The Interdependence between Homelessness and Mental Illness 1

The Interdependence between Homelessness and Mental Illness

Adeleida Bingham

South African College of Applied Psychology (Pty) Ltd.

Diversity and Multiculturalism

Gordon Isaacs

Assessment due date: 08 August 2017

The Interdependence between Homelessness and Mental Illness 2

Plagiarism Declaration
In accordance with SACAPs Plagiarism Prevention Policy and Student Code of
Conduct, Wellness and Disciplinary Policy, I, Adeleida Bingham, the undersigned, hereby
declare that I have abided by APA referencing guidelines, that the work contained in this
assessment submission is my own original work, and that I have not previously in its entirety,
or in part, submitted this work as part of a module or qualification.

Signature: A Bingham Date: 11 August 2017

My sincere thanks to Ian Verey from the Carpenters Shop,

for his time and insights, and for the difference he is making
The Interdependence between Homelessness and Mental Illness 3

Table of Contents

Plagiarism Declaration ............................................................................................... 2

Table of Contents ......................................................................................................... 3

Introduction .................................................................................................................. 5

Scope .......................................................................................................................... 5
An overview of mental health issues among the homeless ....................................... 6

Prevalence .................................................................................................................. 6
Policy ......................................................................................................................... 6
The link ...................................................................................................................... 7
What came first? ........................................................................................................ 7
Illustrating the interdependence between homelessness and mental disorders ......... 7
Poverty and Stress: the forces that lock people in ..................................................... 8
Classification of factors ............................................................................................. 9
Interdependent factors between homelessness and mental illness ........................ 10

Family breakdown ................................................................................................... 10

Becoming homeless: the vulnerable youth. ......................................................... 10
Reunification with family .................................................................................... 10

Substance abuse ....................................................................................................... 11

Prevalence. ........................................................................................................... 11
Substance abuse as cause of homelessness and mental illness ............................ 11
Substance abuse as a consequence of homelessness............................................ 11
Substance abuse as a consequence of mental illness. .......................................... 11
Other substance related impacts........................................................................... 12
Experiences at the Carpenters Shop ................................................................... 12

Difficulty in accessing services and treatment ......................................................... 12

Access difficulty as a consequence of mental illness .......................................... 12
Access difficulty as a consequence of homelessness ........................................... 13

Homelessness factors that could lead to mental illness........................................... 13

Prolonged economic and material deprivation ........................................................ 13

Exposure to harsh living conditions ......................................................................... 13
The Interdependence between Homelessness and Mental Illness 4

Exposure to crime and violence ............................................................................... 13

Mental health factors that could lead to homelessness ........................................... 14

Impaired ability to function ..................................................................................... 14

Impaired ability to maintain relationships and friendships ...................................... 14
Deinstitutionalisation ............................................................................................... 14
Impact of factors on physical health ........................................................................ 15

Conclusion .................................................................................................................. 15

Personal reflection ..................................................................................................... 16

References ................................................................................................................... 16
The Interdependence between Homelessness and Mental Illness 5

"What we would like to do is change the world-make it a little simpler for people to
feed, clothe, and shelter themselves as God intended for them to do. And, by fighting for
better conditions, by crying out unceasingly for the rights of the workers, of the poor, of the
destitutewe can, to a certain extent, change the world; we can work for the oasis, the little
cell of joy and peace in a harried world. We can throw our pebble in the pond and be
confident that its ever widening circle will reach around the world. We repeat, there is
nothing that we can do but love, and, dear God, please enlarge our hearts to love each other,
to love our neighbour, to love our enemy as well as our friend."
- Dorothy Day

Introduction

The author, in an attempt to gain insight on mental health challenges among the
homeless, specifically with regards to the nature and extend of its prevalence and the services
available within a South African context, found that the relationship between mental illness
and homelessness is highly complex and interdependent.
In addition to reviewing local and global research and literature, the author conducted
an interview (Verey, 2017) with Ian Veary, a full-time social worker at The Carpenters
Shop, a second phase facility (Department of Social Development, WCG, 2015) for
vulnerable adults, to get a real-life, hands-on perspective on the topic.
Scope
The author narrowed the focus of this essay to just understanding the various factors
that link mental illness and homelessness, and their interconnected relationships. General
challenges associated in isolation with just homelessness, or just mental health, which do not
necessarily point to an interdependency between the two, was excluded from the scope.
How to address and resolve the significant challenges highlighted in this essay,
specifically with regards to the complex and integrated, multi-discipline approach required to
detangle the interlinked factors systemically, working across various government entities
including health, housing, justice and social services, (Mental Health Commission of Canada)
was not included in the scope of the essay but is recommended to be embraced as a future
research initiative.
The Interdependence between Homelessness and Mental Illness 6

