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).
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
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
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.
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
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
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
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
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
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
“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).