Autry, Mercedes 1

Mercedes Autry
ENG 2010- Intermediate Writing

Treating Mental Illness in the Homeless

Poverty and homelessness have always been with us since the inception of civilization.
As we ascribed culture and affluence to particular members of society for one reason or another,
there has always been a seedy underbelly necessitated perhaps from a sort of karmic variation of
Newtons Third Law which states that for every action there must be an equal and opposite
reaction. However, this doesnt make us insensitive to the plight of the homeless and there is a
strong indication that we are overlooking an invaluable tool to fighting the battle against
homelessness- adequate mental healthcare coverage.
According to the Substance Abuse and Mental Health Services Administration, 20-25%
of the homeless population is affected by a severe mental illness such as Schizophrenia or BiPolar disorder. (Mental Illness) When you compare this to 4.1% of the general population
(National Institute) theres clearly an indication that severe mental illnesses make many
individuals incapable of an acceptable level of social functioning that would enable them to
continuously maintain employment, manage their finances and establish meaningful
relationships with others. In some cases, mental illness can be so disabling that individuals are
not even able to perform basic personal hygiene (National Institute). When these pervasive issues
penetrate deep into an ill individual with an inadequate support network, homelessness is often
the result.
It would seem then that an obvious solution to obtaining a sizeable reduction in our
current homeless population would be to merely treat them. Unfortunately, treating a mental

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illness is not a precise science and there is no one cure-all, what works for one person may
exacerbate the symptoms of another. Also, with the many treatment options available it begs the
question which treatment has the best long term prognosis? What are the best options for persons
with limited incomes? How can we ensure that isolated persons with no family to care for them
are able to continue to receive the treatment they need?
This article is going to attempt to explore some of the different treatment options one
might use to treat the mentally ill while taking into consideration the aspect that there are only
very limited resources that a homeless or poverty stricken individual has access to. We will focus
on two of the more common severely disabling mental disorders- Bi-Polar I, and Schizophrenia.
According to the Mayo Clinic database, Bi-Polar is a mental disorder characterized by
extreme mood swings. The person suffering from the illness will usually experience euphoric
highs and delusions of grandeur during a manic phase. Persons experiencing manic symptoms
may make reckless decisions that defy rationality such as spending exorbitant amounts of money,
engaging in reckless sexual behaviors and violent outbursts towards their loved ones and coworkers. During a depressive phase, a person might experience anhedonia (the inability to
experience pleasure.), and feelings of despair and worthlessness. Suicide is a very real concern in
a depressive episode. Occasionally, Bi-Polar disorder can share some symptoms with
Schizophrenia such as hallucinations, and psychotic breaks with reality.
Schizophrenia on the other hand, is a mental illness that causes a variety of symptoms
including psychotic breaks. It interferes with a persons ability to perceive reality in a normal or
healthy manner. Some classic symptoms dramatized in the media are paranoid delusions,
delusions of grandeur and of course probably the most popularly perceived hearing voices. In
reality, hallucinations can manifest in the form of any sensory perception but auditory

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hallucinations are the most prevalent. Other symptoms according to the National Institute of
Mental Health include erratic thought patterns that severely affect cognitive behaviors and
speech patterns. There can also be anhedonia, a flattening of vocal intonation and facial
expressions, violent outbursts and severe depression. Occasionally, a person suffering from
schizophrenia may even lapse into a state of catatonia.
Persons with both of these disorders are also more inclined to abuse drugs or alcohol in
an attempt at self-medication making these illnesses difficult to isolate outside of addiction or
side effects of substance abuse. However, the reality is that these are both very serious conditions
that without treatment make achieving a satisfactory life difficult to impossible.
In a recent series of articles exploring mental illness, interviews were conducted with
several homeless persons. (Jervais, USA Today) It did not take much conversing with these
people to realize they were suffering from mental disorder. One portrayed a woman with sacks of
dirty clothes bagged on a sidewalk where she slept every night as she waited for the Movie
Star to come pick her up for an impending life of decadence. Another man who had been
sleeping on a park bench for the last 22 years maintained he wasnt actually homeless he was just
a voluntary participant of a long-term socioeconomic study. They interviewed a man living
under an overpass who explained that he had no choice in the matter because his identity was
stolen and erased by federal agents preventing him from obtaining employment or housing.
So what can we do to help these individuals? Get them off the streets and into a safe and
supportive environment? Traditionally, medication is the cornerstone to treating both of these
conditions. However, as mentioned before the treatment must be tailored as results vary with the
individual. Medications must be carefully monitored and adjusted as symptoms are observed.
Treating a bi-polar person with anti-depressants alone will often trigger mania and so this must