An overview of mental health issues among the homeless

Prevalence
The statistics with regards to the relationship of homelessness and mental health
issues are not always consistent due to various issues such as varying sampling practices,
reliability of participants recollections, lack of access to services to provide diagnosis and
the use of different measures to define what qualifies as a statistically significant state of
mental illness (The Shaw mind foundation, 2016, p. 4) and homelessness. (Seager &
Tamasane, 2010) However there is consensus across studies that the correlation is high, using
the common estimate that four in ten homeless people have significant mental health issues
(Glew & Orchard, 2016)
In a landmark study on the homeless in South Africa, (Seager & Tamasane, 2010) it
was found that although only 3% and 6% of children and adults stated that they have been
diagnosed with a mental disorder, 45% of children and 58% of adults experienced symptoms
of depression in the preceding month, which speaks to the need for mental health services
with regards to services among the South African homeless. (Seager & Tamasane, 2010)
Verey (personal communication, August 06, 2017) confirmed that in his own
experience at the Carpenters Shop, the incidence of mental health issues among the homeless
is far higher than in the general population. Although the Carpenters Shop only houses men,
they see both male and female clients. In his experience, for every ten clients, three will be
women and seven will be men, and of those, four will show signs of possible mental illness.
(Verey, 2017)
Policy
Persons with mental illness are protected by The South African Mental Health Care
Act No 17 of 2002, (South African Government, 2002) which states that they are protected
from discrimination and have the right to receive care and services within their
community of residence. (Moyo, Patel, & Ross, 2015) The author noticed that the Act falls
short in that it does not speak to where this community of residence would be, in the case
of the homeless.
Furthermore, the Bill of Rights of the Constitution of the Republic of South Africa
(South African Government, 1996) protects the right to basic healthcare, food and water,
housing and social security and services. (Moyo, Patel, & Ross, 2015)
However, there is often a disconnect between formulating a policy and putting it into
The Interdependence between Homelessness and Mental Illness 7

practice, and the rights of those that are both mentally ill and homeless are still violated as the
implementation of services continues to lag behind the passing of legislation. (Freeman,
2013, as cited by Moyo, Patel & Ross, 2015)
The link
Global studies confirm this link between mental illness and homelessness, for instance
in an urban survey in the United States by the National Coalition for the Homeless (2009),
mental illness was rated by the majority of cities as the third largest cause of homelessness
for single adults and a significant number (mentioned by 48% of cities), and one city found
that 15% of beneficiaries of their public mental health system were homeless once or more
over a year period. (National Coalition for the Homeless, 2009). In England, Perry and Craig
(2015) found that up to 30% of the homeless population reported serious mental conditions
such as major depression, schizophrenia and bipolar disorder.
What came first?
A common theme that emerge from literature around the combination of
homelessness and mental health is that there is an interdependence between the two scenarios
in that the one can directly lead to the other (Perry & Craig, 2015). Due to the scenarios
individual or shared vulnerability factors (Sullivan, Burnam, & Koegel, 2000) the risk of the
other scenario is raised (Moyo, Patel, & Ross, 2015) and there is an aggravation of both the
typical experiences of homelessness, and symptoms and degree of mental disorders over
time, because of the influence the situations have on one another. (Ambrosino, Ambrosino,
Emeritus, & Emeritus, 2008)
Verey (2017) confirmed this theme with experiences from working at the Carpenters
Shop, where he has seen that homelessness can lead to mental illness because of trauma
suffered while living rough on the streets, and mental illness can cause homelessness due to
not being able to keep a job, a divorce, or possibly even drug use, which in turn can lead to
mental illness as well.
Illustrating the interdependence between homelessness and mental disorders
As this relationship became increasingly more difficult to explain in words only, the
author created a model (Figure 1: A model of Interdependence between Homelessness and
Mental Disorders, provided below) to walk the reader through a collection of findings from
studies that indicated this complex interdependence.
The Interdependence between Homelessness and Mental Illness 8

