Homeless in America
The Mentally ill homeless
By: Mia Safaee
The Mentally ill homeless in the United States have been associated with costly use of medical and social services. Which have been ineffective, since the number of homeless with mental illness out on the streets has been increasing.
Sadness of boy in the city (Picture Courtesy of Google Images)
According to National Law Center on Homeless and Poverty, the population for mentally ill homeless people was 57 percent in 2004 though the numbers continue to rise. According to the Journal of Community Health Nursing, the increasing numbers of mentally ill homeless on the streets have been affecting public safety. The HUD COC Application Data on (http://www.hudhre.info/documents )says that on January 2007 nearly 63 percent of the homeless population who were sheltered are individuals and more than 37 percent were families.
To reduce the number of mentally ill homeless on the streets The U.S. Department of Housing and Urban Development, HUD, said that they will be providing 15,000 units of permanent housing in the United States in an effort to reduce the cost and suffering associated with homelessness.
“HUD funds are appropriated each year through the HUD budget,” says Stanley Seidenfeld Regional Supervisor officer in New York and John Roberto, Pittsburgh, HUD supervisor regional operations officer.
He says that HUD gets support from regional authorizing and legislation and several other types of programs.
“The most recent grant given in 2008, which HUD was appointed $1.3 billion nationwide,” he says.
The money does not go toward building new housing Seidenfeld say, but rather goes towards construction work towards previous houses built to keep them operating.
“To receive regular homeless assistance a person must be homeless for one night,” says Roberto.
He says most or several program HUD provides, most applicants must meet the requirement of homelessness to receive housing because there are limited resources.
“But we try to place them in housing that will do them the most good,” he says.
Ultimately, he says what we perceive as homeless is not what other people perceive. We try to get the homeless on the right track if we see that they are homeless we will give them housing over night, but then we eventually move them into transitional housing where they can stay up to two years, but we want to eventually get them in to regular or permanent housing.
Although for a homeless with chronic illness to qualify for housing they must be individuals disabled by substance abuse, have serious mental illness… they must be homeless for a year or more, or had at least four episodes of homelessness in the past three years. “This requirement is place only for homeless who are chronically ill,” says Roberto.
“Many of these people coping with severe mental illness have been trapped in a cycle of homelessness, going back and forth from the streets to a shelter,” says Suzann Legander publisher of the Behavioral Healthcare Journal: Housing First.
John Roberto says that the percentage of mentally ill homeless and homeless people that have no applied to HUD vary by jurisdiction provided by the local government. He says that the percentage of homeless staying in shelters changes daily, it depends on a variety of factors, weather being one of them.
“Among all the homeless people 58 percent were sleeping in emergency shelters or transitional housing facilities, and the rest were on the streets,” says Steve C. Preston Secretary of U.S. Department of Housing and Urban Development.
Many of the shelters caring for the mentally ill do not fully assist the homeless with their fundamental needs and that is why they end up on the streets again. According to the Journal of Community Health and Nursing, health care providers intentionally rely on common health care settings such as required documents, security personal and locked doors, knowing that it will intimidate or frighten the homeless and keep them out.
“Health care providers are most likely keep homeless out because of cost issues,” says Dr. Richa Aggarwal Psychiatrists at Hershey Medical Center.
According to the Journal of Community Health Nursing the transition from homeless to housing usually begins when the police finds them sleeping or wandering the streets. Police will usually take them to a psychiatric hospital for evaluation and if the patients meet the criteria’s they are admitted, but they are usually discharged after two or three days.
Officer Frank J. Divonzo, Penn State Harrisburg campus police says, that officers will sometimes have problems on deciding whether to take them to a hospital, because they consider whether the hospital will release them, after the police have left.
He says that sometimes when a homeless person is taken in they will sometime move in and out of psychosis states, so sometimes they will tell the hospital that they are fine and they don’t need to be here and the hospital will usually release them.
Dr. Aggarwal says, that Hershey Hospital provides programs for both inpatients and out patients they provide the same general programs that they would provide for non-homeless patients. Homeless patients do not need to meet any specific criteria. They just have to meet the same criteria as a normal psychiatric person would need to meet.
Dr. Aggarwal says that some of the criteria that they would have to meet in order to be admitted would be, they are not able to take care of themselves, being harmful to themselves to others… When patients are discharged they have nothing to go back to. One individual said:
“They take you in because the police bring you, but as soon as they drive away, the hospital is trying to toss you back out in the streets.”
Dr. Aggarwal says that some may still be living on the streets, because most state hospitals do not provide facilities for them. She says that they need the necessities of life which are food and shelter, and when the state hospitals do not have facilities for them their basic needs are not meet.
Dr. Aggarwal says, sometimes the Hershey Psychiatric department will get walk- in patients that are sent by shelters and sometimes they walk in off the streets.
“We don’t turn them away, if they need help we provide it for them, and if we see that their condition is severe, we then admit them,” she says.
She also says that some of them they can help, while others they cannot. Usually the patient stays for four to five days. “It depends on the patient, if they need to stay longer they stay,” she says.
Although the social implications that come with the mentally ill homeless having a hard time receiving shelter and getting the proper medical care, they need leads to higher suicidal rates.
From the article, Suicidal Ideation and Suicide Attempts in Homeless Mentally ill Persons: Age specific risk of substance abuse, by the Soc Psychiatry, Psychiatry Epidemiology, published in 2003 the article talks about the cause of suicidal rates among the homeless, but especially high numbers among the mentally ill homeless.
The article says that there is a high rate of suicidal behavior among the mentally ill homeless, but it is unknown whether the homeless populations who are not mentally ill also have a high number of suicidal rates.
