Mental Health, Substance Use Disorder, and Homelessness

My mission as the coordinator for the Faces of Homelessness Speakers’ Bureau is to educate my community about the multifaceted issues surrounding homelessness and poverty – while providing support and teaching self-advocacy to my homeless and formerly homeless brothers and sisters.

Additionally, it is my goal to help the Charlotte County Homeless Coalition build a self-sustaining program that will act as a platform for these men, women, and children to finally have a much needed voice within their community, state, and country.

In addition to my work with AmeriCorps, I am proud to say that I am also a board member of NAMI-Charlotte County. As a member of NAMI, I hope to help raise awareness to the complexities of mental illness and co-occurring disorders as they relate to poverty and homelessness and to advocate for those who have increasingly become invisible to our society.

It is my opinion that society has forgotten that we are all in this together and I feel like many of us get caught up in our own lives – ignoring the fact that some of our fellow brothers and sisters are out here struggling.

It’s as if we are walking through life with blinders on “If it isn’t directly affecting me then why should I worry about it?”

The fact of the matter is we are all affected by these issues whether we choose to realize it or not. We have to change our mindset or things will only get worse.

I don’t think many people realize that the only difference between them and someone who is homeless – is their home.

Homelessness has become an enduring presence in American society. According to reports, more than 630,000 individuals are homeless in this country on any given night--keep in mind, however, that this number is significantly under-counted.

About a third of all adults who are homeless in this country have substance use disorders, and many have co-occurring mental illnesses, as well.

Approximately 45% of homeless individuals suffer from an untreated Axis I mental disorder such as anxiety disorder, bipolar disorder, clinical depression, schizophrenia, schizo-affective disorder, and severe personality disorder.

An estimated 150,000 to 200,000 individuals living in this county suffer from severe schizophrenia or bipolar disorder.

For homeless individuals, mental illness plays a key role in keeping them on the streets.

PTSD is also very prevalent among the homeless population – most notably among our veterans.

Approximately 40% of homeless men are veterans, although veterans comprise only about 34% of the general adult male population.

Over 45% suffer from mental illness and half have substance abuse issues.

It is estimated that some 22 million American’s have substance abuse or dependency problems.

The federal government postulates that these issues cost our country around 40 billion dollars a year.

Because housing stability is essential for treatment and recovery from addiction – homeless men and women that suffer from addiction issues usually have nowhere to go but deeper down into their addictions.

Recent studies indicate that the cost of providing permanent, supportive housing for people with serious mental illnesses or substance abuse issues is more than offset by the savings incurred by the public hospitals, prisons, and shelter systems.

We as human beings have a responsibility to our fellow brothers and sisters who are suffering from poverty, homelessness, mental illness and addiction. Yes we know that providing programs and services costs money – but did you know that the actual dollar costs to our society and economy is higher if we don’t invest in housing and supportive services? These essential programs not only get people off the streets, they also bring Federal dollars into our community where the money can then be recycled 5 or 6 times over within our local economy.

When nothing is done, people with serious mental illnesses and/or co-occurring substance use disorders who are homeless often cycle between the streets, jails, and high-cost care, including emergency rooms and psychiatric hospitals. This is inhumane, ineffective, and costly.

On the brighter side, research indicates that people with serious mental illnesses and co-occurring substance use disorders who are homeless, once believed to be unreachable and difficult to serve, can be engaged into services, and can accept and benefit from mental health services and substance abuse treatment, and can remain in stable housing with the appropriate support systems.

We know what works--now we must take what we know and implement it.

It is important that efforts to end homelessness address the substance use treatment needs of this particular population. These efforts can be modeled and supported at the Federal and state levels, but the real work takes place with us--in the communities where these individuals live.

The human and financial toll of homelessness for people with serious mental illnesses and or co-occurring disorders in incalculable.

Importantly, strategies to prevent and end homelessness among people with serious mental illnesses or co-occurring disorders must be based on a strong foundation of knowledge about who these individuals are, why they are susceptible to homelessness, and what has been done to learn more about their characteristics and service needs.

Unfortunately many programs are tailored for this specific population, instead of with them – which is why some researchers believe that no matter how many times a person enters treatment, they often fail to recover.

Much of what we know attests to both the extreme vulnerability and the remarkable resilience of this disadvantaged and disenfranchised group. Most importantly, however, is the fact that people who are living with mental illness and co-occurring disorders can and do recover.

Housing First is the most affective avenue for people to reach and remain in a housed and productive place in society.

Having a safe and stable home is crucial for anyone to recover from poverty, mental illness, or substance abuse disorders. And while having a place to call home is a social and financial responsibility, it also gives us an enormous sense of dignity.

When we begin to live our lives with new found joy, self-respect, and a sense of self-worth, healthy choices are likely to follow.

Research and practice reveal that communities can reach out to people with mental illnesses and substance use disorders; engage them in treatment; and create local partnerships to increase availability and access to affordable housing, employment, and treatment and supports to help prevent and end homelessness.

Understanding how to do so, however, begins with knowledge about why people with mental illness and addictions are vulnerable to becoming homeless and why they have a difficult time exiting homelessness.

It’s important for us all to remember that people who are homeless are people first. The fact that they may have mental illness or co-occurring disorders doesn’t diminish their rights, their responsibilities, or their dreams.