Figure 1: A model of Interdependence between Homelessness and Mental Disorders

Poverty and Stress: the forces that lock people in

Poverty (Moyo, Patel, & Ross, 2015) is seen as the force that results in, and locks
people into homelessness, (National Coalition for the Homeless, 2009) while the chronic
stress from the survival mentality required by life on the streets (Verey, 2017) is the force
that results in, and locks people into mental illness, resulting in a revolving loop of
interdependency between the two situations experiences and effects, as illustrated below:
The Interdependence between Homelessness and Mental Illness 9

Figure 2: The revolving loop of interdependency between Homelessness and Mental Illness

Employment and residential stability are critical resolutions which could release
individuals from this loop, (Glew & Orchard, 2016) but as the National Coalition for the
Homeless in Canada confirms: the combination of mental illness, substance abuse, and poor
physical health makes it very difficult for people to obtain employment and residential stability.
(2009)
Classification of factors
The author found three main classifications of factors within this loop: (a) factors that
are interdependent, (b) homelessness factors that could result in mental illness, and (c) mental
illness factors that could result in homelessness.

Figure 3: Classifications of interdependent and dependent factors

In addition, these factors are also intertwined with one another. The author will
discuss these factors within the three classifications and refer to other sections when there are
interrelationships between factors within and across the various classifications.
The Interdependence between Homelessness and Mental Illness 10

Interdependent factors between homelessness and mental illness

The author identified three key interdependent factors that are both cause and
consequence of mental illness and homelessness: (i) family breakdown, (ii) substance abuse
and (iii) difficulty in accessing services and treatment.
Family breakdown
In a Hillbrow-based study, Moyo, Patel and Ross (2015) found that family breakdown
is the most common reason for homelessness and that the correlation between coming from a
broken family and being homelessness as well as mentally ill, is very high.

Figure 4: The cause and effect of Family Breakdown

Becoming homeless: the vulnerable youth.

The history of homeless people often originates in childhood, (Scott, 2000)
when they left home due to parental addictions, longstanding neglect and/or physical
and sexual abuse (Ambrosino, Ambrosino, Emeritus, & Emeritus, 2008). May, Page
and Brunsdon (2001) confirmed that severe family conflict often underlies the
reason for many homeless people to choose to, or be coerced into, leaving home
Another risk factor for homelessness, specifically in South Africa, is running,
or being part of, a child-headed household after the death of parents due to HIV and
other factors. (Perry & Craig, 2015)
Reunification with family
It is noteworthy to mention that one of the key roles that the Carpenters Shop
fulfil is assistance with reunification with family members, which can include
facilitation to restore family bonds, which can lead to reintegration back into
mainstream society and no longer having to make use of welfare services. (Verey,
2017)
The Interdependence between Homelessness and Mental Illness 11

Substance abuse
Substance abuse has been found to be both cause and consequence, for both
homelessness and mental illness, as well as a contributing factor to disease transmission. It is
closely linked to family breakdown (May, Page, & Brunsdon, 2001) and the vulnerable youth
(Health24, 2013):

Figure 5: The cause and effect of Substance Abuse

Prevalence.
About a third of homeless people have significant substance abuse problems. (Moyo,
Patel, & Ross, 2015) The prevalence is higher under those that are both homeless and
mentally ill, where approximately half suffer from substance dependence and abuse.
(National Coalition for the Homeless, 2009) Veary confirmed that in the experience of the
Carpenters Shop, the risk and incidence of drug use on the street is very high as it helps them
to cope on the streets. (Verey, 2017)
Substance abuse as cause of homelessness and mental illness
Substance abuse are often the underlying cause of suffering poor mental health as
well as becoming homelessness. (Moyo, Patel, & Ross, 2015) Mathiti confirmed the
relationship in a South African study (Mathiti, 2006, as cited by Moyo, Patel & Ross, 2015)
Alcohol and so-called street drugs, including inhalants (such as glue), (Health24,
2013) cannabis (dagga), crack cocaine and crystal methamphetamine (tik), are cheap and
comparatively easy to obtain and when abused, apart from severely impacting physical
health, leads to brain damage and contributes to serious mental disorders such as
schizophrenia, bipolar disorder and major depression. (Health24, 2013)
Substance abuse as a consequence of homelessness.
Christensen further argues that substance abuse can be a consequence of time spent
on the streets. (Christensen, 2014 as cited by Moyo, Patel & Ross, 2015)
Substance abuse as a consequence of mental illness.
Due to poor access to medical services, treatment and medication, as discussed under
The Interdependence between Homelessness and Mental Illness 12

