Social And Health Factors That Lead To Homelessness

The issue of homelessness is universal. Almost every country is trying to find a solution to reduce the growing homeless population. In the United States, there seems to be a misunderstanding about homelessness and a perception that it is a self failure or a flaw that has made an individual or family homeless. Taxpayers can be hesitant to vote for bills that will allocate funds to assist in welfare programs and government assistance, due to the thought that there must be something morally wrong with people that are living on the streets or in shelters. The term “welfare queen” has been used a lot in news and in everyday conversations about why funding government aid programs should not be prioritized. The truth is there are many factors to how and why people become homeless ranging from predatory lending practices done by mortgage brokers or for-profit universities, criminal history, overall health including mental health and addiction, housing and rent prices increasing dramatically, and lastly income inequality and discrimination. In this paper, we will discuss a few of these determinants and try to bring light to the cycle of homelessness and why it is so difficult to break the cycle.

Psychiatric disorders affect 30-40 percent of people who are homeless (Lippert et al. 2015). There are a few different types of homelessness; chronic, episodic, and transitional. Chronic homelessness is “characterized by a few spells lasting long periods of time, reflecting a persistent homeless state” (Lippert et al. 2015). Episodic homeless is defined by “residential instability, with frequent shifts between housed and homeless circumstances” (Lippert et al. 2015), and transitional homeless “comprises a short, isolated homeless spell between moves from one stable housing situation to another” (Lippert et al. 2015). There is something known as the accumulation of risks perspective which is mainly referring to the idea that problems accumulate for homeless people (hardships) that can accumulate over the life course. The accumulation of risks perspective holds that “earlier advantages (and disadvantages) influence the accumulation of resources (or hardships) throughout the life course and exacerbate health inequalities over time” (Lippert et al. 2015). This perspective is further supported by the stress theory, which is the theory that “disadvantaged social positions carry greater exposure to stressors and weaken the stock of economic, psychological, and social resources that may be deployed to cope with life stress, ultimately jeopardizing mental well-being” (Lippert et al. 2015). A study done by Adam Lippert and Barrett Lee concluded that “psychiatric disorders are most common among people who are chronically or episodically homeless and least common among the new-entry homeless. It was also found that the lower prevalence of mental health problems among the new-entry group is related to this group’s fewer encounters with life stress”. Approximately 78 percent of the homeless population suffer from at least one substance use disorder (excluding tobacco use disorder) and 68 percent suffers from at least one mental disorder (such as depression, PTSD, schizophrenia, bipolar disorder) and 55 percent suffers from both substance use and mental disorders (Schutz 2016). The strongest and most consistent risk factors were substance use disorders and mental illnesses, followed by low income and other income-related factors.

In 2012, the National Alliance to End Homelessness presented the notion that homelessness in the United States can be ended, rather than managed. It is believed that ending homelessness is “achievable through a reimagined approach that combines evidence, resources, innovative thinking, and political will” (Henwood et al. 2015). It has been nearly 70 years since the United States adopted the United Nations Declaration on Human Rights, which stated housing as a fundamental human right that should be attainable by all. “Homelessness has a disproportionate impact on certain historically marginalized or stigmatized groups, including African Americans and individuals with mental illnesses and other evidence” (Henwood et al.2015). There have been studies that document the high costs of healthcare, behavioral health, criminal justice, and other services persons experiencing chronic homelessness incur- upwards of $40,000 per year- make it abundantly clear that the continued existence of homelessness is staggeringly expensive to taxpayers.

