters Blog
Despite the advances in treatment and awareness surrounding mental health issues in recent years, mental illness still carries an enormous amount of stigma. The infographic below, published by Homeless Link UK, provides some details about the complex relationship that exists between mental health and homelessness.
Individuals with mental health issues are more likely to be homeless, as mental illness has a detrimental impact on all aspects of their life. People suffering from poor mental health find it more difficult to maintain close relationships with family and friends. Their cognitive abilities may be affected; making them more likely to misunderstand others and question the motives of members of their support network. Difficulties are also likely to arise at work, as individuals may be unable to deal with workplace stresses. Many ultimately find themselves unable to maintain employment. After looking at how having mental health issues can poorly impact an individual’s life, and understanding that these stressors can pile up, it’s clear why individuals suffering with mental health issues are more likely to be living in critical housing situations.
Homelessness on its own can cause issues in mental health. Transitioning from housing to living on the streets is an enormously stressful and difficult situation. Individuals trying to get off the streets may find that there are few employment, educational, and housing supports in place to help them with their goals. Impediments in the journey from being homeless to living in an adequate housing situation can be demoralizing and depressing. In circumstances where an individual's mental health issues have acted as a precursor to their homelessness, homelessness often only further amplifies their condition. Increased exposure to harmful drugs, poor nutrition, and difficulty accessing appropriate medical care because of homelessness are all factors that directly impact mental health. It doesn’t come as a surprise when the above infographic shows that all of the mental health illnesses represented have greater representation among the homeless than among the general population.
The discrepancy between the mental health of the general population compared to the homeless population is most pronounced when considering the incidence of depression. The survey conducted by Homeless Link revealed that homeless individuals are thirteen times more likely to suffer from depression. Although the UK was the site of this survey, these sorts of discrepancies extend beyond geographic borders. In a survey conducted by St. Michael's Hospital, 31% of the homeless population was shown to suffer from depression. This is opposed to 4.8% of the general population who suffer from depression according to figures provided by the Canadian government.
In the absence of care and support, many homeless individuals suffering with mental health issues turn to drugs and alcohol as a coping mechanism. 41% of those surveyed by Homeless Link reported such behaviour. This leads to increasing instability in their lives and may ultimately lead to concurrent disorders, a condition representing 12% of the homeless population surveyed. The term concurrent disorder refers to being diagnosed with both mental illness and a substance abuse problem. Over the course of treatment, it’s difficult for specialists to determine if mental health issues, substance abuse problems, or both are causing symptoms and behavioural problems. There is an evident need for specialized, coordinated programs and services that address this specific subgroup.
Perhaps, rather than viewing this issue from a numbers-oriented perspective, it would help us to focus on individual stories.
Martin was professionally educated and employed before his mental health issues resulted in him becoming homeless. Martin was fortunate to find the help he needed at the Mustard Seed shelter in Calgary. Like in Martin’s experience, to meet the needs of people experiencing mental health problems, a number of services are required.
Evictions prevention refers to any strategy or program designed to keep individuals and families in their home and that helps them avoid entering into homelessness. Usually eviction prevention programs are geared at renters but the same programs are often effective for homeowners at risk of foreclosure. Eviction prevention is seen as an ‘upstream’ solution to homelessness by reducing the number of people who become homeless.
There are a variety of homelessness prevention or eviction prevention strategies. A few program options include:
- Rent Banks that provide short-term or temporary loans or payments of outstanding rental arrears.
- Energy assistance payments to help with the costs of utilities such as electric, water or gas. This often frees up a household’s income to make their rental or mortgage payment.
- Community legal clinics or credit counselling agencies that work with a tenant/landlord or home owner/mortgage company to address outstanding financial or legal issues.
- Supports to help tenants with notices of eviction to understand the eviction process and their rights and obligations concerning the notice.
Image by Flickr/aazamthefilmmaker
We received this tweet from Jordan Dawe on Twitter. He asks where donations can best be used to help people experiencing homelessness.
@homelesshub For donations to help homelessness, what kind of organization helps most? Food banks? Shelters? Giving directly to people?