Difficulty in accessing services and treatment, street drugs are often used by the homeless
to self-medicate, which in addition to the risk of addiction can transfer disease, if the drug is
injected. (National Coalition for the Homeless, 2009) This health impact is discussed in more
details under the section Impact of factors on physical health, further on in this essay.
Other substance related impacts.
Verey mentioned an important extended risk often in progression of substances use
under the homeless, namely getting involved in drug related activities in order to earn a living
(Verey, 2017) which in turn leads to Exposure to crime and violence, as addressed further
on in this essay.
Experiences at the Carpenters Shop
Verey noted that among the mental health cases seen, there is a survivors mode,
where individuals are just trying to make it through each and every day, where a place to eat
and safe shelter helps to at least alleviate some of the distress they are experiencing. During
the night, they need to find a place to sleep on the street and might turn to substances,
especially alcohol, as a way to relieve anxiety. Verey reflected that it is sad to see evidence of
this hardship when clients start to arrive in the morning. He is aware that access to proper
treatment would make changes for them, but due to the number of cases and the shortage of
staff, it is often difficult to provide everything that is required to bring real change about, if
the client is not able to assist with independence due to mental health struggles. (Verey,
2017)
Difficulty in accessing services and treatment
Perry and Craig (2015) found that among the mentally ill homeless who required
treatment, more than a third were not receiving it, partially due to difficulties in access.

Figure 6: The cause and effect of Access Difficulties

Access difficulty as a consequence of mental illness

The nature of mental illness also makes it difficult for homeless persons to negotiate
street life and meet basic needs for food, safety, shelter and treatment (Ambrosino et al.,
2008:223) (Moyo, Patel, & Ross, 2015)
Individuals with mental illness are often significantly stigmatised by the broader
The Interdependence between Homelessness and Mental Illness 13

community, and their immediate social network frequently rejects them also. (Scott, 2000)
Access difficulty as a consequence of homelessness
Healthcare professionals are often unwilling to attend to homeless people due to
perceptions such as being dirty, and being unworthy and undeserving of medical services
(Moyo, Patel, & Ross, 2015) Prolonged experiences of stigma, prejudice and discrimination
such as this can eventually lead to mental illness. (Moyo, Patel, & Ross, 2015)

Homelessness factors that could lead to mental illness

In addition to the interdependent factors discussed above, there are also factors that
accompany homelessness which could result in mental illness, namely prolonged economic
and material deprivation, and exposure to harsh living conditions, crime and violence.

Figure 7: Homelessness factors contributing to mental illness

Prolonged economic and material deprivation

McNaughton (2008) recognises economic and material deprivation, on par with
family breakdown and depression, as a factor that contributes to the homeless becoming
mentally ill due to prolonged material, social and emotional drain of resources.
Exposure to harsh living conditions
The time spent on the street and its accompanying living conditions and stresses lead
to some homeless people becoming mentally ill. (Moyo, Patel, & Ross, 2015)
Exposure to crime and violence
Females that are homeless are particularly vulnerable with regards to sexual abuse and
rape, (Moyo, Patel, & Ross, 2015) which can lead to depression, suicide, substance abuse and
PTSD. (Goodman, Fels, Glenn, & Benitez, 2006)
Verey stated that common signs of mental illness seen among the homeless include
typical symptoms of schizophrenia such as paranoia and delusions, which he seen as an effect
of being continuously fearful; as well as symptoms pointing to PTSD especially among older
white men that have served in the army. (Verey, 2017)
Verey also mentioned that assault or accidents that happen on the street can result in
traumatic brain injury which may contribute to mental problems. (Verey, 2017)
The Interdependence between Homelessness and Mental Illness 14

Moyo, Patel and Ross (2015) also found that the police do partake in inflicting
violence and intimidation on this vulnerable population.

Mental health factors that could lead to homelessness

The final classification of factors are those that are prevalent in mental illness which
could result in homelessness, namely impaired ability to (i) function, and (ii) maintain
relationships and friendships, as well as (iii) deinstitutionalisation.

