The Plight of the Mentally Ill Homeless in the US Essay Example for Free

The Plight of the Mentally Ill Homeless in the US Essay Introduction The issue of homelessness in the US has been of serious concern since the 1980s when the problem first became apparent. Budget deficits, brought about by massive diversions to military spending, forced a cutback on most social services. Today, approximately 7% of the population has been homeless at least once in their lives. Estimates place the number of people who experience homelessness each year at 3 million, more than half of which are families with children. (Donohoe, 2004) Of that number, roughly 25% have serious and chronic mental problems. (Mental Illness and Homelessness, 2006) The purpose of this paper is to provide a historical and social context to homelessness in the US, with particular focus on the mentally ill. Current statistics and demographics for the mentally-ill homeless will also be presented followed by an analysis of programs currently being undertaken with regards to this sector of the population. The Numbers The homeless population can be divided into three types based on how long and often they are homeless. About 80% are temporarily homeless, those who experience a single, short period (about two weeks) of homelessness that is not repeated. The episodically homeless (approximately 10% of the homeless population) are also short-term spells of homelessness but may be repeated at unpredictable intervals over a period of time. The chronically homeless, 10% of the population, request the use of homeless assistance facilities and services over a protracted period at frequent intervals. (U. S. Department of Health and Human Services, 2003) Overall, 39% have reported mental illness of which 25% are considered seriously ill. Among the last group, 50% are mentally ill or with substance abuse problems. This translates to approximately 150,000 chronically homeless, mentally ill people at any given time, and the mentally ill homeless have the most difficulty in relinquishing assistance programs. Of this population, 23% are veterans. (National Mental Health Information Center, 2003) Characteristics of the homeless mentally ill The mentally ill are often have been institutionalized at some point in their lives, and may have been involuntarily committed or have received treatment unsuitable for their condition. Since they are not completely functional because of their disability and poor hygiene, they tend to be prone to physical ailments, such as respiratory disease, HIV, and tuberculosis, that remain untreated until an advanced stage, if not death. They are usually members of a community that have become alienated from friends and family because of their disability and institutionalization, losing whatever support system they may have had. Many have been charged with misdemeanors, and their life expectancy is approximately 45 years. (National Mental Health Information Center 2003) Causes of homelessness among the mentally ill The 1960s saw an initiative to reduce the number of mental hospitals in the US because of reports that patients were receiving indifferent treatment, and to transfer the institutionalized to community-based treatment centers. However, practically all states where unable to provide adequate facilities for the accommodation of the released patients. Many were reduced to becoming homeless. (Peirce, 2001) In the 1980s, budget constraints forced even more premature releases from managed care of people suffering from schizophrenia or manic depression, overburdening an already bogged-down system. In a study of 187 released patients from Metropolitan State Hospital in Massachusetts, 27% had been homeless for more than 6 months, 66% of whom having no access to proper medication. There are more untreated mental cases in the population than the 90,000 receiving treatment in hospitals. In Berkeley, California, as many as 500 mentally ill people wander the city on any given night. (Homelessness: Tragic Side Effect of Non-Treatment, 2003) Federal assistance programs are often inadequate to provide housing for this disabled population, and rising housing costs make it difficult even for mentally stable people to obtain suitable housing. Mentally ill people are less likely to obtain steady employment and, though having no need for long-term institutionalization, are in need of regular access to treatment and rehabilitation services in order to function independently. The paucity of community-based health centers and suitable housing facilities increases the risk of homelessness for the mentally ill. (National Coalition for the Homeless, 2006) Homelessness is mostly associated in urban areas (Armour, 2003), 71% in cities, 21% in the suburbs and 9% in rural (National Mental Health Information Center, 2003). It is therefore mainly for city officials to address the problem of homelessness, especially the mentally ill who are most vulnerable to chronic homelessness and most in need of city social services. However, the response of most cities is to make it a crime to be homeless, and many of the mentally ill homeless are incarcerated in conditions that will only worsen their condition. In the Twin Towers jail in Los Angeles, commonly referred to as the biggest jail in the world, 2,000 of the inmates are mentally ill, some imprisoned for many years for minor transgressions. Police authorities often have no other place to put them but in jail. (Campbell, 2003) Homeless people with mental disorders are not only more likely to die from poor physical health as a consequence of their disability, they are more likely to be raped, die from accidents and exposure to the elements, and murdered. There is a tendency for the general population to shun the homeless because of fear and intolerance for perceived laziness, and the mentally ill homeless are regarded as dangerous and unpredictable. Many treat the mentally ill homeless as sub-humans. (Homelessness: Tragic Side Effect of Non-Treatment, 2003) Initiatives Undertaken for the Mentally Ill Homeless The U. S. Department of Veteran Affairs has provided one of the largest percentages of public health care in the US, accommodating more than 8% of inpatient psychiatric