— Jordan Dawe (@freedryk) August 8, 2014
Thanks for an interesting question Jordan.
Donations are interesting. There has been some great research/stories about how post-disasters (especially big ones) resources of community organizations get swamped just managing donations. The same can be true for community organizations working with homeless folks.
Donating clothing means that someone needs to open the donations, clean it, mend it, sort it etc. etc. etc. Much of what is donated is inappropriate – dirty, ripped, worn, out of fashion or not appropriate (i.e. children’s clothes to a single, adult men’s shelter). When I worked at a shelter in Oshawa in the mid-90s we had access to a lot of suits from the 60s/70s. In today’s environment of limited space and resources, the additional complication of bed bugs means many shelters just refuse to accept clothing or only purchase new clothing for their clients. The latter also speaks to the worth and dignity of the individual. A job search isn’t going to be helped by showing up in an outfit that is 30 years out of date, stained and ill fitting. Instead of donating clothes -- have a garage sale and sell what is appropriate and donate the funds raised. You can also look at donating to an organization like Dress for Success which provides professional attire for disadvantaged women who need it. You can donate money or your nearly new suit.
Donating food can also present challenges including the sorting, reviewing, distributing issues listed above. Many people who are homeless are immune-compromised so it is important that any food they receive from a shelter, drop-in or meal program be nutritious and healthy. This is particularly true for prepared food; many shelters will not accept it because there is no way of knowing what it contains, cooking/storage conditions etc. For canned goods, central food banks are better set up to manage large-scale food collection and will then funnel food to food pantries and organizations as needed. When you’re donating pick new or non-expired items. See what is listed as most needed by the food bank. Remember, if you want to give ONLY to people who are homeless, you need to know that a large percentage of people who use food banks are housed and a great number are working. For them, food banks are a response to a financial emergency, ensuring there is access to food when money has to go to larger expenditures, such as rent, medical bills, or something otherwise unforeseen. To learn more about the way food assistance programs are accessed by youth who are experiencing homelessness see this chapter of our Youth Homelessness in Canada book.
We wrote about giving to people on the streets asking for money last year in one of our most popular blog posts: Should I Give Money to Panhandlers? As we discussed then this is completely a personal decision. We also suggested a few options for those who were worried about how the money would be spent:
- Give the money to an organization working with people experiencing homelessness.
- Buy a street newspaper.
- Buy a small gift card – i.e. for a local coffee shop or fast food restaurant.
- Use the money to donate food to a food bank.
Jordan, your question about what kind of organizations help the most is a good follow-up for our first suggestion of donating directly to an organization.
What we do know is that ending homelessness requires a multi-faceted response. All sorts of organizations are needed and they can’t be rated. Shelters, drop-ins, food banks, support programs, counselling, literacy classes, job or life skills training, recreational programs and housing services are all a piece of the puzzle. We won’t suggest that one program be selected over another. However, we will give you a couple pieces of advice:
- Give from your heart. Did you see an ad on transit or in a newspaper that spoke to you? Are you more interested in youth concerns than adult issues? Do you want to help people get housing? Get food? Find a job? Pick the charity or non-profit that most fits with your desires and interests.
- Do your research. Don’t be afraid to ask questions. Larger organizations will have a fundraiser or development officer whom you can ask questions. Many websites will list annual reports or you can request one. Ask how your money will be spent. Find out how they stand with the Canada Revenue Agency (understanding that there is a lot of controversy about that these days).
Finally, if you don’t have the resources to donate, maybe you have the time to volunteer. Remember some organizations will require a specific skill set, training and/or a vulnerable sectors/police check. You can look for both short and long-term volunteer opportunities. When I worked frontline, the favourite volunteers were those who knew how to cut hair and those who played guitar and could lead a sing-song. Being awesome at cribbage never seemed to hurt either. Overall, just being a sympathetic ear and a friendly face can go a long way.
Image from Flickr/colros
The definition of health has changed greatly over the last century. While ideas of health used to define only biological illnesses or disorders, today the World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The infographic above, published in the United Kingdom by Homeless Link, provides the reader with a brief snapshot of the health problems suffered by homeless populations with the modern definition of health in mind; a definition that goes far beyond an individual’s physical health to include mental health and lifestyle factors.