There has been some success using participatory action research on addressing the health care needs in the homeless population. It has been found that serious mental illness exacerbates morbidity in cardiovascular disease, diabetes, obesity, asthma, epilepsy, and cancer, often resulting in barriers to health care services and lack of treatment adherence (Broadbent et al. 2008; Kessler et al. 2005). These cumulative risk factors often end in adverse health outcomes. Homeless people in rural settings have reported negative encounters with health care professionals, describing examples of demeaning and disparaging nature (Kiser et al. 2018). In a recent national study, the unmet health needs of the homeless, as compared with the general population, could be 6 to 10 times greater, while the inability to access medications and treatments can become insurmountable barriers when there is a need to focus on basic survival skills including nutrition, safety, hygiene, and shelter (Baggett et al. 2010). The participatory action research that was done was a collaborative approach between community members, the homeless individuals, representatives from homeless shelters, and the academic community jointly participating and sharing control over all phases of the development, implementation, and evaluation of the project from assessment to dissemination (Kiser et al. 2018). There are several obstacles to access to care including lack of insurance, lack of money for copayments, lack of access to medications, and challenges with transportation. The project was successful because the participatory action research has given a voice to key members of the community involved but it has also required high levels of time, trust, turf-sharing, and respect for each member of the coalition. The housing first model has been described as the “clear solution” to chronic homelessness by developing immediate access to private-market, scatter-site housing without prerequisites for sobriety, psychiatric stabilization, or completion of previous treatment programs (United States Interagency Council on Homelessness, 2010). The United States Interagency Council on Homelessness works to “coordinate the Federal response to homelessness, 2013, para. 1). The system works to develop a better understanding of homelessness estimates and trends and can be used to measure meaningful progress to end homelessness over the next decade. Since the 1990s, the question of “how can we help homeless people” has transitioned to “how can we solve their homelessness?”. The housing first approach was initially viewed as counterintuitive but is now a leading solution to rapid housing of the most vulnerable homeless people. This strategy undoubtedly requires an unprecedented national partnership between public, private, nonprofit, and faith-based sectors. Ending homelessness means “that every community will have a comprehensive response in place that ensures homelessness is prevented whenever possible, or if it can’t be prevented, it is a rare, brief, and one-time experience” (What Does Ending Homelessness Mean? 2018). Specifically in the United States, New York is starting to use some Medicaid funding to finance the construction of new permanent housing, Abilene, Texas has recently ended homeless in the veteran community (Broom 2019). Housing costs should not compromise other basic needs.

Housing and rent prices are divided into two parts: the cost of maintaining, operating, and construction, the land that the building sits on and how valuable that location is. The inability to pay rent that covers just building maintenance or operating costs is due to income, however, if there is a struggle to find affordable decent housing even if a person can cover the overall building costs then the issue is the affordability of the location. For many years major metropolitan cities in the United States, especially west coast cities like San Diego, Los Angeles, and San Francisco, the price of the land has increased dramatically. The buildings themselves are barely renovated and rarely offer any more amenities than a private bathroom, however, the location is desirable. Portland, Oregon is seeing a rise in gentrification similar to what was experienced in San Francisco post-WWII (Barton 2011). Once undesirable, industrial areas like the Northwest or even the North and South East districts have been “discovered” by wealthy affluent families. Lower-income housing is becoming less prevalent and individuals or families are being evicted without the option to resign a lease due to property owners wanted to increase rent. The property owners know once more affluent people move to the area the overall downtown center will improve which will again reinforce the higher cost of the rent. Currently, in the Portland area, the overall rent and housing prices are increasing creating a hot market where homes are being sold within days of being listed. Gentrification is pushing out longtime residents and forcing them to move outside of their districts or outside of their counties, uprooting children from schools, creating longer commute times to work, and creating overall instability in their lives and the lives of their children. Childhood housing instability puts children’s school readiness at risk in turn lowers overall educational attainment (Ziol 2013).

Causality has been discovered in areas that at one time were deemed undesirable, or locally undesirable land uses and increased gentrification in those areas with increasing land price. Usually, these areas are close to industrial plants, warehouses, and are generally not close to a body of water, or natural areas. This area had lower property value or lower land value. Once these areas are cleaned up or have the potential to be cleaned up it is common for developers or wealthier individuals to start to buy up land and property in order to then profit on the incoming gentrification. Cities are not trying to create gentrification, they are merely trying to clean up the city and create a more equitable living situation, unfortunately, this brings about gentrification by creating a model where people of the lower class, or minorities are being moved out of their homes, maybe by being bought out, or eventually being unable to afford the overall rise in the land price. “If improvements in environmental quality encourage gentrification and the displacement of lower socioeconomic status populations, benefits may flow instead to higher status residents while costs are incurred by the people least able to afford them” (Eckerd 2011). There need to be environmental quality improvements being made to all areas of a city without gentrification happening. Yet it has been seen like stated above, that no environmental improvements need to be made for there to be gentrification. Only if land shows some potential and could be profitable, so it is difficult to predict when and where gentrification will occur.

Having a criminal record is considered a “symptom” of being homeless, this is because of a large overlap between being homeless and having a criminal history. 'Not only are the large number of people released from criminal justice institutions at increased risk for homelessness, but conversely, homeless people are vulnerable to incarceration' (Tsai et al. 2013). Being incarcerated for any number of months or years does not in itself lead to lack of job attainment and job education, rather incarceration just keeps individuals from progressing their lives because they are in a cell or have the stress of court dates and fines (Tsai 2016). Some of the more common crimes that homeless individuals are arrested for are disorderly conduct, vagrancy, and public intoxication. There is a hypothesis that the homeless population isn’t being arrested because they are a violent threat to society, but they are a nuisance to society therefore being put in a cell for some time will benefit society as a whole, called the “rabble management thesis” (Fitzpatrick 2011). This thesis can be proven when looking at the common crimes and seeing that these crimes do not typically affect others, rather just affect the individual. Anything more serious like assault, burglary, or trespassing is typically done to find a place to sleep over the night, or means to secure a place to sleep.