In many cases, these individuals become homeless because they are poor, and because mainstream health, mental health, housing, vocational, and social service programs are unable or unwilling to serve them. Furthermore, they also become subject to ongoing discrimination, stigma, and even violence.

By law in America, the rights of individuals without housing are equal to the rights of those with housing – However, as we have seen; many cities establish laws and practices that violate the basic human rights of these individuals.

Studies indicate that a person with a mental illness has a 64% greater chance of being arrested for committing the same offense as a person who does not have a mental illness.

Shockingly, out of the top ten meanest cities in our country for the criminalization of the homeless--4 are in Florida.

Another problem is the “not in my backyard” syndrome that many communities have adopted. This can come in many forms such as vocal community opposition to group living situations, or they can be less obvious, such as steering public funds away from housing initiatives that serve controversial populations.

When these individuals have no-where to live, they can and usually do, end up living in the woods, jails, and other institutions.

Probably no condition is as closely connected with homelessness as chronic alcohol dependence.

Conceivably, the homeless could have been stereotyped as unemployed men who needed jobs or job training, as elderly people who needed our concern and care, or as individuals who were physically and mentally disabled. Because, instead, they were stereotyped as alcoholics, the societal answer to their problems often relate to some form of institutionalization, whether jail or detoxification program.

I think want many people don’t realize is that addiction is a psychological disorder that affects behavior. Drug addiction has well-recognized cognitive, behavioral, and physiological characteristics that contribute to the continued use of drugs despite the harmful consequences.

I have met numerous addicts in my lifetime and never once has anyone ever told me that they want to or enjoy being addicted to drugs or alcohol. In fact, many want desperately to stop but are, in many cases, unsuccessful despite countless attempts at treatment and sobriety.

A contributing factor to this failure is the lack of support systems available for these individuals once they exit treatment. Often times, family and friends turn their backs on these individuals because they are fed up with the cycle or they themselves don’t have the support and knowledge needed to cope with this often traumatic rollercoaster ride.

Without the ongoing care and persistent advocacy that family members provide, many people with serious mental illnesses or substance abuse issues are at greater risk of becoming homeless.

Another reason why so many of the chronically homeless fail to recover or refuse treatment is due to negative experiences. Research indicates that this population is difficult to re-engage in services once they have had a negative experience with an unresponsive treatment system. Therefore, when working with these individuals, it is essential to their recovery that they feel safe and can trust those who are advocating for them.

Much like those with mental illness, people with substance use disorders can and do recover. Studies show that 55% of individuals who remain in AA for more than 90 days will be sober after one year, and 50% will be sober after 5 years.

The very fact that people who have serious mental illnesses and substance abuse disorders have learned to survive on the streets speaks to their strength, their resiliency, and their perseverance, all of which are protective factors that can be harnessed to aid in their recovery process.

Street life for these homeless men and women can be confusing, dangerous, and frustrating. Individuals shuffle unsteadily between detoxification centers, shelters, bus stations, day programs, jail, abandoned buildings, and soup kitchens. It is a painful life complicated by, but also made more bearable because of, the use and abuse of drugs and alcohol.

Although only about 5% of people with serious mental illnesses are homeless at any given time, as many as two-thirds of all people with mental illness have experienced homelessness or have been at risk of becoming homeless at some point in their lifetime.

Once homeless, people with co-occurring disorders have more problems, need more help or are unable to benefit from services, and are more likely to remain homeless than any other group of people.

Unfortunately homeless men and women who suffer from addiction related issues are less likely than those with mental illness or co-occurring disorders to qualify for Federal disability benefits – in large part because individuals with substance use disorders, no matter how serve, are not considered disabled under Social Security Administration guidelines – even though many researchers would argue that substance use disorders are a very disabling condition.

Making matters worse, people with serious mental illnesses and or co-occurring substance use disorders that are homeless require a broad range of housing, health and mental health care, substance abuse treatment, and social services, all of which typically are provided by separate agencies with separate funding streams. The burden of coordination falls on the individual, but people with serious mental illness or co-occurring disorders, especially those who are homeless, are ill-prepared to negotiate a fragmented service system unaided.

A lack of coordination between the hospitals and community-based providers to ensure appropriate housing, treatment, income, and supports means that these individuals fall through the cracks in the system and may – as a result – become homeless.

Recovery from homelessness, much like recovery from mental illness and or substance use disorders, is a process. Researchers define recovery from homelessness as being sober, employed, and housed; identifying six themes that support this process: spirituality, self-insight, security, self-awareness, support, and suppression of poor self-concepts and negative attitudes.

Lack of support or connection to others may be the single most important factor as to why people become and stay homeless.

For many homeless individuals, outreach workers are the first to break through the isolation and begin to move people toward a life of greater health and personal stability. This requires compassion that can be translated into concrete action.

It is about regarding all human beings as intrinsically valuable. Person-centered values are at the heart of a system that empowers people with mental illnesses and substance use disorders to recover.

These individuals deserve to have a choice in housing, treatment, and support services. They deserve to have a voice – to have a say in the programs, policies, and services that are designed to serve them.

They deserve to feel empowered by being educated and allowed to make choices in matters affecting their lives.

They deserve to have dignity and to be treated with the same respect that others demand for themselves, and they deserve the opportunity to be hopeful -- because we all know that hopelessness only breeds helplessness and despair.