This question came from Jonathan S. via our latest website survey: “It’s been suggested that PTSD is common among people who have been homeless for a long time. What research has been conducted to show this and what avenues have been put into place to ease them back into community living?”
The relationship between trauma and homelessness is complex and has been the subject of many studies – simply search “trauma” on our site and you’ll see what I mean. Trauma has been shown to be a significant factor in the lives of people experiencing homelessness. It can lead to a variety of mental and physical health issues, and a reason some people cope with substance use.
Many people experience trauma before they become homeless. A 2008 study in Sydney found that 98% of the male participants had experienced a traumatic event, compared to and of that percentage, 79% showed a lifetime prevalence of post-traumatic stress disorder (PTSD). For 59% of those participants, PTSD symptoms began before their first time being homeless. Another study from Australia, conducted in 2006 with youth, found that half of all participants had experienced trauma before homelessness.
Events that occur during childhood are particularly powerful. In the At Home/Chez Soi study, 46% of participants reported having adverse childhood experiences (physical, emotional and/or sexual abuse). In 2015, Bender et al. discovered that 79% of homeless youth participants has experienced two or more types of child abuse, and each instance more than doubled the likelihood that youth met criteria for PTSD.
Further, Intergenerational trauma – dealing with generations of violence and oppression from colonial projects like residential schools - is a primary issue for Aboriginal Peoples, who continue to be disproportionately represented in the homeless population.
Trauma can be both a cause and a consequence of homelessness. The experience of homelessness itself can also be traumatic and cause PTSD, as it makes people more vulnerable to discrimination, adversity, social exclusion and violence. Many of the stories shared in Homelessness is One Piece of My Puzzle showed that trauma is a powerful cause and result of homelessness. In a 2015 U.S. study, 23-30% of the participants (homeless men) screened positive for PTSD. There were other important findings, including that:
Those with positive PTSD screens had been homeless longer and were more likely to have met time criteria for chronic homelessness. They were significantly more likely to be veterans and to report violent attacks, abuse histories, and mental health problems. Importantly, only 69% of those with positive PTSD screens acknowledged current mental health problems. These individuals were much less likely to report mental health counseling in the prior year.
In other words, the longer someone experiences homelessness, the more likely they are to exhibit symptoms of PTSD. And due to the unpredictable, rough nature of chronic homelessness, many don’t receive counselling or other services that they may need.
2 ways to help: Housing First and trauma-informed care approaches
People experiencing chronic homelessness are not just at a higher risk of exhibiting PTSD, they also tend to have more severe issues with physical health and substance use, higher incidents of involvement with the criminal justice system, and face more discrimination. Even though it is estimated that people experiencing chronic homelessness are a minority – about 2-4% - they use more than half of all available homelessness services because they have the greatest needs.
This is why many researchers have advocated for prioritizing people who are chronically homeless in Housing First programs, which remove many of the barriers to housing and goes beyond housing services to provide clinical (counselling, therapies, medication) and complementary services (employment services, case management, etc.) as well.
Given the prevalence of trauma and PTSD amongst this population, helping them adjust to long-term housing also requires trauma-informed care (TIC) at all personal, practice and organizational levels. It is rarely possible for someone to thrive in a new apartment or community without addressing symptoms of PTSD or their trauma in general. After reviewing literature, Hopper, Bassuk and Olivet (2010) came up with the following definition of TIC:
…a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment.
In TIC, workers are aware of and sensitive to the experiences that others may have had, and bring that knowledge forward in language and practice. The table pictured right (from the British Columbia TIC practice guide), shows how “problem” approach differs from a strengths-based TIC approach. (The guide overall is a great resource for anyone curious about the specifics of developing TIC practices.)
Supportive housing, when implemented well, can also work very well for people who have experienced trauma. A 2015 study of two supportive housing programs for women experiencing homelessness in Toronto found that participants reported increased housing stability, improved family life, and an increased sense of safety and wellbeing. This was attributed largely to the TIC approach, but also the harm reduction framework that both programs worked within.
Drop-in programs can also be an effective option. Workers at Phoenix Rising ran a program in 2005 for youth experiencing homelessness that was trauma-informed and focused on helping youth understand their trauma, triggers and learn different methods of coping. After the program, participants’ symptoms of PTSD were greatly reduced.
Helping people who’ve experienced chronic homelessness and/or PTSD adjust to stable housing isn’t an easy task and it requires many people working together. If you’re interested in more resources on trauma, PTSD and trauma-informed care, read:
- Trauma-Informed Approach in the Context of Housing First
- Trauma-Informed Care and Homelessness
- 10 Tips for Recovery-Oriented, Trauma-Informed Agencies
- The Trauma-Informed Organizational Toolkit
- Avoiding re-traumatization and fostering recovery among people experiencing homelessness
- SAMSHA resources on trauma
- Do frontline workers know about trauma-informed care?
- Recognizing trauma, tools to use with clients, and self-care for front-line workers (video)
This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.