Las Vegas, Nevada Homeless Community

Las Vegas, Nevada Homeless Community Mental Health

Situated in a hot, dry, desert valley, Las Vegas has experienced phenomenal growth in recent years, including large influxes of retirees as well as Latino immigrants searching for work. This population surge is primarily due to the casinos located on Las Vegas Boulevard, commonly known as "the Strip" which is actually located in an unincorporated township within the city borders of Las Vegas called "Paradise" which also contains the city's airport and convention center (Ventura, 2003). According to Ventura, "The story of Las Vegas is inextricably bound to the story of the Strip. Its casinos spur the area's unprecedented growth by providing jobs for working people while creating a backdrop of activity for the retired and others who relocate to Las Vegas Valley as a lifestyle choice" (2003, p. 97). Despite the glamour of the Strip, many jobs in Las Vegas are unskilled, minimum wage (or even lower for undocumented workers), and the large influx of newcomers means that homelessness can even affect those who are employed. For instance, Rothman and Davis emphasize that, "The mismatch between decent-paying occupations and affordable housing increased the estimated number of homeless people from 2,000 in 1990 to more than 18,000 in 1999, one-fifth of whom hold regular part- or full-time jobs" (2002, p. 141).

2.

Community Assessment.

Although a large number of exclusive gated communities exist in the suburbs of Las Vegas where the affluent enjoy lush green lawns and air conditioned luxury, other parts of the Las Vegas community are not so fortunate. North Las Vegas and West Las Vegas in particular remain characterized large percentages of minorities, including thousands of undocumented Latino residents in the former and almost all African-Americans (about 15,000) in the latter (Ventura, 2003). Las Vegas is approximately 131 square miles in size and is situated in Clark County which contains approximately 97,000 African-Americans total, as well as just over 7,000 Arabs (Abdullah, 2009). According to Abdullah, "Among African-Americans, conservative estimates put the number of Las Vegas Muslims at 2,000. Among Arabs, the census lists Lebanese (2,857), Syrians (967), and Egyptians (772). The remaining Arab population is comprised of Palestinians, Jordanians, Moroccans, Iraqis, Yemenis, Algerians, Saudi Arabians, Tunisians, Kuwaitis, Libyans and people of 33 other Middle Eastern ancestries" (2009, p. 26). In addition, approximately 11,182 Filipinos live in Las Vegas (Clarin, 2009).

The City of Las Vegas (http://www.lasvegasnevada.gov/FactsStatistics/census_data.htm) cites the most recent U.S. Census Bureau figures for the city (but not including Clark County) as shown in Table 1 below:

Table 1

Demographic Breakdown of Las Vegas

General Characteristics

Number

Percent

Total population

564,484

White

399,848

70.8

Black or African-American

57,945

10.3

American Indian or Alaska Native

3,286

0.6

Asian

30,769

5.5

Native Hawaiian or Other Pacific Islander

2,856

0.5

Some Other Race

49,417

8.8

Two or More Races

20,363

3.6

Hispanic or Latino (of any race)

169,573

30.0

Veterans

46,179

11.3

Source: City of Las Vegas Census Data, 2011

Population estimates for the larger metropolitan area of Las Vegas-Paradise-Henderson in Clark County are shown in Table 2 below.

Year

Population

Type

Source

1990

852,646

Census

Official

1999

1,381,086

Estimate

Official

2000

1,563,282

Census

Official

2010

2,282,708

Calculation

Source: Las Vegas population, World Gazetteer, 2011

A genogram of Las Vegas is provided in Figure 1 below.

City of Las Vegas,

Nevada

Healthcare Access

Psychosocial Health

Environmental Health

Population

-13 major hospitals (see complete list at Appendix a)

- Numerous community-based resources

- Extensive homeless population (current estimates place the number at 13,338 for Clark County

- Poverty levels commensurate with national averages

- Consistently hot weather creates exposure issues for homeless

- City statutes prevent feeding homeless in city parks

- Population: 564,484 (Las Vegas only)

- Predominately white (70.8%) with large contingents of Hispanic/Latino (30%) and Black/African-American (10%)

- Median age: 35.5 years

Community Diagnosis

For the dimensions assessed, there remains a paucity of effective interventions for the wide range of healthcare and mental health problems that characterize the homeless condition in Las Vegas. More effective use of community-based resources through partnerships with local hospitals, clinics and mental health services must be developed to address these needs.