Figure 8: Mental health factors contributing to homelessness

The National Coalition for the Homeless in the USA (2009) has noted that patients
with schizophrenia or bipolar disorder are particularly vulnerable with regards to becoming
homeless, due to these factors.
Impaired ability to function
Mental illness is often accompanied by a reduced ability to function independently
which, by itself, could lead to homelessness. (Ambrosino, Ambrosino, Emeritus, & Emeritus,
2008)
Impaired ability to maintain relationships and friendships
Similarly, those suffering from significant mental illness often has an impaired ability
to form and keep stable social connections due to factors such as misinterpretations of others
actions, irrational reactions and the pushing away of those who could and may want to help
them, which make them more vulnerable to becoming homeless. (National Coalition for the
Homeless, 2009). Tipple and Speak (2009) found this reduced ability to form and maintain
social relationships as one of the disturbing expressions of homeless persons with mental
illness (as cited by Moyo, Patel & Ross, 2015)
Verey mentioned that relationships with others are seen to help with improving
mental health, and that single persons are often particularly at high risk. (Verey, 2017)
Deinstitutionalisation
In the second half of the 20th century, the preferred model to cater for mental illness
changed from institutionalisation to expecting family and communities to cater and care for
those with mentally ill. (Cross et al., 2010, as cited by Moyo, Patel & Ross, 2015).
The Interdependence between Homelessness and Mental Illness 15

Deinstitutionalisation was identified as a risk factor for homelessness, in that family and the
communities may not have the necessary supportive services, (Carol, Karina, David &
Edward, 2004, as cited by Moyo, Patel & Ross, 2015), as well as the fact that relationships
may become poor due to the inherent impaired ability to maintain those relationships by the
individual with a mental disorder, as described in the previous section.

Impact of factors on physical health

The factor of impact on physical health is a backdrop to almost all factors and as such,
will be discussed last, as a separate classification.

Figure 9: Poor physical health as a backdrop to most factors

The homeless has higher rates of hospitalisation for physical illnesses, mental illness,
and substance abuse than the homed. (American Psychological Association)
Various studies cite a high prevalence of respiratory infections, dermatological
conditions, infections, cancer and liver damage, (Perry & Craig, 2015), hypertension,
diabetes (American Psychological Association), and especially HIV and tuberculosis within
the South African context, (Moyo, Patel, & Ross, 2015) under the homeless. Exposure to the
elements, especially at night (so-called sleeping rough), injuries from or transmission by
violence or accidents, poor nutrition, inadequate hygiene (National Coalition for the
Homeless, 2009) and alcohol and substance abuse all contribute to these typical conditions.
(Perry & Craig, 2015) Taking precaution to prevent the contraction or development of disease
is extended by suffering from mental illness. (National Coalition for the Homeless, 2009)
Verey mentions that the homeless that are also HIV positive sometimes struggle to get
their medication, and/or take their medication intermittently when they have it, resulting in
their bodies getting weaker. In combination with substance abuse disorder, this scenario can
lead to depression.

Conclusion

This essay focussed on the link between homelessness and mental illness, and how the
The Interdependence between Homelessness and Mental Illness 16

two situations and their interdependent factors impact each other, to the point of holding
captive those that are subject to both situations.
Organisations such as the Carpenters Shop are deeply aware of these challenges and
witness its expression on a daily basis.

Personal reflection

Bernie Glassman said:

When we bear witness, when we become the situation homelessness, poverty,
illness, violence, death - the right action arises by itself. We dont have to worry about what
to do. We don't have to figure out solutions ahead of time. Peace-making is the functioning of
bearing witness. Once we listen with our entire body and mind, loving action arises.
(Glassman, 1998)
Without disregarding the significant funding and structures required to address this
situation, the author found resonance in the words above, which spoke to her own awareness
being lifted during the time of interviewing for, and writing this essay. An incident comes to
mind, where the author parked her car after dark in a side-street in the CBD. As I returned
later that evening, two parking attendants argued with one another in raised voices as they
approached me. I noticed a shift in my thinking. Before, I would try to not to make eye
contact and drive away as soon as possible; but that night I wondered where those parking
attendants would be sleeping that night and whether my insignificant tip to the one who made
it to my window, would result in injury later on by the other attendant. Awareness seemed to
have dissolved some of my previously held fear and stigma.

