Treatment for the Homeless

Homeless Mental Health Mental health is an issue that is deemed to be very under-treated and very under-diagnosed within the United States. Beyond that, there are populations that are much more at risk than others. A good example would be the prison population where drug use and mental health issues are both rampant. However, there is another group that is highly stricken and very vexing and difficult to treat and that would be the homeless. Indeed, many people that are homeless are in that position due to mental health issues.

Mental health is often not the only issue involved as comorbidity can exist with substance abuse. However, mental health will be the focus of this report. Facets of the homeless with mental health that will be focused upon within this report will include issues like diversity, ethics, values, social justice, diagnosing of patients, initiation/termination of care, aftercare, and the broader topic of social work when it comes to treating and otherwise interacting with the homeless.

While mental health can be very difficult to deal with and treat when it comes to the homeless, it is something that social workers and other related professionals should absolutely strive to address and deal with. Analysis As partially indicated in the introduction, there is deemed to be a high concentration of mental illness within the homeless population. This is perceived to be even truer in certain situations. To clarify that, there are two main types of homeless people.

There are those that come upon a short bit of bad luck and these people are often able to reobtain housing in fairly short order. By contrast, there are those that are persistently and constantly homeless over a period of time. The latter of those groups is deemed to be much more likely to be mentally ill and thus in need of intervention and treatment options from social work agencies. At the same time, alcohol and other drug abuse is actually fairly consistent across all types of homeless peoples.

The length, depth and breadth of a person's homelessness obviously has a lot to do with how many stressors and other aggravating factors they have. This in turn will lead to more issues with being able to start treatment, continue treatment until it can reasonably be terminated and keeping those people on the straight and narrow after they are treated (Lippert & Lee, 2015).

While some may hold that a lot of the people that are homeless are in their situation due to actions or inactions of their own doing, this is simply not the case. Further, even if it were true, leaving it untreated and unabated would not be ethical, would not be consistent with proper social justice and there can be things done to address the mental health needs of people that are homeless. Further, these interventions can go far enough so as to prevent continued mental illness once treatment is rendered.

Such was proven in a Housing First program that showed that there was a reduction in re-offending among formerly homeless adults with mental disorders. The stakes are made quite clearly in that study when they state that those that are mentally ill are at high risk of being arrested as are the homeless. When those two traits converge within the same person, the overall risk of arrest is obviously going to be even higher.

Beyond the obvious ethical and social justice issues as it relates to treating and helping the homeless with their mental health issues, there are also significant public costs associated with not treating those people and otherwise addressing the problem in a way other than simply incarcerating and dismissing the homeless as an issue.

Rather than just make laws banning panhandling and sleeping in certain public areas, it is asserted by many that there needs to be a focus on the source of the problem and treating those that have said problem. Indeed, if the root cause of the problem, mental health in this case, is not addressed, the problem will not go away and will certainly get worse as more and more people are untreated for mental illness and thus become homeless as a result.

Beyond the above, there is a clear over-representation of mentally ill people in prison systems and being in prison is not really where those people need to be unless they are truly violent even with the proper treatments and thus unfit for release into broader society. For those that are just violent or those that know they need treatment but refuse to engage in the same, prison may be the answer.

However, for those that are not violent and that want to get treated, rehabilitation in the form of mental health treatment can and should be funded so as to reduce the suffering of those that are mentally ill and the negative social aftermath that is commonly left in their wake (Somers, Rezansoff, Moniruzzaman, Palepu & Patterson, 2013).

When it comes to ethics and social justice, it should also be pointed out that a lot of the people that are chronically or even occasionally homeless and mentally ill at the same time have children and they need to be protected as well in the form of their parent or parents getting the mental health that they deserve.

The author of this report has seen more than one situation where a parent is greatly struggling even when they are trying extremely hard but the children suffer nonetheless because there is nothing simple or easy about being homeless. Further, homeless and/or mentally ill people with children can be unwilling and scared to come forward and ask for help out of fear that their children will be seized by the state due to the parent due to the mental illness and/or the homelessness.