Figure 1. Genogram of Las Vegas, Nevada

3.

Health Concerns of the Community

a.

Background in relation to "Healthy People 2020" and local public health data that characterizes this health concern.

Among the goals of Healthy People 2020 is the objective to reduce the incidence of substance abuse in the United States (Healthy People 2020 objectives, 2011, p. 305). As elsewhere, substance abuse -- together with (not surprisingly) gambling addictions -- is a major problem for the homeless in Las Vegas. One community health center counselor in Las Vegas reported that, "Ninety percent of my clients have gambling and alcohol problems. Drugs, meth, cocaine. Heroin is starting to come back. Gambling is one of the ways to raise money for this. Just being around the casinos they have access to free alcohol" (Littlejohn & Gran, 1999, p. 24). As noted in Table 1 above, approximately 46 thousand veterans live in Las Vegas; Healthy People 2020 indicates that about 7.1% of this population (or 3,266 veterans) will likely have a substance abuse problem as well (Healthy People 2020 objectives, 2011).

b.

Data from national, state, and/or local level related to the homeless community mental health concerns.

According to the U.S. National Library of Medicine (MedLine), health issues can create a downward spiral for the homeless from which escape is difficult or even impossible without intervention. In this regard, Medline (2010) emphasizes that, "Poor health can contribute to being homeless, and being homeless can lead to poor health. Limited access to health care can make it worse. That is why the health of homeless people in the United States is worse than that of the general population" (Homeless health concerns, para. 2). Some of the common health problems among the homeless population include the following:

1. Mental health problems

2. Substance abuse problems

3. Bronchitis and pneumonia

4. Problems caused by being outdoors

5. Wound and skin infections

6. Many homeless women are victims of domestic or sexual abuse.

7. Homeless children have high rates of emotional and behavioral problems, often from having witnessed abuse (Homeless health concerns, 2010)..

4.

Community Description

Current data on gender, age, socioeconomic status and education levels in Las Vegas are presented in Table 3 below.

Table 3

Education, Age, and Income Levels in Las Vegas

General Characteristics

Number

Percent

U.S.

Male

285,298

50.5

Female

279,186

49.5

Median Age (in years)

35.5

36.7

Under 5 years

45,818

8.1

6.9

18 years and over

410,555

72.7

75.5

65 years and over

65,155

11.5

12.6

Bachelor's degree or higher

21.3

27.4

Per capita income (in 2008 inflation-adjusted dollars)

$27,988

$27,466

Median household income (in 2008 inflation-adjusted dollars)

$55,113

$52,175

Median family income (in 2008 inflation-adjusted dollars)

$63,589

$63,211

Families Below the Poverty Line

8.7

9.6

Individuals Below the Poverty Line

11.7

13.2

Source: City of Las Vegas Census Data, 2011

a.

Describe how the health concern is linked to health inequity for this population / community.

According to Costello and Bouras, "Mental health problems are socially defined and, as a result, they are highly interactive with the context in which the person lives and the social expectations placed upon him/her. In defining mental health, a whole range of factors needs to be taken into consideration, encompassing not just the individual, but also the wider ecology within which the person lives" (2006, p. 241).

b.

Use data to support the conclusion. The official Web site for the City of Las Vegas emphasizes that, "Thousands of homeless individuals and families can be found on the streets, in parks and other locations throughout the city of Las Vegas on any given day" (City of Las Vegas homeless services, 2011, para. 1). The current estimates of the homeless population are set forth in Table 4 below.

Table 4

Las Vegas Homeless Census

Census Components

2007

2009

Street count of unsheltered homeless people - on streets, in vehicles, in makeshift shelters (such as tents), and encampments

3,747

3,027

Shelter count of homeless people - emergency shelters, transitional housing, and domestic violence shelters

3,844

7,004

Hidden Homeless Estimate - based on a telephone survey of 1,001 households in Clark County.