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be tempered by a mood stabilizer and frequently a benzodiazepine which although an invaluable
tool for treating mental illness can be addictive and withdrawals can cause seizures and even
death. Schizophrenics must often take antipsychotics that have very undesirable side effects such
as muscle tremors. Some medications even require blood draws and lab tests to be run every
week such as with lithium in which therapeutic doses often border on the line of dangerous blood
toxicity, or clozapine which can trigger a condition known as agranulocytosis where white blood
cells are destroyed thus severely compromising the persons immune system.

Source: www.up2sd.com

Obviously, one cannot traipse through the city conducting clinical assessments and
sticking homeless people with needles for blood draws, and yet it is imperative that we get help
for these individuals. Disregarding all the fiscal and societal research that has been done on the
benefits that treatment of these peoples confers on a community as a whole, one cannot help but
also be compelled to focus on the individual; to become acquainted and familiar with the person
and have the desire to see that person well and cared for and finally comfortable and happy.

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In non-homeless individuals, patients rely heavily on support and encouragement from
what psychologists refer to as a support network, usually compromised of family and close
friends to assist them in adhering to their treatment plan and ensuring they dont miss therapy or
medical appointments. In a homeless person, any kind of such a network is deficient if not
completely absent, and so a different approach must be taken.
It is this that drives one to consider a somewhat recent approach to combating
homelessness known as supportive housing. Individuals are taken off the streets and put into
their own residences either free or at a greatly reduced rate of normal housing. This however is
not enough as noted by several publications which state Even if homeless individuals with
mental illnesses are provided with housing, they are unlikely to achieve residential stability and
remain off the streets unless they have access to continued treatment and services. (Mental
Illness). As more research is conducted on this we see more federal funding as well as supportive
housing programs springing up from non-profit organizations such as Catholic Community
Services or The Supportive Housing Coalition reaching out to their respective local homeless
populations.
New housing programs are being developed which take into consideration the special
circumstances and additional factors that occur when the patient is homeless. One article
published by the Journal of Community Psychology cited six factors that must be incorporated
into treatment in order to allow for best re-integration and a positive long term prognosis for the
mentally ill homeless. These factors were identified as housing, community participation, civic
activities, religious faith, social support, and treatment support (Tsai, Rosenheck, p.460)
As the correlation between mental illness as a causative agent of homelessness is further
explored and the efficacy of treatment for this population involving supportive housing in

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conjunction with medication and therapy is better established one would hope to see the
development of even more of these programs and increased funding. It is an overwhelming task
and there might never be a network large enough or well-funded enough to get every homeless
person the help that they need, but given the preliminary studies that have been done it seems
very worthwhile to make the attempt.

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Works Cited
Mental Illness and the Homeless National Coalition for the Homeless, July 2009
Web: www.nationalhomeless.org/factsheets
National Institute of Mental Health Internet Database. http://www.nimh.nih.gov
Diseases and Conditions: Bi-Polar Disorder Mayo Clinic Staff, www.mayoclinic.org
Diseases and Conditions: Schizophrenia Mayo Clinic Staff, www.mayoclinic.org
Jervais, Rick Mental Health Disorders Keep Thousands on the Streets USA Today,
August 27th, 2014
Tsai, Jack; Rosenheck, Robert
Conceptualizing Social Integration Among Formerly Homeless Adults With Severe
Mental Illness Journal of Community Psychology, Vol.40 No.4 2012, pg.460