The percentages in the infographic tell a story. 80% reported struggling with some form of mental health issue. 73% of those surveyed reported physical health problems. 39% take drugs or are in the process of recovering from a drug problem. These are all alarming figures. However, comparing figures between the homeless population and the general population provides us with proof of the incredible discrepancy that exists between both groups. Compared to the general population, health issues are experienced at much higher levels by homeless people. This discrepancy is most striking when considering the drug consumption - in the UK homeless people are 7 times more likely to have used drugs in the past month compared to the general population. Factors contributing to increased drug use among homeless populations include pre-existing mental health issues, alcoholism, and lack of access to healthcare.
There are barriers across all the stages of the healthcare delivery process when Canadians who are homeless try to receive treatment. Difficulties arise even before a homeless person enters a clinic. Patients usually have to place an appointment prior to a consultation, and those affected by homelessness are unlikely to have a phone or a permanent address. Even once when being treated, homeless individuals may receive a diminished quality of care because of how a healthcare service provider judges their situation. Gaps in healthcare provision can also end up causing financial worries, as accessing provincial and federal healthcare reimbursements is more difficult to access for homeless people compared to the general population. For example, an individual may not have the necessary documentation to obtain a Canadian health card or provincial healthcare coverage. The 2007 Street Health Report’s findings showed that more than a quarter of those surveyed had been refused healthcare because they didn’t have a health card.
Following a hospital visit, homeless people run into problems when it comes to accessing follow-up healthcare on their condition. In most cities, healthcare provision for homeless people is managed entirely by emergency departments. Both chronic and acute conditions are unlikely to receive treatment under such a delivery model - until they become emergencies. A system in place that only addresses emergency situations is unfit to meet the everyday healthcare needs of Canada’s homeless population. Chronic health conditions that require regular check-ups, mental health issues, and substance abuse are threats to health and well being that are all poorly mitigated under such a model. When we compare the current status of care provided to homeless populations with the WHO’s holistic definition of healthcare, it’s evident that current provisions in place for homeless populations are inadequate.
Accordingly, health outreach for homeless populations is of critical importance when we consider how Canada can provide proper healthcare. In the past, hostel outreach programs for homeless clients with a history of mental illness have shown promise, and have been associated with decreased symptoms and an increase in social functioning. Managed Alcohol Programs, built around a harm reduction approach, have been carried out in cities across Canada, and participants in those programs report reduction in alcohol-related harms and improvements in mental health.
It’s unlikely that there will ever be a simple one-step solution towards achieving health and well-being for populations, homeless or otherwise. However, investing in research and programs directed towards the needs of homeless populations, including filling in the gaps that currently exist in healthcare delivery, surely acts as big step towards reaching that goal. Failure to account for the health needs of homeless populations is likely to perpetuate and further exacerbate existing problems.
Inadequate income, employment and education are well documented as causes of and contributing factors to people cycling in and out of homelessness. However, on the flip side they also create possibilities for moving from homelessness to housing.
Developing education, training and employment (ETE) programs for people experiencing homelessness is different than doing so for the housed population because of exacerbating factors such as lack of a permanent address, inability to maintain proper hygiene or nutrition in a shelter, challenges of following shelter rules while employment, physical or mental health and addictions issues etc. There is a need for skills-based training including job readiness skills and life skills training including money management and cooking/shopping.
Because the education levels of people who are homeless are lower on average than the general public, they may experience challenges with participating in the formal labour market. Programs to help improve the education levels of people experiencing homelessness need to recognize and accommodate these challenges. This is a similar situation for work programs and is one of the reasons why social enterprise programs – which focus more on community good than profit – are so successful in the homelessness sector.
Youth experiencing homelessness have their own unique set of challenges accessing income, education and employment, as do single parents. Most programs for homeless youth in Canada focus on skills development (getting them into the job market) rather than on providing them with the opportunity to finish school. Homeless families also experience challenges in getting adequate educational supports for their children.
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