This paper is an examination of the factors contributing to homelessness in the mentally ill, and the impact of the Internet on their existence.  The Internet has evolved a thousand fold in the past few years, and its usefulness is unpredictable.  Within this paper, the mentally ill homeless, are given ways to help themselves through the Internet.  The factors, causes, and life of mentally ill homeless are discussed.
 

I. Introduction (taken from interview with Claudia Guignard)

Tina is a white, pregnant teenager who fled her home at age fifteen due to physical and emotional abuse. She lives on the streets of a major city in the United States, hanging out at a McDonalds restaurant during the day.  Along with other homeless teens, called the “McPunks,” she survives by panhandling for money and scrounging each day for a new place to sleep. In this surrogate family group everyone has a role to play, ranging from father to mother, even siblings and distant cousins, giving each other the affection they may never have gotten at home.  
Debbie and Ken, a middle- aged couple, live out of their car on a dirt road in St. Paul, Minnesota. They struggle to keep their car running while looking for work.  The abuse of alcohol is a major contributing factor to their homelessness. After two months of only sporadic temporary labor, Ken and Debbie decided to drive to Florida to find work rebuilding homes after Hurricane Andrew.  Pulled over in Georgia for a DWI, they never made it to Florida. After Ken completed his thirty- day jail sentence, they returned to St. Paul, trying to survive on a small, monthly welfare check.  Chronic alcoholism affects their ability to support themselves. They continue to live in poverty and on the edge of homelessness.

A Vietnam veteran, West Side, has camped out year round on the streets of Minneapolis, Minnesota since returning from the war.  On the coldest of nights, he sleeps in four sleeping bags. West Side insists that he is “not really homeless” since he chooses to “live out.”    Although he drinks heavily and makes no attempt to disguise it, he gets up at 5:30 a.m. every weekday, rain or shine, to volunteer at Catholic Charities.  Whenever the Minneapolis police evict West Side and his friends from along the railroad tracks, the group moves on up the river to a new location.
The above case studies represent only a few of the many homeless people on the streets of our country today.  The homeless come from all sections of our population, young and old, male and female, all ethnic groups.  However, the common thread of the three cases cited above is the presence of a major mental illness. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, defines mental illness as a, “Clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress, or disability, or with a significantly increased risk of suffering, death, pain, or an important loss of freedom (page XXI, 1994). Although there are many diagnostic categories associated with mental illness, all involve impairment in one or more important areas of functioning.  In other words, the individual with a mental illness is less likely to be able to cope with the stresses of daily living and to adapt as necessary to meet the activities needed for survival.  
Whether defined as a major depressive episode, generalized anxiety, schizophrenia, addiction or post-traumatic stress disorder, the presence of a major mental illness increases the risk of a person becoming homeless.  According to the National Alliance for the Mentally Ill, severe mental illness places an individual at high risk for homelessness.  “The problem of homelessness, espescially of people with mental illness among the homeless population is one of the most pervasive social, economic, and moral problems in the United Sates” (National Mental Health Association).
 

II. Statistics:
Estimates have placed the number of homeless people at as many as 600,000 on any given night ( Interagency Council on the Homeless, 1994).  Recent research indicates that as many as 7 million Americans have experienced homelessness at least once in the second half of the 1980’s (same source).
 The National Alliance for the Mentally Ill states that approximately one-third of the homeless suffers from a severe mental illness. However, not all mentally ill people actually become homeless. Estimates note that only 5 percent of the estimated 4 million people who have a serious mental illness are homeless at any given time (National Resource Center on Homelessness and Mental Illness, 2000). 
There are actually two categories of mentally ill individuals who can be homeless: those who have some sort of mental disorder and become homeless because of it and those who develop a mental disorder after a bout of homelessness.  In a brochure put out by the National Mental Health Association (NMHA), the first category is discussed, “Many individuals who have a mental illness are at risk of homelessness due to inappropriate institutionalization or inappropriate confinement in jails; difficulties in locating and maintaining housing; accessing specialized residential and rehabilitation programs; gaining federal and state income maintenance payments and accessing responsive treatment programs” (National Mental Health Association).