References

Ambrosino, R., Ambrosino, R., Emeritus, H. J., & Emeritus, S. G. (2008). Social work and
social welfare: an introduction (6th ed.). Belmont, California: Thomson Brooks/Cole.
American Psychological Association. (n.d.). APA Fact Sheet: Health & Homelessness.
Retrieved August 07, 2017, from American Psychological Association:
http://www.apa.org/pi/ses/resources/publications/homelessness-health.pdf
Canadian Mental Health Association. (n.d.). Homelessness. Retrieved August 07, 2017, from
Canadian Mental Health Association: http://www.cmha.ca/public-
policy/subject/homelessness/
The Interdependence between Homelessness and Mental Illness 17

Department of Social Development, WCG. (2015, April). Norms and Standards for Shelters
for Homeless Adults. Retrieved August 07, 2017, from Western Cape Government
(WCG): https://www.westerncape.gov.za/assets/departments/social-
development/norms_and_standards_for_shelters_for_homeless_adults.pdf
Glassman, B. T. (1998). Bearing Witness: A Zen Master's Lessons in Making Peace. New
York: Blue Rider Press (Penguin Group).
Glew, C., & Orchard, B. (2016, November). Stop the Scandal: the case for action on mental
health and rough sleeping. Retrieved August 07, 2017, from St. Mungo's:
https://www.mungos.org/publication/stop-scandal-case-action-mental-health-rough-
sleeping/
Goodman, L. A., Fels, K., Glenn, C., & Benitez, J. (2006, September). No safe place: Sexual
Assault in the Lives of Homeless Women. Retrieved August 07, 2017, from VAWnet:
http://vawnet.org/sites/default/files/materials/files/2016-09/AR_SAHomelessness.pdf
Health24. (2013, November 25). 9 most common street drugs. Retrieved August 07, 2017,
from Health24: http://www.health24.com/Mental-Health/Alcohol/Drugs-special-
report-20120721
Health24. (2013, July 04). Sniffing for a high. Retrieved August 07, 2017, from Health24:
http://www.health24.com/Mental-Health/Alcohol/Sniffing-for-a-high-20120721
May, M., Page, R. M., & Brunsdon, E. (2001). Understanding social problems: issues in
social policy. Oxford: Blackwell.
McNaughton, C. (2008). Transitions through homelessness: lives on the edge. New York:
Palgrave Macmillan.
Mental Health Commission of Canada. (n.d.). Housing and Homelessness. Retrieved August
07, 2017, from Mental Health Commission of Canada:
https://www.mentalhealthcommission.ca/English/focus-areas/housing-and-
homelessness
Moyo, U., Patel, L., & Ross, E. (2015, May). Homelessness and mental illness in Hillbrow,
South Africa: a situation analysis. Social Work/Maatskaplike Werk, 50(1), 1-21.
doi:10.15270/51-1-425
National Coalition for the Homeless. (2009, July). Mental Illness and Homelessness.
Retrieved September 07, 2017, from National Coalition for the Homeless:
http://www.nationalhomeless.org/factsheets/Mental_Illness.pdf
The Interdependence between Homelessness and Mental Illness 18

Perry, J., & Craig, T. K. (2015, March/April). Homelessness and mental health. Trends in
Urology and Men's Health, 6(2), 19-21. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1002/tre.445/pdf
Scott, J. (2000). Chapter 21: Homelessness and mental health. Principles of Medical Biology,
14, 487-498.
Seager, J. R., & Tamasane, T. (2010). Health and well-being of the homeless in South
African cities and towns. Development Southern Africa, 27(1), 63-83.
South African Government. (1996). Constitution of the Republic of South Africa, 1996 -
Chapter 2: Bill of Rights. Retrieved August 07, 2017, from South African
Government: http://www.gov.za/documents/constitution/chapter-2-bill-rights
South African Government. (2002). HPCSA (Health Professions Council of South Africa).
Retrieved August 07, 2017, from The South African Mental Health Care Act No 17 of
2002:
http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/legislations/acts/mental_
health_care_act_17_of_2002.pdf
Sullivan, G., Burnam, A., & Koegel, P. (2000). Pathways to homelessness among the
mentally ill. Social Psychiatry Psychiatric Epidemiology, 35, 444-450.
The Carpenter's Shop. (n.d.). The Carpenter's Shop. Retrieved August 07, 2017, from The
Carpenter's Shop: http://www.thecarpentersshop.org.za
The Shaw mind foundation. (2016, December). Mental health in the homeless. Retrieved
August 07, 2017, from The Shaw mind foundation:
http://shawmindfoundation.org/wp-content/uploads/2016/12/Shaw-Mind-
Homelessness.pdf
Verey, I. (2017, August 06). Personal Communication. (A. Bingham, Interviewer)