Homelessness in America – TED Video explains how we can take our own small and meaningful steps to end homelessness and admit and respond to the inequality in our midst.
Homelessness exists when people lack safe, stable, and appropriate places to live.
Sheltered and Unsheltered people are homeless. People living doubled up or in overcrowded living situations or motels because of inadequate economic resources are included in this definition, as are those living in tents or other temporary enclosures.
Health care for homeless people is a significant public health challenge. Homeless people are more likely to suffer injuries and medical problems from their lifestyle on the street, which includes poor nutrition, exposure to the harsh elements of weather, and higher exposure to violence (robberies, beatings, and so on). At the same time, they have little access to public medical services or clinics.
Each year between 2–3 million people in the United States experience an episode of homelessness (Caton et al., 2005). The psychological and physical impact of homelessness is a matter of public health concern (Schnazer, Dominguez, Shrout, & Caton, 2007). Psychologists as clinicians, researchers, educators, and advocates must expand and redouble their efforts to end homelessness.
The APA Presidential Task Force on Psychology’s Contribution to End Homelessness, commissioned by James Bray, Ph.D. during his tenure as APA’s president, developed a mission to identify and address the psychosocial factors and conditions associated with homelessness and define the role of psychologists in ending homelessness. Individuals without homes often lack access to health care treatment (Kushel et al., 2001). Chronic health problems and inaccessibility to medical and dental care can increase school absences and limit employment opportunities (APA, 2010).
People without homes have higher rates of hospitalizations for physical illnesses, mental illness, and substance abuse than other populations (Kushel et al., 2001; Salit, Kuhn, Hartz, Vu, & Mosso, 1998). Physical & Mental Health Poor physical health is associated with poverty in general but seems to be more pronounced among those who are without homes (APA, 2010).
Rates of mental illness among people who are homeless in the United States are twice the rate found in the general population (Bassuk et al., 1998). 47% of homeless women meet the criteria for a diagnosis of major depressive disorder—twice the rate of women in general (Buckner, Beardslee, & Bassuk, 2004). When compared with the general population, people without homes have poorer physical health, including higher rates of tuberculosis, hypertension, asthma, diabetes, and HIV/AIDS (Zlotnick & Zerger, 2008), as well as higher rates of medical hospitalizations (Kushel et al., 2001).
When compared with the general population, people without homes have poorer physical health, including higher rates of tuberculosis, hypertension, asthma, diabetes, and HIV/AIDS (Zlotnick & Zerger, 2008), as well as higher rates of medical hospitalizations (Kushel et al., 2001).
Sexually transmitted diseases including HIV/AIDS are prevalent among some subgroups of people without homes. Age, gender, and ethnicity are linked to such HIV/AIDS risk behaviors as injection drug use and high-risk sexual practices (Song et al., 1999) Mental Illness & Homelessness Distinguishing between those with and without severe mental illness may be particularly important. Assertive community treatment offered significant advantages over standard case management models in reducing homelessness and symptom severity for homeless people with severe mental illness (Coldwell & Bender, 2007).
The President’s New Freedom Commission on Mental Health made clear the need to address the public mental health system’s delivery of service to people without homes and with mental illness. This population is more likely to use hospitals than regular outpatient care (North & Smith, 1993), which is not only more expensive but results in fragmented service and less attention paid to ongoing mental health needs. Shinn and Gillespie argued that although substance abuse and mental illness contribute to homelessness, the primary cause is the lack of low-income housing.
People with substance and other mental disorders experience even greater barriers to accessible housing than their counterparts: income deficits, stigma, and a need for community wraparound services. The remediation of homelessness involves focusing on the risk factors that contribute to homelessness as well as advocating for structural change.
Ill health and Homelessness and health concerns often go hand in hand. An acute behavioral health issue, such as an episode of psychosis, may lead to homelessness, and homelessness itself can exacerbate chronic medical conditions or lead to debilitating substance abuse problems. At the most extreme, a person can become chronically homeless when his or her health condition becomes disabling and stable housing is too difficult to maintain without help.
Persons living in shelters are more than twice as likely to have a disability, according to the Department of Housing and Urban Development, compared to the general population. On a given night in 2014, nearly 20 percent of the homeless population had severe mental illness or conditions related to chronic substance abuse, according to the 2014 Point-In-Time Count. Thousands of people with HIV/AIDS experience homelessness on a given night.
Physical health conditions such as diabetes and heart disease are found at high rates among the homeless population, in addition to injury and physical ailments from living outdoors. Many people experiencing homelessness have also experienced trauma, either resulting from homelessness or in some way leading to it. Behavioral health issues and trauma are found disproportionately among unaccompanied youth who are homeless.
The Mental Health Parity and Addiction Equity Act of 2008 require that health insurance plans cover behavioral health treatment such as therapy equally to that of physical health treatments. Health Care Access Treatment and preventive care can be difficult for homeless people to access, because they often lack insurance coverage, or are unable to engage health care providers in the community.
This lack of access can lead a homeless individual to seek medical attention only once his or her condition has worsened to the point that a trip to the emergency room is unavoidable. Federally Qualified Health Centers and Health Care for the Homeless Clinics, which are available in most communities across the U.S. provide some basic health services to homeless persons without cost.
Also, the Affordable Care Act (ACA) allows states to expand their Medicaid public health insurance program to cover more people with very low incomes. Previously, Medicaid was limited to covering people with children or with a disability. The ACA has also increased the number of community-based care options, such as with “Health Homes.” Health Care Solutions Housing is an essential component of health and health care. Moreover, effective strategies to end homelessness must always take into account the extent of health conditions and disability faced by homeless people.
For chronically homeless people, the intervention of permanent supportive housing provides stable housing coupled with supportive services as needed – a cost-effective solution to homelessness for those with the most severe health, mental health, and substance abuse challenges. With the advent of the ACA, funding through Medicaid will be an essential financing component for the supportive services in permanent supportive housing.