When it comes to referrals and getting people the help they need, this can create obvious issues. However, it is important to get an intervention in place for such people as there are signs from the scholarly literature that the presence of children can create new and unique factors relating to mental illness when speaking of homeless people that have dependent children. An interesting fact that some people may be unaware of is that while mental illness may lead to homelessness, the same can be true in reverse.

Quite often, becoming homeless by itself can lead to the degradation of a person's mental state and this can happen when children are present. In many ways, this presents a multi-faceted problem that is comprised of homelessness, mental health and the presence of children that are themselves affected and see their parents affected as well. The latter item in that short list, on its own, can cause its own problems with the children involved.

Even if removal of the child from the parent's custody until they get their metnal health and other affairs sorted is not the most attractive option, it can sometimes be the best way to proceed as it lifts a burden off the parent temporarily. So long as the parent acts in good faith and gets the treatment they need, they should be reunited with their child or children soon enough.

The children need to be in a stable and structured environment and this can involve something other than the custody of a parent even if the parent is willing. The issue is whether the parent is able from a financial and mental health standpoint. If they are not, the social work agencies probably need to step in (Chambers et al., 2014). As noted already, structure and stability is a huge part of getting someone treated and on the road to recovery.

The author of this report personally knows and understands that it is important and pivotal for someone in the different stages of treatment and recovery to have their life in a certain formulation and structure even if they do not have a house to call their own. This applies when speaking about overall patient engagement in the process, when the patient is being diagnosed, during the core/middle phase and when there are plans to terminate or at least pause treatment.

One major way to provide structure and stability for a homeless person is to remove the homeless aspect from their life. This can be accomplished through shelters or low-cost housing. Not all jurisdictions have these sort of facilities at the ready but many that do not have such accommodations will operate through Section 8 or something else similar so as to get a person housing at low to no cost while they recover financially and mentally.

It has been found through experimental and quasi-experimental studies that people that are given at least temporary accommodations during their mental health treatment process do much better in terms of healing and progressing than those that remain in a state of perpetual or intermittent homelessness. After all, getting someone a semi-permanent place to stay is going to be better in many ways as compared to someone that is couch-hopping and moving from house to house over a short period of time (Stergiopoulos et al., 2015).

Regardless of the housing scenario for a homeless person getting treatment, the overall treatment path is roughly the same for everyone involved except for the most mentally ill and suffering individuals. One thing that is key, as noted before, is that homeless people cannot be treated with the approach as people with homes, jobs and "regular" families and agencies that do run the risk of losing out on an opportunity to help a patient in dire need. There is a good amount of customization and tailoring that needs to occur.

For example, many of the homeless people out there are veterans of the United States Armed Forces or other military agencies. With that in mind, there are a good amount of clinics and shelters that are customized and tailored towards veterans and a lot of this happens with the cooperation and consultation of the Veterans Administration, the agency of the United States government that most often deals with soldiers and their struggles after they leave active service.

Obviously, mental health is one of the larger concerns and issues for veterans as many of them have post-traumatic stress disorder (PTSD), traumatic brain injury (TBI) or other anxiety-related disorders. Another facet of care that should be focused upon with the mentally ill homeless, and this is true of both veterans and regular civilians, would be the primary health care that homeless people quite often miss out on.

In conjunction with federal agencies like the Department of Health and Human Services, there has been a lot of attention paid recently to the primary healthcare needs of patients that are homeless in addition to whatever mental health and/or substance abuse issues they may be experiencing at the same time.

The main pain points when it comes to the mentally ill homeless would be those with PTSD in general, anyone who has any form of schizophrenia and anyone who experiences "severe" psychiatric symptoms as defined and summarized on the Colorado Symptom Index (Chrystal et al., 2015). Another linchpin of helping the homeless, especially those with mental health issues, would be the broader support of the community.