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Mental illness, as well as military history, are extremely common in the homeless community that has previous experience with the criminal justice system. A longer history of incarceration is usually in tandem with a history of mental illness compared to short-term or no history of incarceration (Rosenheck et al. 2013). It has also been found that if there is the proper treatment for mental illness, for example, someone who is brought into the criminal justice system with symptoms of impulsive behavior or assault associated with drug use then counseling and coinciding with substance abuse treatment is beneficial and lowers that person’s risk of being re-arrested (Roy et al, 2016). Since mental illness and homelessness are so in tandem there is an issue with re-establishing individuals who have involvement with the criminal justice system and co-occurring disorders.

Obtaining and maintaining housing is by far the most difficult for these individuals. Not only is obtaining a means of housing difficult but the added stress of attaining a job; back in 2005 a national study was done that researched 5 U.S. cities to figure out if employers would hire someone with a criminal background, overall 65% of employers said that they would never higher someone, regardless of the offense, who had a criminal background (Clark et al. 2017).

Discrimination plays a big role in arrests and can be a predictor for the possibility for an individual to be re-arrested. In Canada a study was done with a total of 607 participants, a common predictor of re-arrest was male gender and aboriginal ethnic background (Clark et al. 2017). Profiling done by police is common not only in Canada but is common in the U.S. as well. Discrimination takes many forms, not only ethnic but there is also sexual discrimination, for example, a police officer arresting a homeless transgender individual prostitute because of personal biases instead of arresting a female prostitute. Discrimination can lead to mental health issues like depression and suicidal tendencies, this already happens with people who are sheltered face discrimination; the result is tenfold for those who face discrimination and are homeless. Once an individual has a criminal record, especially someone who is already facing daily discrimination due to race, gender identity, sexual identity, or mental health issues, finding a job, maintaining healthy habits, and obtaining a home or apartment can be difficult and usually, most of those priorities take a backseat because a lot of the times it seems like a lost cause.

Due to the way our criminal justice system works we do not give enough emphasis on rehabilitation, instead, it is much more common to just house people that society perceives as a threat for a period of time and then they are released. Unless properly housed a lot of already homeless individuals will become homeless again, and will most likely be re-arrested, then instilling the belief among society and police officers that homeless individuals are a lost cause or they do not care about their well-being, which reinforces the homeless individual that they are a lost cause because no one is telling them differently.

This brings us to the issue of police decision-making. Many times police are not properly trained to handle homeless individuals. Many homeless individuals, like stated above, have co-occurring mental health problems, sometimes they are genetic, and sometimes they are brought on by traumatic events that have happened in their lives, sexual abuse, death of parent or guardian, early drug abuse/addiction, or long family history of incarceration. The officers that are dispatched to the scene for example of public intoxication, see is just a drunk individual and are trained to obtain relevant information and to make an arrest if warranted. The officers are not considering the possible life events that have to lead this individual to become homeless or feel ostracized from their community. Even if an officer has a personal empathetic feeling associated with the intoxicated homeless individual, they have a protocol to adhere to.

Officers may have difficulty identifying signs of mental illness or temporary mental instability. It is not protocoled to locate or to contact a local hospital or clinic while on the scene but to make arrests and maybe ask those questions later. Our criminal justice system is set on retribution and justice that it has lost sight of the individuals who need it the most. Homeless individuals with mental illness have nowhere to go, making them an easy target for arrests because they are more visible than other offenders. Homeless individuals with mental issues are also more likely to be taken advantage of by other offenders. They have a higher chance of being targeted to perform certain illegal jobs, which in turn again give them a higher chance of being arrested; because of the lack of trust for police homeless individuals are not as likely to cooperate (Clark et al. 2017).

Overall in every journal, article, TED talk, and book that we have read or watched, there is one concept that stands out the most and the most repeated. In order for our nation to begin to solve the problem of homelessness, we must create a fully integrated system that helps all sectors of public health, public housing, and veteran affairs to become one strong program. Communication is necessary within each and cooperation is crucial in order for this system to work.

There are many extenuating factors that contribute to an individual's journey into and out of homelessness. In order to prevent the cycle completely, it is imperative we address these causes. The homeless population isn’t a fixed group of people, it is ever-changing with people who are just coming into or out of homelessness. Things like mental health issues, substance and alcohol abuse, run-ins with the criminal justice system, housing inequality, and income inequality all need to be considered. The first step in addressing the housing need across the United States.