care. Since 23% of the homeless mentally-ill population is veterans, the provision of such targeted psychiatric services to an at-risk population is a positive factor in the fight against the increase of the homeless mentally-ill. (Gamache, Rosenbeck and Tessler, 2000) However, for the other sectors of the homeless population, the Veterans Affairs program does not apply. In efforts to provide a more comprehensive blueprint for address the issue of the homeless mentally ill, several studies have been undertaken. A two-year University of Pennsylvania study published in the Housing Policy Debate of 5,000 homeless with serious mental problems in New York stated that it cost the same amount in public dollars to provide supportive housing, health services and employment assistance to the mentally ill as to provide social services to homeless people for the same period. (Franzen, 2001) The Department of Housing and Urban Development (HUD) initiated the federal Continuum Care Program to combat homelessness, the core of which is called the Continuum of Care Initiative, which began a study of 4,000 homeless people in 1996 aimed at identifying factors that pertain to homelessness in the US. The HUD released the report entitled â€Å"The Forgotten Americans Homelessness: Programs and the People They Serve† in 2000. It was reported that 39% of the subjects were mentally ill. The report identified the primary goal of the homeless (find employment) and how much of the population reacted favorably (76% who lived as families and 60% who lived alone ended homelessness) to access to housing, health care and other needed services. The report outlined strategies that resulted in a US$45 million additional funding for homeless programs in 2000 and helped finance housing, employment and other self-sufficiency programs for 300,000 homeless people. (Tyler, 2002). In 2003, the U. S.Department of Health and Human Services (HHS) followed up on the HUD initiative and submitted a report that showed that health care costs of a homeless medically-ill person was US$ 11,000 more a year than that of the same person after being provided with suitable housing. The Needs of a Chronically Homeless Person Cross Many Service System Boundaries Source: U. S. Department of Health and Human Services (2003). Ending Chronic Homelessness: Strategies for Action. Retrieved February 1, 2007 from http://aspe. hhs.gov/hsp/homelessness/strategies03/ch. htm#ch2 In response to these studies, the following services were identified as necessary for ending homelessness among medically ill people: information and referral; outreach and engagement; mental health and counseling services; inpatient services; income management and support; residential treatment services; discharge planning; life skills services; education and skills training; and employment services. With a time frame of 10 years, the HHS outlined three goals of the initiative: 1. Provide easier access for at-risk populations to treatment and support services by simplifying document requirements, increasing outreach programs and extending the period of eligibility for benefits. Strategies to assist service providers in carrying out the objectives of the assistance programs, such as inter-agency collaboration for data sharing, in-service training for mainstream service providers as well as a marriage of homeless-specific and mainstream service providers working in tandem to provide services for eligible patients are also suggested. 2. Promote efficiency and flexibility in allocating funds that address chronic homelessness by encouraging cooperation between concerned departments in the federal, state and local levels in terms of programs and service delivery. Incentives are to be formulated to encourage such collaboration, especially when it comes to mainstream and homeless-specific funding sources. The need for a coordinating body was pinpointed. 3. Reduce the number of the homeless population by identifying populations at risk (i. e.veterans, deinstitutionalized mental patients) and providing programs that would ensure the ability to acquire decent housing such as employment assistance and regular health monitoring. (U. S. Department of Health and Human Services, 2003) The response at the city level, where the issue of the homeless is most pressing, has been mixed. Some cities still handle homelessness using punitive measures. In Sarasota, Florida, a person can be arrested for having no other place to live. Business leaders in Lawrence, Kansas, pressured city hall to curtail social services and pass ordinances targeted at the homeless. The anti-panhandling law in Atlanta, Georgia was imposed on a Hurricane Katrina evacuee after he was caught selling wares in an upper-class mall. Supportive housing was also banned within the city limits. In Little Rock, Arkansas, homeless people are not allowed on buses even if they have tickets, simply because they are homeless. (National Coalition for the Homeless, 2006) Other cities are more constructive. The Ft. Lauderdale police department and The Taskforce for Ending Homelessness, Inc.have teamed up to form the Homeless Outreach Team to provide social services and place the homeless in shelters in Broward County, Florida, cutting down the arrest record of the homeless by 2,400 annually in the 5 years of the program’s operation. The Homeless Outreach Psychiatric Evaluation Team in Pasadena, California is a partnership of the Pasadena Police Department and the Los Angeles Department of Health to provide mental health services to the homeless population. A tri-city cooperation in Ohio fund programs that provide social services at during off-hours to people ineligible for state assistance. The Homeless Court Program formed in 1989 in San Diego, California assists the homeless in resolving misdemeanor charges that prevent their access to benefits such as housing and employment. In Washington, D. C. , business owners solved the problem of the homeless wandering the street during the day when shelters are closed by establishing a day center that can accommodate 260 people where they can get a meal, shower and do laundry. (National Coalition for the Homeless, 2006) Proposed Plan for Community-Based Assessment Program. The