The issues of mental health and homelessness are inextricably intertwined. Mental health affects the lives of individuals by hindering them to conduct the functions of their daily lives such as paying their bills, maintaining their jobs and managing their households. Apart from disrupting their daily life, mental illness also prevents people from developing and maintaining stable relationships. Such problems range from the threat of being attacked, difficulty in meeting fundamental needs and problems gaining access to mental health services. On the other hand, homelessness exists when individuals lack safe, stable and suitable places to live. Therefore, people with mental health problems are at a greater risk of becoming homeless.
However, these problems are being complicated by the socio-cultural and gender structures within the present mental health services. This is especially true for individuals with chronic mental illnesses, particularly those that may influence their reality testing such as bipolar disorder, major depression, and schizophrenia. Hawaii, like other states of America, sees a relationship between mental health problems and homelessness. In this state, mental health problems may be the most potential risk factors that contribute to homelessness. This paper seeks to discuss mental health and homelessness in Hawaii. It will start by the definition of the problem both globally and locally, highlight some of the factors that contribute to mental health and homelessness and further discuss some alternative solutions for these problems.
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Definitions of mental health and homelessness problems globally and locally
The relationship between mental health problems and homelessness has been the subject of psychiatric research and sociopolitical discussion for quite a while. According to studies carried out in the last two decades, it has been found that the lifetime prevalence rates of mental illness of between 60 percent and 93.3 percent are among the homeless (Hwang, 2011). These results reveal that individuals who are homeless are more likely to experience compromised mental health than the total population. For some, these problems can come before the onset of homelessness or through interactions with other determinants such as employment and income influences. Mental health problems can either become critical with continued homelessness or contribute to homelessness. In Western countries, homeless people have higher mental illness prevalence as compared to the total population and mostly suffer from drug dependency and alcoholism.
As opined by Brown (2016), approximately 20 to 25 percent of homeless people have a severe mental illness. In the United States, people with mental health are widely overrepresented in the population of individuals that experience homelessness. From the study conducted on a given night in 2017, it was estimated that out of 550, 000 people in America that are homeless, one in five had a mental health problem. The percentage of people experiencing chronic homelessness with mental health problem was even higher accounting to one in three. According to a study conducted by the National Institute of Mental Health, it was found that about 6 percent of Americans have mental health problems and 45 percent of the homeless population indicates a mental illness diagnoses history. In America, the mental health problem is mostly cited as a significant cause of homelessness, showing causative relationships that surpass mere correlation.
Individuals that are homeless and suffer from mental illnesses are even more prone to physical health problems that occur as a result of neglect of self-care. Because of the increase of factors such as mental health disabilities and substance, homeless people are likely to be incarcerated. It is evident that every state in the United State arrest more homeless and mentally ill people than it hospitalizes. According to the Withy et al (2008), about 17.3 percent of prison inmates that suffer from severe mental illness were homeless before being arrested and 40 percent were homeless at one point in their lives. The problems associated with mental health disabilities and homelessness is worse in Hawaii. It is among the leading state that has the highest rate of homelessness in America, which affect approximately 505 out of one hundred thousand.
As much as the state has experienced a slight decrease in the ratio of homelessness, the homeless issue poses a major toll on the health system. According to the 2017 Hawaii Statewide Homeless Point-In-Time Count research, it is true that Hawaii has experienced a 9 percent decrease in homelessness. One of the major factors contributing to homelessness in Hawaii is the rental market. Renting a home is simply out of reach for numerous individuals in Hawaii. The high rate of homelessness has to lead to mental illness to most of the homeless population in Hawaii. With this increased rate, there is a need for the state to develop programs that can help these homeless people out of these problems.