There are many unsupported myths about why there are so many homeless persons with mental disorders.  One of the most prevalent is that the increase in homelessness is due to the release of patients from mental institutions.  This myth is dispelled on the “National Coalition for the Homeless” website, which states that, “Most patients were released from mental hospitals in the 1950’s and 1960’s, yet the vast increases in homelessness did not occur until the 1980’s, when income and housing options for those living on the margins began to diminish rapidly.”
 

III. Contributing Factors
 Many of us tend to think of issues such as mental illness and homelessness in a linear fashion.  That is that “A” causes “B” which then leads to “C.”  However, it is rarely possible to point to a single cause of homelessness for any one person.
According to Claudia Guignard, “with a complex and multifaceted issue such as homelessness, the idea of circular causality is more appropriate.” Circular causality is a psychological construct meaning that multiple factors interact to determine the outcome of any situation.  Conditions such as the presence of a mental disorder, unemployment or underemployment, inadequate education, poverty, etc. all interact to affect the lifestyle of each person.
We know that a number of individual and environmental factors clearly increase the risk of homelessness for people with mental illnesses.  Identifying these factors makes it possible to develop plans that can reduce the risk of homelessness and to develop strategies to assist those who are already homeless. These factors can be broken down into the following categories: individual risk factors, environmental risk factors, structural risk factors and family/community risk factors.  

Risk factors:
Individual Risk Factors –

1. The nature of mental illness
The symptoms of serious mental illnesses increase vulnerability to become homelessness.  Depending on the disorder, people with a mental illness may experience periods of extreme paranoia, depression or actual hallucination and the disruption of thought patterns.  When symptoms occur, individuals may engage in behaviors that threaten their housing stability such as disturbing their neighbors, missing rent or utility payments, even neglecting housekeeping to such an extent that they are evicted. They may also experience repeated hospitalizations that result in the inability to keep up with the rent 
 One distinct characteristic of mental illness is its unpredictability, symptoms coming and going in response to stressful life situations. The mentally ill may need help in managing their everyday affairs.  Many people with mental illnesses also have difficulty developing and maintaining comfortable social relationships. This can lead to loneliness and isolation as well as conflicts with family, employers, landlords and neighbors.

2. Co-occurring mental illnesses and substance abuse disorders
As many as one-half of all people who are homeless and have a serious mental illness also have a substance abuse disorder (National Resource Center on Homelessness and Mental Illness, 2000). The interaction of mental illness and substance abuse is complex with characteristics of denial of the condition, refusal of treatment and medication, antisocial, aggressive and even sometimes, violent behavior with high rates of suicide.  Self-help groups that have been shown to be effective in helping people to curtail alcohol and other drug use, may be reluctant to include people with additional mental illnesses.

3. Exposure to victimization
Persons with serious mental illnesses who have been physically or sexually victimized at some point in their lives may be particularly vulnerable to homelessness, especially if the victimization was perpetrated by a family member.  Research findings point to a high prevalence of sexual abuse trauma in the lives of homeless women with serious mental illness. 
 

Environmental Risk Factors -

1. Mental health system factors
Research has shown that the risk of homelessness is particularly high among people with mental illnesses who are leaving institutions.  Many individuals released from hospitals or jails into uncertain situations have no follow-up agency to help them make the transition back into community life.

2. Resource limitations
Too often, funding and other resources for support services are not available. When individual and group therapy, medication supervision and monitoring are available by trained support persons, the outcome can be vastly improved.

3. Lack of integrated community-based treatment and support services
Although much has been learned in the past decade about effective treatment interventions and preventing homelessness among those with serious mental illness, uncoordinated and fragmented services persist.

4. Lack of community-based crisis alternatives
Even with supportive services, some people with mental illnesses experience residential instability for a time, either through leaving their housing on short notice or through evictions.  Thus for many people with serious mental illnesses, hospitalization, often far from home, is the only option when they are in crisis

These are all the factors given by the National Mental Health Association in their prevention pamphlet –

1. Lack of affordable housing
Individuals with mental illnesses often become homeless for the same reasons as other people with low incomes, primarily the lack of affordable houseing.  When housing is affordable, it is often unsafe, in bad repair or located far from necessary services and public transportation.