Further, this community support is something that has to be fostered, developed and created in the first place as it does not happen automatically nor does it keep up its intensity just by inertia alone. Beyond that, there are specific models that some support groups take on when it comes to such support. One example would be what is known as critical time intervention (CTI).

In at least some iterations, there is a triangular relationship in which three dyadic relationships exist, those being worker/client, worker/primary support and primary support/client. Structured and specific models like this are seen as a way to help in the discharge and transitional service process. This structure (or others like it) are seen as an aid and an advantage in avoiding the "vicious cycle" of institutionalization and/or homelessness.

Indeed, it can be quite challenging to help a homeless patient with severe mental health issues avoid such a nasty cycle. The needs that can be met, in whole or in part, through this community-based support include psychiatric treatment, substance abuse treatment, medical care, public assistance, social welfare benefits, the resolving of immigration issues, school, employment, day programs, social connections/networking and the list goes on.

Even with all of the busy-work that occurs with the community support and their associated agencies, the patient has a burden to reach as well. For example, if a patient is given a space in public housing, there are certain rules that they are required to follow. Those rules tend to be rather strict and disobedience of those rules can lead to sanctions or even expulsion from the public housing. After all, the actions of some patients cannot be allowed to endanger the progress and structure of other patients.

If a certain patient is not willing and able to get treatment at a certain point in their life and their struggle, there is only so much the community agencies and other support can do. This can (and should) hold true when dependent children are involved. Indeed, a mother can say that they want to get well and be a good mother/father to their child.

However, if they are unwilling or unable to get to the place they need to be physically and mentally, that does not mean nearly as much as the patient might hope. Ultimately, the safety of the child is most important. The author of this report has seen more than once case where a mother says she is really serious but her actions simply do not back up that assertion (Chen, 2014).

The just-made point segues into a fairly major flaw that can creep up when it comes to assessing and helping the mentally ill homelessness and that is subjectivity. Just as the mentally ill homeless themselves shave subjectivity and objectivity issues they need to deal with, the people helping the mentally ill homeless sometimes have to struggle with that as well. Indeed, when Child Protective Services (CPS) makes a decision to yank a child from a parent's custody, they are often making a judgment call.

So often, they are acting from a position of excessive caution rather than what is verifiably and provably going on. Much the same thing can be seen when dealing with the homeless. Even mentally ill people can put on a good show when it comes how competent they are. At the same time, mental health and social work professionals need to keep their personal lenses and prisms as they view the homeless as objective and free from judgment as possible.

Again, there is the consideration of exercising a strong amount of caution. For example, if there is a very good chance that a mentally ill patient might hurt himself or herself, that person may need to be committed. At the same time, that call should not be made too quickly or with too much casualness. Being too quick to commit someone can lead to civil rights and trust issues but being too gun-shy can lead to a dead patient due to suicide.

Lastly, it has to be noted that the transitive and chaotic nature of a homeless person's life can make it all the more harder to monitor a patient and exercise due diligence about the same (Gadermann, Hubley, Russell & Palepu, 2014). Something else that the author of this report is trying to emulate and understand is the actual identification and understanding of what leads to homelessness, what those people are going through and so forth. The scholarly sphere has addressed this question as well including through very vast longitudinal studies.

Indeed, it can be very informative to study and interact with a mentally ill homeless person over time and see what happens as they progress. One can see what works, what does not work and the reactions that the mentally ill homeless give to either outcome. One particular study actually dealt with some people that went through a substance abuse program in the 1990's. About 17-19 years later, it was decided to seek out those people and find out what directions and "trajectories" their lives had taken since then.

The people treated back in the 1990's were treated for up to eighteen months before the program was shuttered for them. One thing they found is that people tend to kick drug habits as they get older. However, mental health issues are much more stubborn, at least they tend to be, because those issues don't just "go away" over time which is what tends to happen with drug use.

Even so, it was found that only the worst of the worst mental illness sufferers (much like drug users) continued to suffer after all those years. It really just comes down to when "enough is enough" and treatment is truly craved and desired to the point that the patient is willing to do anything to get better and as soon as possible.