3,826

3,307

Total Count of Homeless in Clark County

11,417

13,338

Source: Homeless census, 2011

Although there are a number of community resources available to assist the homeless population in Las Vegas (discussed further below), city officials have adopted an "out-of-sight, out-of-mind" approach in many cases to help keep panhandlers and beggars away from the Strip where they might encounter tourists. In fact, Baker reports that, "In Las Vegas a person can be jailed for up to six months for handing out food to homeless people in the city's parks. The law has been used against charities that operate mobile soup kitchens" (2009, p. 4).

5.

Community Resources -- resources and partners (governmental, missions, activities, hospitals, websites, etc.) currently involved with the health concern of this community.

The City of Las Vegas reports that it "works with a number of local agencies to address the homeless problem through partnerships, plans and reports" (City of Las Vegas homeless services, 2011, para. 2). Some of the programs offered by the city include those set forth in Table 5 below.

Table 5

City-Sponsored Community Resources for the Homeless in Las Vegas

Community Resource

Description

Housing and Homeless Services

In accordance with the Home for Homeless Nevadans: 10-Year Plan to Reduce Homelessness, the goal is to ensure that more 900 individuals either avoid the cycle of homelessness or enter permanent housing over the next 10 years.

Reconnection to Family Program

This program provides one-way, one-time, out-of-town transportation assistance to individuals and families to reach designated housing with awaiting family and/or other secure housing situations and support.

Donation Stations to End Homelessness

A way to contribute to the city's Home for Homeless Nevadans: 10-Year Plan to Reduce Homelessness. Spare change normally given to panhandlers will be redirected into programs for those at-risk of homelessness and currently homeless in the city of Las Vegas. Restored parking meters are painted a vibrant green color and installed in strategic downtown locations with significant foot traffic and panhandling issues. All collected coins will go directly to enhancing the city's Housing and Homeless Services Program.

Source: City of Las Vegas homeless services, 2011

Other community resources have a religious basis. For instance, built in 1977 by former members of the Nation of Islam using a grant from boxing champion Mike Tyson, Masjid as-Sabur has established a number of social projects including feeding the homeless, providing free health clinics as well as regular schools for poor and needy families; moreover, in collaboration with a Los Angeles-based philanthropic organization, Masjid as-Sabur has also undertaken a number of other social service projects in recent years (Abdullah, 2009). Other representative religious-based community resources and others that receive federal funding are set forth in Table 5 below.

Table 5

Neighborhood Services Department Resources for the Homeless

Organization

Services Provided

Catholic Charities #2

Purchase food products for feeding the homeless.

Catholic Charities #1

Provide transportation, clothing, Sheriff and Health cards for homeless to gain employment.

Catholic Charities #2 -- St. Vincent Help

Provide case management and permanent affordable housing for homeless clients.

Family Promise

Provide emergency shelter for homeless at various churches.

Shade Tree -- Substance Abuse Additions Recovery

Provide substance abuse counseling to residents of the emergency shelter program.

Salvation Army -- Vocational Training Services

Provide job training and job readiness services to homeless clients.

Source: City of Las Vegas Neighborhood Services Department, 2011

6.

Diagnosis - discuss aspects of the health concern of this community that is NOT being addressed despite the efforts of the partners involved.

The City of Las Vegas concedes that there are thousands of homeless on the streets of the city on any given day, but the long-term goal for reducing homelessness only includes 900 people. Clearly, developing affordable housing represents one of the most important issues facing the homeless population in Las Vegas today. In the meantime, the other common problems that afflict the homeless, including mental health and substance abuse issues remain underserved.

7.

Outcomes Identification -- describe ultimate outcomes or goals for improvement related to the health concerns of this community.

Clearly, gambling is not going to go away any time soon in Las Vegas and the concomitant gambling addictions and substance abuse issues that afflict the city's homeless must be addressed using 12-step programs such as Gamblers' Anonymous, Alcoholics Anonymous and Narcotics Anonymous. In addition, city statutes that prohibit feeding homeless people in parks and other public places should be repealed.

8.

Planning

a.

Recommend nursing actions to improve the health concern. To truly address the vast array of healthcare problems that characterize the homeless population, nurses must "hit the bricks" and visit the homeless where they congregate.

b.

Explain how nurses might work with the community and the population of interest to improve the health concern -- select primary and secondary prevention activities only.