Psychological causes and effects of homelessness

Homelessness has deep psychological effects on individuals, especially children and adolescents. Furthermore, rates of mental illness among homeless people are estimated to be more than twice the rate for the general population. Homeless individuals are typically unable to access adequate mental health care and treatment, and in its absence, they often sink deeper into the social isolation and economic desperation that further hinders their ability to find safe and stable housing.

TYPE OF PSYCHOLOGY: Developmental psychology; psychopathology; social psychology

Introduction

According to the American Psychological Association, homelessness occurs when a person lacks a safe, stable, and appropriate place to live; both unsheltered and sheltered individuals can be considered homeless. The US Department of Housing and Urban Development estimated that on any given night in 2023, approximately 653,100 people were homeless in the United States and an estimated 143,105 people were chronically homeless. Rates of mental illness among homeless individuals in the United States are much higher than rates for the general population. According to the US Substance Abuse and Mental Health Services Administration (SAMHSA), in 2022 approximately 21 percent of homeless people in the United States had a serious mental illness. Individuals with schizophrenia or bipolar disorder are particularly vulnerable to experiencing periods of homelessness. Serious mental illness without proper treatment and social support inhibits a person's ability to carry out essential aspects of daily life, disrupting their ability to maintain employment and housing.

One of the reasons for the high prevalence of mental illness among the homeless is the large-scale deinstitutionalization of mental hospital residents in the 1960s. The advent of antipsychotic medications for treating schizophrenia and bipolar disorder also contributed to the perceived decrease in need for continuous care; mental hospitals started to release residents in large numbers with prescriptions for antipsychotics and other medications. However, these individuals often stopped taking their medications, either because of their prohibitive cost or because they did not feel they were necessary or helpful, resulting in the reemergence or exacerbation of their psychiatric symptoms. Community and mental health centers were originally intended to fill the vacuum, but funding cuts rendered them inadequate as a safety net.

Often, the psychiatric conditions and symptoms of individuals with mental illness make it difficult for them to obtain and maintain employment. Furthermore, the inability of many poor individuals with mental illness to support themselves financially and to obtain adequate treatment, as well as the lack of affordable housing in many communities, causes many individuals with mental illnesses to end up in shelters or on the streets. Homelessness often causes individuals with mental illness to enter a downward spiral of ever more desperate conditions, compounding their physical and mental health problems.

Some individuals who did not have preexisting mental diseases prior to becoming homeless may develop psychiatric disorders or symptoms after becoming homeless, triggered by the stress of living on the streets or in shelters. Homeless people are often the victims of crime, particularly theft and physical assault, with homeless women being especially vulnerable to sexual assault and rape. The trauma of such abuse can provoke the emergence of or exacerbate the symptoms of conditions such as depression, post-traumatic stress disorder, bipolar disorder, and schizophrenia, especially in individuals with a genetic predisposition. Homeless children often experience emotional and developmental problems; the negative effects of trauma from physical and sexual assault most likely have a greater effect on their psychological development than that of adults.

Psychological Causes

Mental illness interferes with individuals' ability to attend to essential aspects of daily life, including self-care, household management, and employment, placing individuals with mental illness at greater risk for experiencing periods of homelessness. Furthermore, poverty prevents many individuals with mental illness from obtaining adequate mental health care and treatment. However, although mental illness puts individuals at a greater risk for becoming homeless, poverty and a lack of affordable housing remain the principal causes of homelessness.

As the economic situation of individuals with mental illness becomes more desperate, they face even more obstacles to obtaining and sustaining employment and housing. Many individuals with mental illness have other physical illnesses or mental conditions, including drug and alcohol addiction, diabetes, hypertension, and asthma, further hindering their ability to maintain employment. Mental illness can make it difficult for individuals to adequately care for comorbid conditions and other physical health problems. Individuals with mental disorders encounter more barriers to accessible housing than individuals without mental disorders through income deficits, stigma, and discrimination. Homelessness then exacerbates both physical and mental illnesses.