One thing that was found, and this speaks to the social justice vein of discussion in this literature review, is that criminal sanctions often had very little to do with why and how someone got their life sorted. Indeed, this should inform law enforcement and social work agencies. Even if vagrancy and panhandling (among other things) are criminalized, they do not do much in terms of dealing with the problem at hand.

Instead of dealing with the symptoms and manifestations of homelessness, there should instead be a focus on treating the root cause. That being said, no sane person would argue that protecting children affected by mental illness should not be protected from the violence and/or dysfunction of their parents when they are untreated (Rayburn, 2013). One thing that may be less traditional and clinical but may help nonetheless is the use of spirituality.

To be sure, if a patient is averse to the infusion of religion and their treatment, it should not be foisted and forced upon them. However, many of the people in the United States are religious in some form or way and healthcare itself has seen a lot of intermixing of spirituality and healthcare. In many ways, spirituality and faith can be a way for a person to mentally sustain and support themselves as they go through tough times and experiences.

One group that this seems to particularly pertain to would be mentally ill homeless mothers of young children. Alternate and different approaches are increasingly seen as being necessary because homeless mothers are one of the fastest growing subsets of homeless people in the United States. Further vexing and complicating matters when it comes to homeless mothers is that while mental health issues often contribute to a person being homeless, not a lot is known about the factors that affect a mother's mental health.

It has been found that the fusing of spirituality and mentally ill homeless mothers leads to some pretty strong correlations when it comes to things like forgiveness, congregational problems, negative religious coping and overall spiritual meaning. It should be made clear that religion infusion is not something that is effective in all instances. Indeed, some homeless mothers that are mentally ill may go to a church and feel they are being judged and mistreated, whether this is actually true or not.

Beyond that, assessing efficacy and outcomes when it comes to religion and mentally ill homeless mothers is not the easiest thing to quantify because of how hard it is to keep up with and monitor the people and patients involved (Hodge, Moser & Shafer, 2012).

The author of this report thought it would be helpful to gain an international perspective since a lot of the people in the United States (and thus, a lot of the homeless) are from cultures and/or countries that are not American in terms of their source. One country that has been studied in terms of the mentally ill and what can and does happen when they are homeless would be Japan.

A study of 423 people was done and it centered on two different areas of the city of Tokyo, Japan. The average age of the people involved was actually rather high, sitting at 60.9 years. However, the vast majority of the homeless people were men. Of the sample, 392 were men and 31 were women.

This is not completely different than the United States given that homeless people tend to be men but the overall ratio is not nearly that out of phase and the numbers are evening up by the way, as mentioned earlier in this report. Anyhow, the findings in Japan and Tokyo in particular were not all that different from the United States even with the cultures of the two countries being fairly different.

Indeed, they found that interventions and assistance like supportive housing, emotional social support, healthcare services (including those services above and beyond just mental health) and so forth are all assisting and helpful when it comes to the eventual outcomes for the mentally ill that happen to be homeless. Indeed, an all-inclusive and comprehensive approach is better overall than just doing the mental health treatment. This makes sense given that the patients involved are dealing with issues that go far beyond just mental health.

As has been stated multiple times throughout this report, one of the major aggravating factors that leads to a mentally ill homeless person not getting treated is that they do not have a stable home that they can afford. If this is removed as an issue, at least until the person can stabilize, this can make the chances of success much higher. This is true in the United States as well as in Japan (Ito, Morikawa, Okamura, Shimokado & Awata, 2015).

One part of dealing with the homeless, the mentally ill in particular, is keeping track on them. This has already been mentioned and covered in this report but will be drilled down upon in this part of it. The source about to be mentioned also adds some international flavor and context to the discussion and research within this report.

