The purpose of this paper is to analyze the impacts the effects of being homeless with a bipolar disorder. The overall design of the study involved making use of scholarly journals and various nursing management and community resources. The findings from the study revealed that the effects of being homeless with a bipolar disorder include exacerbating mental illness, increased risk of substance abuse, increased likelihood of incarceration, and worse health outcomes. The recommendation is to make use of community interventions to that focus on assisting the homeless with bipolar disorder as it is a high-risk population. The interventions could involve a community health service program or a housing outreach service.
Bipolar Disorder and Homelessness
Hundreds of thousands of people in the United States and all over the world spend their nights on the streets due to homelessness. A significant percentage of the population is likely to have mental disorders such as schizophrenia, depression, bipolar disorder, and schizophrenia. Bipolar disorder is a common and severe disorder that affects many homeless people. The mental illness can be associated with delusion thinking which can impair their judgment. A person with bipolar disorder can have dramatic mood swings. One can alternate between periods of mania through an elevated mood and periods of depression by having an intense feeling of sadness. Homeless people face several challenges daily. The challenges become worse when homelessness is coupled with other disorders. The effect of homelessness with bipolar disorder is that it increases the symptoms of bipolar disorder, increases substance abuse, increases the likelihood of incarceration, and results in worse health outcomes.
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Increased Symptoms of Bipolar Disorder
Homelessness with bipolar disorder can further exacerbate mental illness. Homelessness can be a traumatic event for any individual which can further worsen a person’s mental illness. The homeless individual is likely to experience a higher level of psychiatric distress, increased amount of alcohol use, and lower chance of recovery which can further worsen their condition. Psychiatric distress can also lead to various symptoms such as depression, fear, anxiety, substance abuse, and sleeplessness. The increased level of distress could also result in a further alternation between the periods of mania and periods of depression. The individual may experience fewer periods where they have a normal mood.
The relationship between homelessness and bipolar disorder is also interrelated. Bipolar disorder increases the chances of being homeless as one can find it challenging to maintain stable employment or they could have little income. Their delusional thinking could lead them to withdraw from friends, families, or other people. Such a loss of support leaves them with fewer coping resources. Bipolar disorder can also impair the ability of a person to be resourceful or more resilient as their thinking could impair their judgment. All these factors can lead to an increased risk of homelessness. On the other hand, homelessness amplifies one’s poor mental health and worsens the symptoms of bipolar disorder. The individual can thus experience severe symptoms associated with mental illness. It can result in increased experiences of various mood swings.
Increased Substance Abuse
Substance abuse is highly prevalent among the homeless population with bipolar disorder. One of the reasons for the increased abuse of various drugs is the belief in self-medication where individuals may want to relieve their state of distress caused by homelessness. Additionally, homeless individuals with bipolar disorders have a high prevalence of using stimulants. These stimulants are used for self-enhancement where they assist the individual with bipolar disorder to maintain their manic state that is characterized by impulsivity, excitement, and instability.
The increased use of stimulants and other drugs is evident in research. Maremmani et al. (2017) studied 497 homeless participants where 146 were identified as having bipolar disorder. The study established that the individuals that had bipolar disorder had greater use of drugs like cocaine, tranquilizers, hallucinogens, opiates, and cannabinoids. The percentage was higher compared to other individuals that suffered from mental illness like schizophrenia spectrum. The most popular drug among individuals suffering from bipolar disorder was cocaine and opiates. The study illustrated the increased relationship between substance abuse and bipolar disorder in the highly vulnerable urban homeless population. The severe psychiatric conditions and adverse psychosocial factors made the homeless population more likely to engage in substance abuse.
Increased Likelihood of Incarceration
Another effect of homelessness with bipolar disorder is that it increases the likelihood of incarceration. Homelessness among people with bipolar disorders can result in more encounters with law enforcement. People with bipolar disorder are usually more likely to be incarcerated compared to other individuals with other mental disorders. Their encounter with further with homelessness where they lived in an unstable condition could further increase the rate at which they commit the crime. Melo et al., (2018) examined the association of mental illness with homelessness and incarceration. The study observed that the presence of the two conditions of homelessness and bipolar disorder increased the rate of incarceration by up to 16.4%. Some of the factors that resulted in incarceration were substance abuse and non-adherence to medication.