Solutions for mental health and homelessness in Hawaii
As much as there are numerous challenges in assisting those people that are both homeless and suffering from severe mental illness, it is important as a nation, state or community to find suitable ways to serve these individuals. One of the ways that can be of help to homeless people with mental health disabilities is prioritizing the Housing First Model in Hawaii. A Housing First Model is a homeless approach that provides permanent shelter to individuals experiencing homelessness, thereby ending their homelessness as well as serving as a platform from which they can pursue individual goals and enhance their quality of life. This model is guided by the belief that individuals require fundamental needs such as food and a place to live before attending anything less critical such as attending to substance use issues as well as seeking for a job.
Prioritizing Housing First Model is important because it promotes urgency to place homeless people or those people are at risk of homelessness with mental health disabilities in housing quickly. There is an enormous and extensive evidence base that reveals that the Housing First Model is an effective solution to homelessness. As indicated by various studies, between 75 percent and 95 percent of households remain housed annually after being re-housed quickly (Withy et al, 2008). Apart from providing a house to homeless people, the Housing First Model provide supportive services such as job training programs, attending schools as well as having fewer instances of domestic violence. The Housing First Model is also a cost-efficient approach. Providing homeless people access to housing saves costs for many communities because housed individuals are less likely to utilize emergency services such as jails and hospitals as compared to homeless individuals. As much as the Housing First Model provides supportive services, it does not effectively discontinue substance use because there is no restriction for the use of drugs.
Another solution for mental health and homelessness in Hawaii is enhancing permanent supportive housing. Providing permanent supportive housing to mental health and homeless people is one of the most cost-effective means of preventing chronic homelessness in Hawaii. Supportive housing provides a safe, healthy environment for homeless people to feel secure as they become useful members of the community. This program incorporates permanent, affordable rental housing with the best community-based supportive services that assist the homeless and people with devastating and long-term disabilities such as mental illnesses, severe health conditions, and substance use disorders to access and maintain stable housing in the community. While at the permanent supportive housing, these people can be linked to life-saving resources where they can easily find job training, individual development services, mental health treatment, and counseling services.
A vast body of studies reveals that individuals who live in supportive housing can stay stably housed in the community, minimize the use of costly systems, particularly emergency health care and corrections (Brown et al, 2016). Some of the advantages of permanent supportive housing are low barriers to entry, emphasizes choice and further provides voluntary and assertive services. On choice emphasis, permanent supportive housing optimizes client housing choice as well as the services they receive. Additionally, supportive housing providers do not need clients to hit benchmarks before moving into the house. As much as permanent supportive housing has numerous advantages, it increases government expenditures on building affordable housing for homeless people with the mental health problem.
Providing affordable medical treatment is another critical solution for homeless people with mental disorders to have a better chance at recovery if they get professional and affordable treatment. Affordable medical treatment ensures that homeless people with mental health problems receive medical care timely at affordable costs. It is therefore important for the government starting from the federal government to local government to ensure that homeless people receive proper medical treatment to prevent mental health problems. This can be achieved only if the government expands Medicaid to cover homeless people who seem to be below poverty lines. Apart from expanding Medicaid, the government can also deliver support services in a more coordinated fashion.
Conclusively, the issue of mental health and homelessness is inextricably interrelated. To start with, mental health influences the lives of people by destructing them from carrying out their daily activities. On the other hand, homelessness exists when an individual lacks the safe, stable and appropriate place to live. To manage these intertwined problems, it is important to deal with them collectively. The solutions that can be used to manage mental health problems and homelessness are providing affordable medical treatment, enhancing permanent supportive housing and prioritizing Housing First Model in Hawaii.
References
Brown, R. T., Goodman, L., Guzman, D., Tieu, L., Ponath, C., & Kushel, M. B. (2016). Pathways to homelessness among older homeless adults: Results from the HOPE HOME Study. PloS one , 11 (5), e0155065.
Hwang, S. W. (2011). Homelessness and health. Cmaj , 164 (2), 229-233.
Withy, K. M., Amoa, F., Andaya, J. M., Inada, M., & Berry, S. P. (2008). Health Care Needs of the Homeless of O’ahu. Hawaii medical journal , 67 (8), 213