following is a generic plan and timetable for a community-based program composed of volunteers in collaboration with local police authorities based on needs assessment criteria designed to assess the level of intervention required for a population of 5,000 residents. Recruitment and orientation of potential members through flyers and announcements at the community or city hall 1 month Data gathering on the homeless population based on arrest records and field research 3 months Tracking down identified homeless people and conducting interviews to identify perceived needs 6 months. Analysis of interviews by trained professionals for recommendations on the services needed for the target population 1 month Submission of results and recommendations of the study to the concerned city and community departments to acquire funding and other assistance 1 month The above plan will address the needs of a specific population with particular demographic and social factors that will determine the type and scale of social services, health management, housing and employment assistance that would most effectively eliminate the homeless mentally ill population. The smallness of the target population will make it more manageable, especially for volunteer organizations, and easier to acquire and manage funding for whatever needs that are identified. Conclusions Studies have shown what police authorities and social organizations have been pointing out for some time: the costs of incarcerating and treating mentally ill homeless people would be greatly reduced if they receive regular treatment and medication and provided with the ability to take themselves off the streets. (Campbell, 2003) This would mean more funds for more people receiving community-based health and housing privileges. The proposed plan for needs assessment is only the initial stage for providing for the homeless mentally ill at the community level for small populations. Many studies deal with the needs of a large population that may not be applicable in the micro-level, especially if the community in question has particular cultural and social issues unique to that community. It may also serve as a model to identify other subgroups of the homeless such as those substance abuse problems. It must be brought to the next level, actual service and support delivery. Many of the initiatives in all levels of public social service access are headed in the right direction, mostly as a result of recommendations from comprehensive studies of the issue. Inter-agency collaborations are providing good models for all communities to follow, but they are a handful compared to the magnitude of the problem at hand. More cooperation is needed to make effective use of funds, mainstream and homeless-specific service providers, law enforcement agencies and volunteer organizations. Moreover, the homeless mentally ill are still victims of public ridicule and loathing. People of the community must acknowledge that the most effective way to assist the homeless mentally off the streets and into productive lives is by providing social services, mental health access, employment assistance and supportive housing at the community level. In the long run, the most cost-effective way getting rid of them is to make them productive, functioning citizens. References Armour, S. (2003) Homelessness grows as more live check-to-check. USA Today.Retrieved February 2, 2007 from http://www. usatoday. com/money/economy/2003-08-11-homeless_x. htm Campbell, D. (2003) 300,000 Mentally Ill in US Prisons. Common Dreams. org. Retrieved February 2, 2007 from http://www. commondreams. org/headlines03/0303-09. htm Donohoe, M. (2004) Homelessness in the United States. Medscape Ob/Gyn Women’s Health. Retrieved January 31, 2007 from http://www. medscape. com/viewarticle/481800 Franzen, H. (2001) Housing Mentally Ill Homeless People Makes Economic Sense. Scientific American Inc. Retrieved January 31, 2007 from http://www.sciam. com/article. cfm? articleID=000EF22A-AA04-1C5E-B882809EC588ED9F Gamache, G, Rosenbeck, R. and Tessler, R. (2000) Factors Predicting Choice of Provider Among Homeless Veterans With Mental Illness Psychiatric Services. Retrieved February 1, 2007 from http://www. psychservices. psychiatryonline. org/cgi/content/full/51/8/1024 Homelessness: Tragic Side Effect of Non-Treatment (2003) Treatment Advocacy Center. Retrieved February 1, 2007 from http://www. psychlaws. org/generalResources/fact11. htm Maleque, S. and Brennan, V. (n. d. ) Homeless Mentally Ill. Factline: Tracking Health in Undeserved Communities. Retrieved February 1, 2007 from http://www. meharry. org/Fl/Mental_Health/Homeless_Mentally_Ill. html#mh%20disab National Coalition for the Homeless (2006) Mental Illness and Homelessness. Retrieved January 31, 2007 from http://www. nationalhomeless. org/publications/facts/Mental_Illness. pdf National Coalition for the Homeless (2006) Report accuses US cities of criminalizing the homeless. City Mayors Society. Retrieved February 1, 2007 from http://www. citymayors. com/society/homeless_usa2. html. National Mental Health Information Center (2003) Homelessness Provision of Mental Health and Substance Abuse Services. Retrieved February 2, 2007 from http://mentalhealth. samhsa. gov/publications/allpubs/homelessness/ Peirce, N. (2001) Help for the Mentally Ill Homeless: Rectifying a 30 Year Old Problem. Stateline. org. Retrieved February 2, 2007 from http://www. stateline. org/live/ViewPage. action? siteNodeId=136languageId=1contentId=14273 Tyler, R. (2002) Homeless in America. NewsHour Extra. Retrieved January 31, 2007 from http://www. pbs. org/newshour/extra/features/july-dec02/homeless.html U. S. Department of Health and Human Services (2003) Ending Chronic Homelessness: Strategies for Action Chapter 2. Retrieved February 1, 2007 from http://aspe. hhs. gov/hsp/homelessness/strategies03/ch. htm#ch2 U. S. Department of Health and Human Services (2003) Ending Chronic Homelessness: Strategies for Action Chapter 5. Retrieved February 1, 2007 from http://aspe. hhs. gov/hsp/homelessness/strategies03/ch. htm#ch5 U. S. Departmentof Veterans Affairs (2006) Overview of Homelessness. Retrieved February 1, 2007 from http://www1. va. gov/homeless/page. cfm? pg=1.