Worse Health Outcomes
The effects of homelessness with bipolar disorder can result in a further worsening of health outcomes. Having any mental illness is itself a barrier to access to proper psychiatric care. There is a low motivation to attend various appointments in case one suffers from bipolar disorder or any other mental illness. The experience of homelessness can further reduce the ability of an individual to go for any psychiatric care. People that experience homelessness are more likely to have experienced increased trauma. The presence of traumatic brain injuries, cognitive impairment, and bipolar disorder negatively impact health literacy. The interactions with the health care system can also quickly turn out to be negative.
Homeless people that have bipolar disorder are more likely to encounter severe health issues compared to the general homeless population. Bipolar disorder among the homeless is usually associated with having an increased risk of mortality from suicide and disability. One can also be at risk of suffering from various diseases such as tuberculosis, HIV/AIDS, hepatitis infection, hypertension, and drug dependency (Ayano et al., 2020). The lack of proper treatment and the inability to follow prescriptions as required increases the risk of mortality for the population.
The health-seeking behaviors of homelessness with bipolar disorder is very low. Loubière et al. (2020) analyzed the determines of healthcare use include outpatient and inpatient services among homeless people with both schizophrenia or bipolar disorder. The findings of the study showed that 61.1% of the participants had one hospitalization stay in the past 6 months and 51% had visited the emergency department for mental issues or regulation issues. One of the main barriers that the population faced was financial barriers in the form of health insurance and resources when seeking hospital care. Having bipolar disorder and increased alcohol use was associated with not using emergency department healthcare services.
Poor Family Support
People with bipolar disorder and are homeless are further likely to lack support from their families. Bipolar disorder for an individual that is homeless can result in longer periods without getting in touch with their families or friends. Having bipolar disorder or any other mental illness presents a critical challenge when interacting with other members of the community. Incarceration among individuals can further impact their relationships with their families. Homeless individuals with bipolar disorder thus required an increased level of support to help them improve their condition.
Community Interventions
Homeless people that have bipolar disorder are likely to experience more adverse outcomes and problems compared to the homeless population. Poor management of bipolar disorders among the homeless can lead to further deterioration of their economic, occupational, and social status. An increase in the number of interventions should be directed to the population to help them with their condition. Community-based mental health services can play a critical role in improving their health outcomes. The interventions could include services such as street psychiatry and integrated primary care.
The homeless population with bipolar disorder could also encounter more barriers to employment and have poorer health. The use of a housing outreach service that provides a safe way to live can stabilize one’s illness and help individuals on their path to recovery. Providing stable housing for people with mental illnesses can improve their health outcomes. The intervention can also focus on social skills and cognitive training that focuses on the development and maintenance of relationships. Such training could help homeless people with bipolar disorder to successfully regain their housing.
Conclusion
Homelessness for people with bipolar disorder can result in devastating consequences as it makes their access to health care and self-care difficult. Homelessness can result in increased distress which can lead to more manic episodes and other episodes of mental illnesses such as anxiety, fear, and depression. It can lead to an increase in substance abuse as a coping mechanism or as a way to further enhance their mood through stimulants. Homelessness with bipolar disorder can also lead to an increased rate of incarceration. The population can also have more disastrous health outcomes as they experience increased challenges with accessing proper health care. Poor family support and the low chance of maintaining stable employment worsens their situation. The recommendation for the study is that more interventions and care should be directed to the homeless population, specifically those with bipolar disorder. The first intervention should involve the provision of community-health based services such as street psychiatry and primary care. The next intervention could involve the provision of housing outreach services to stabilize their illness.
References
Ayano, G., Shumet, S., Tesfaw, G., & Tsegay, L. (2020). A systematic review and meta-analysis of the prevalence of the bipolar disorder among homeless people. BMC Public Health , 20 (1), 1-10.
Loubière, S., Tinland, A., Taylor, O., Loundou, A., Girard, V., Boyer, L., & Auquier, P. (2020). Determinants of healthcare use by homeless people with schizophrenia or bipolar disorder: results from the French Housing First Study. Public Health , 185 , 224-231.
Maremmani, A. G., Bacciardi, S., Gehring, N. D., Cambioli, L., Schütz, C., Jang, K., & Krausz, M. (2017). Substance use among homeless individuals with schizophrenia and bipolar disorder. The Journal of nervous and mental disease , 205 (3), 173-177.
Melo, A. P. S., Lima, E. D. P., Barros, F. C. R. D., Camelo, L. D. V., & Guimarães, M. D. C. (2018). Homelessness and incarceration among psychiatric patients in Brazil. Ciência & Saúde Coletiva , 23 , 3719-3733. https://doi.org/10.1590/1413-812320182311.12522016