In the United Kingdom, they have people (just like that exist in the United States) that do what is known as "come to notice." Come to notice is when a person approaches a police officer or mental health professional or checks into a mental health ward with a mental health crisis. The factors leading to the crisis can be real or they can be completely imagined and manufactured by the mind of the person involved.

Either way, there is a fairly common tendency for these people to eventually check themselves out of the hospital or otherwise go missing after their initial reveal to the police or mental health professionals. It can be completely vexing and confusing for mental health and police professionals why someone would come forward and then subsequently disappear. Perhaps there is fear of police or other forced incarceration due to the mental health issues and/or police-witnessed infractions such as littering, panhandling and so forth.

There is also the possibility that the person in question is simply acting without any rationality or mental acuity and thus just about anything they do is unpredictable and hard to control. Regardless, helping the homeless people is complicated by a number of factors and the homeless people's ability is much easier to pull off in general as they do not have a stable address that they can be expected to return to and they are mentally imbalanced in general.

However, there should be a good faith effort to locate and assist people that cry out for help like that. It is possible to find them and there can be success stories when those people are found. The solutions and interventions should obviously focus more on mental health treatment and less on police punishment and incarceration.

Indeed, the mentally ill do not get much of any assistance when they are jailed and the jailing often makes things worse if not terrible as compared to how bad they already are (Pakes, Shalev-Greene & Marsh, 2014). In addition to the mentally ill that approach police and the homeless mothers mentioned before, another subsection of homeless that deserve their own mention are the young.

Indeed, the minds and experiences of the young are still being formed and developed and thus it is much easier (comparatively speaking) to address their needs than it would be to help a sixty-year-old man, as an example, who is quite set in his ways. While they are more easily helped than older people, the young are also much more likely to have negative contact with police.

Further, this negative contact usually has a lot to do with drugs (at least in part) and this can lead to prison sentences and other behavior that can greatly elongate the same. Indeed, studies on the subject have found that there is a "significant association" between drug use/mental health issues and arrest, length of time of being homeless, depression level and length and so forth.

Indeed, a great amount of the prison population is mentally ill and the running (but unfunny) joke is that prisons are basically very large and punitive mental institutions. Of course, the best way to deal with that happenstance would be to focus on the factors that lead to all of this eventuality happening but it is not that simple. Indeed, identifying the factors themselves is not the hard part.

Indeed, the hard part is deciphering how the factors affect and lead to each other because that is almost certainly what is going on in many to most cases of youth offenders (or potential youth offenders) that are homeless. The stakes are obviously high because the rates of high school dropout, unemployment, drug abuse, pregnancy, mental illness (prevalence and actual severity) and arrest rates are all higher for the homeless as compared to those that have a consistent place to lay their head at night (Fielding & Forchuk, 2013).

Even with the ostensible fact that helping the homeless and mentally ill is a good thing to do, there are two problems that make that assertion hard to follow through on and otherwise believe in. First, many people, mentally ill or not, are not actively seeking help and feel that they do not need to be saved. Not all of these people actively engage in criminal and unethical behavior but a lot of them do.

When drugs are involved, there is a much higher likelihood that crime is play because this is often necessary to raise money and resources to feed their habit, whether it be alcohol or an illicit drug like methamphetamine, crack or heroin. Further, the public has little sympathy for such people and the mental health argument is often dismissed as being a mitigating factor because of the possible or actual death and destruction that is rendered by the person.

In much the same way, family members often turn their backs on their homeless family members because of their drug use and/or mentally ill status because they don't want to be stolen from, assaulted, or otherwise subjected to negative events. Lastly, there is a concern about how much money could and should be spent on services for the homeless. As noted before, not everyone that is homeless wants help even if it is quite obvious that they do.

Some homeless have given up on life and just presume that the street life will be the norm for the rest of their days. All of the above feeds the notion that there are things that the homeless are entitled to versus what they need. In the end, all they really "need" in the eyes of many is food and some form of shelter, even if the latter is an overpass.

However, there are those that argue that the homeless should be treated with "dignity" and that the overuse of mental health commitments can actually become a.