“Methods Data from multi-site outreach programs were used to investigate whether rates of serious suicidal idealization and recent suicide attempts varied with age and substance abuse diagnoses,” said the publisher of the article.
The article says that suicide attempts were most common in case of the younger mentally ill homeless than compared to the older mentally ill homeless. The article also says that alcohol and drug abuse did not seem to increase the thought of suicide among them.
“However, a significant interaction between age and substance abuse was observed showing that among older clients, those with drug and alcohol abuse were at significantly greater risk of suicidal idealization than those without substance abuse problems,” said the publishers of the article.
The growing rate of suicide among the homeless is cause for concern. Rates of suicide at attempts depend on the person’s age, but depression is the main cause of suicide with all ages. In a study of first time homeless men living on the streets 7 percent reporter thoughts of suicide while approximately a third of the homeless men living in shelters reported a past a past suicide attempt.
The growing number of the homeless population intensifies the need for more people to understand their situation. A test conducted for this study showed that in the past 30 days 41-44 percent of suicide thoughts and suicidal attempts was said to be reported less among mentally ill homeless of 30-39 years old. The finds of the study show that age, substance abuse, and mental illness all play a factor in suicidal attempts and treats among the homeless.
The economic status for mentally ill homeless people is very cost effective. Robert Rosenheck the publisher of the America Journal of Psychiatry the Cost effectiveness of Services for Mentally Ill Homeless People: The Application of Research to Policy and Practice, in his journal, he says that about one-quarter of homeless Americans have serious mental illnesses and providing housing for them is very cost effective to the economy.
The publisher groups the services provided for the mentally ill homeless into three categories: Outreach programs, Case management, and housing payments. The study calculated the cost of medical care for one year for mentally ill homeless veterans and the total cost was approximately 8,000 dollars.
“The first published cost-effectiveness study case for homeless people compared a broker case management intervention,” said Rosenheck.
He says the case management places clients in treatment programs. The treatment programs exceed 9,000 dollars per client. The cost for health treatment rose three percent over one year.
“The goal of specialized homeless service programs must ultimately be to transition clients into mainstream housing,” says Rosenheck. The cost for providing services to the mentally ill homeless is high considering that less than half of them are taking advantage of the housing and medical services.
The study on Homeless, Mental illness, and Criminal Activity: Examining Patterns over time examines the severity psychological symptoms between street homeless, and sheltered homeless and whether housing and living on the street played a role in their criminal activities. For the study, they had 207 mentally ill homeless participants. The participants were interviewed nine times over four years to see if the severity of their illness worsened or got better, and how the changing of their illness affected their criminal activities.
The study found that mentally ill homeless were more likely to be arrested for minor offenses like camping without a permit or indecent exposure. Other researchers found that they were charged with trespassing, sleeping in abandoned buildings, or sleeping on park benches.
Office Divonzo says, that most of the times parks have been taken over by the homeless, so the police will make them move so that they do not appear to be a blemish on the state.
“It’s mainly political,” he says.
He says that some prisons do a better job with treating mental illness. Some will consider the nature of the prisoners’ illness, the nature of the crime, and look for the resources that are available to them. Other prisons just treat them like any other criminal.
The system is structured to treat the mentally ill homeless differently. Officer Divonzo says that they would usually be sent to a mental health institution or a secure mental health institution depending if they had any previous history of violence. He says that officers are supposed to take them there, but that is not the reality of the situation, the reality is that the police officer will not be able to identify them as mentally ill, and they will most likely be sent to regular prison.
City Police cleaning up a homeless persons home. (Picture courtesy of Google Images)
Homeless individuals may adopt some illegal activities such as theft to get by. In most cases, officer Divonzo says that when a homeless person committees and non- violent crime the police push them off, because if they were to give them citations they would not have the means to pay the fines. Sometimes they receive more than one citation and since they cannot pay them, they are taken to court.
If a judge is available for misdemeanors the homeless individual will often be tried at Night Court, taken to court, and tried right away.
The study found that homeless individuals are less prone to criminal activities when they are confined in a homeless shelter where they are given the assistants they need. Officer Divonzo says that they have rarely found cases of homeless with mental illness committee violent crime. In most cases in downtown Harrisburg, they were hardly ever jailed.
He says when they are jail they are jailed for a while just so that they can cool off.
“In other cases, some mentally ill homeless have been tasered or shot by the Harrisburg Police, because the officer didn’t know how to handle the situations,” says Officer Divonzo.
He also says that it depends on the officers’ training in how to deal with these types of situations.
There is little evidence to back up the relationship between homeless and non-violent crimes compared to violent crimes.
“In fact, research suggests that people with mental illness have a modestly higher rate of committing violent crimes than that of the general population,” said Mulvey E.P author of the Journal Hospital and Community Psychiatry.
Homeless men were generally no different from that of the general population in committing violent crimes. Arrests among mentally ill homeless men and the general population did not statistically differ or were lower for murder, rape, and aggravated assault, though robber rates were significantly higher for mentally ill homeless males. Homeless males were less likely arrested for violent crimes. Officer Divonzo says that 9 out of 10 of the mentally ill homeless are not arrested when they have committed violent crimes.
If they are taken to jail most of them will typically have psychosis states.
“The reason for this is that they cannot be in closed spaces or close to people,” he says.
He says usually when they are jailed for the first time the get into arguments and fights with people. Depending on the prison, if the officer does not anticipate it they usually react harshly to their out bursts.
“They only react this way, because they cannot handle the confined space,” he says.