Contrary to popular belief, most homeless individuals with mental illness are willing to accept treatment services, although access to care remains difficult. People with schizophrenia and some forms of bipolar disorder may experience paranoia, hallucinations, and delusions, making them suspicious of outsiders' attempts to help them. However, according to the National Coalition for the Homeless, outreach programs have greater success when they establish a trusting relationship through continued contact with the people they are trying to help.

Psychological Effects

Homelessness has definite psychological effects, ranging from the detrimental effects of disrupted sleep to the deep psychological trauma inflicted by chronic stress, instability, and exposure to violence. Sleep problems are rampant among homeless people living on the streets or in shelters, where there is constant noise, crowding, and interruption of sleep. On the severe end of negative effects, violent physical and sexual attacks are much more likely to be made on the homeless than on the general population. For example, a sexual assault is twenty times more likely to be made on a homeless woman than on a woman in the general population. These violent assaults result in considerable emotional and psychological trauma in survivors, often leading to post-traumatic stress disorder, anxiety, depression, suicide attempts, substance abuse and addiction, and further psychiatric symptoms. The death rate among the homeless is also three times greater than that of the general population, with many homeless people dying from preventable or treatable illnesses or from unprovoked violence. Homeless people with mental illness are even more vulnerable than other homeless individuals to violent attacks and death.

Another important consideration is the number of children and adolescents who are homeless. Homelessness has multiple significant psychological and developmental effects on children. Homeless preschoolers are more prone to developmental delays in language, motor skills, and social skills. Children who experience chronic stress due to poverty or homelessness have poorer concentration and memory, affecting their ability to learn. They also display more aggression and shyness, have sleep problems (often due to the noisy environment of the streets and in shelters), are more likely to exhibit aggressive behavior, have lower self-esteem, and experience more disruptions to their education. Homeless children are twice as likely to experience hunger as nonhomeless children; hunger has serious negative effects on children's physical, emotional, and cognitive development.

Some families consisting of women and children become homeless after escaping from child abuse, spousal abuse, or domestic violence. In addition to possible developmental problems, these children also have to struggle with the psychological trauma and aftereffects of abuse. A study of homeless and runaway adolescents suggests a link between domestic abuse and depression in these adolescents. Homeless adolescents are more likely to have health problems, including respiratory diseases and sexually transmitted diseases, as well as substance abuse problems, than their counterparts in the general population. The combination of developmental, psychological, and medical problems makes homeless adolescents extremely susceptible to poverty and homelessness in adulthood.

Potential Solutions

According to the US Department of Health and Human Services, most homeless individuals with mental illness do not require institutionalization but would benefit from a supported housing program that offers mental health care and treatment. However, the number of affordable housing and community treatment services is insufficient to accommodate all the homeless who suffer from mental diseases. Additional resources are urgently needed so that the mentally ill homeless can have access to continuous treatment and therapy. Additionally, making community activities and certain types of employment available to homeless individuals with mental illness may help break the vicious cycle of homelessness and unemployment. Programs that assist homeless individuals and individuals with mental illness to find housing, such as the Projects for Assistance in Transition from Homelessness (PATH) program, need to be expanded to bring these individuals into stable, safe housing where they can receive the adequate social support and treatment. Supplemental Security Income checks, which are the sole income source for some Americans with disabilities, currently fall far short of the amount required to cover rent and other necessities. Increasing this amount to keep up with rising living costs can help ease the situation for some of the homeless population. The Department of Health and Human Services has initiated a program to recruit homeless children and their families into the national Head Start program to provide much-needed education and other services via community and daycare programs. Studies have shown that preschool education and participation in the Head Start program improve preschoolers’ development of various skills. Other programs available to help homeless people include the Treatment for Individuals Experiencing Homelessness (TIEH), which expands access to mental and substance use disorders treatment; SSI/SSDI Outreach, Access, and Recovery (SOAR), which increases access to Social Security disability benefits for eligible children and adults; and the Children's Mental Health Initiative (CMHI).

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