2. Insufficient disability benefits
Without special support, people who have a serious mental illness are often unable to work in the competitive marketplace that hinders their ability to produce adequate income.  Although most of these individuals qualify for supplemental income from the government, rarely is the amount adequate for full support. For some recipients who work, even minimal income may cause them to lose their benefits.
3. Lack of coordination between mental health and substance abuse systems
The apparent role of substance abuse in the loss of housing suggests that substance abuse treatment for persons with mental illnesses is critical.  Yet a longstanding tradition of separate mental health and substance abuse services has restricted the ability of existing agencies to provide adequate treatment.  Treating individuals in two separate systems places an additional burden on the patient but also leads to mistrust and poor coordination. 
 

Family/Community Factors -

1. Stigma and discrimination
Although a Fair Housing Act was passed in 1988 that prohibits discrimination against people with disabilities, problems are still widespread. Part of the problem is negative stereotypes and unfounded fears about the mentally ill. 

2. Poor family relationships
People with mental illnesses who become homeless have less contact with their families and are more likely to have poor family relationships than those who are not homeless.  Often relationships deteriorate over time as relatives become exhausted and frustrated with helping someone who may have recurring periods of disturbing behavior.
 

IV. Prevention:
 Mentally ill people can be helped.  The only problem is that few of the suffering actually take advantage of the help, and when they do not show up for their help, then no one can go out and find them.  A large problem for homeless people that are actually trying to get a job or find help can’t leave an address or phone number.  Another thing that makes it difficult for mentally ill homeless people is discrimination.  When the mentally ill actually do get help, the statistics are promising.  Despite the hardships of helping homeless people with mental disorders, some steps are being taken to improve their lives.  After congress passed laws allocating more money for transitional programs, an organization called The National Resource Center on Homelessness and Mental Health (NRCHMH), came up with a different type of support program called Safe Haven Programs.  The program is described on the NRCHMH web page called Creating Safe Havens for Homeless Persons with Severe Mental Illness “Safe Havens programs are distinguished from traditional mental health programs as they do not prescribe a maximum length of stay and do not require that residents leave the premises during the day. Unlike many traditional residential-type programs, Safe Havens do not require their residents to participate in treatment programs. However, a program goal is to provide a safe and secure environment for residents, where once they become comfortable and come to trust the staff and other occupants, they can be engaged in mental health, substance abuse, and other treatment and supportive services.”  It is great to see the advances that are being made; however, it just isn’t enough yet.
 

Use of the Internet -
  Many of the causative factors identified as contributing to homelessness in the mentally ill could be addressed through the use of  Internet services.   The Internet opens up a world of possibilities. With adequate access and proper education, the Internet could provide endless advantages to assist this segment of our population. Examined below are some specific areas that could beneficial to our homeless and mentally ill population:

1. Up-to-date and accurate information
Information on medical and emotional conditions with recommendations for proper treatment could assist the homeless, mentally ill to secure proper care.

2. Self-help support groups
The issue of isolation and loneliness addressed earlier could be remedied by the use of on-line support groups.  Self-help groups have been proven effective with substance abusing populations.

3. Available services
Knowledge about available services and the coordination of these services could be posted on the Internet. Directions for the location of these services could also be published.

4. Address capability
The lack of a permanent address for homeless people has held some of them back in the job market of today. Even if qualified to fill a certain position, employers have been unable to reach the applicants. The addition of a permanent address site on the Internet could provide this service

5. Educational possibilities
Many educational opportunities exist on the Internet today.  College degrees as well as technical training exists that could assist the homeless to become more marketable.

6. Job search services
The posting of available jobs could assist the homeless to secure much needed income.

V. Conclusion : 
Homelessness is a very complex thing which is caused by many factors.  It is even growing to new levels, which is why something must be done.  The Internet is a great place to start unfortunately, it is not enough.  People must take what they can learn and expand it to improve the support for homeless.

“The problem of homelessness especially of people with mental illnesses among the homeless population is one of the most pervasive social, economic, and moral problems in the United States” (National Mental Health Association).