Homelessness and Mental HealthHLTH 203- Dr. Sharon KirkpatrickOliver Maynard-Langedijk, Angela Dilks & Maurran Rajalingam

What Is Homelessness? What Is Mental Health?

Homelessness: Lacking a night time residence (unsheltered, emergency-sheltered, or temporarily sheltered) that is intended for human habitation or living in an unstable circumstance; at serious risk for losing stable housing (Castellow, Kloos, & Townley, 2015)

Mental Health:“A state of well-being in which every individual

realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” - (World Health Organization, 2014)

The Link Between Homelessness & Mental

Health● Clear link between stressors of homelessness to mental health disorders including psychiatric distress and psychosocial vulnerability (Castellow, Kloos, & Townley, 2015)

● Interacting risk factors stemming from social, environmental, financial, biological, and political barriers:○Affordable housing, income sources,

education/employment, social/community supports, health care services, substance abuse, etc.

Population-Based Approach & The Challenges

● Working from the social ecological model

● Intended and unintended consequences● 235 000 people experience

homelessness in Canada/year (Gaetz, Gulliver, & Richter, 2014, p. 5)

● When homeless individuals seek help, morbidity & mortality rates are greater, increased need for intensive treatment (Darkwah et al., 2012, p. 1)

● Stakeholders: Government Officials/Policy Makers, Community Liaisons & Health Care Professional (and so on…)

The Health Care Professional● Delivery of preventative/educational

programs, harm-reduction strategies, and individual advocacy (World Health Organization, 2005)

● Realize that mental illness is frequently derived from an array of causal factors; not only medical reasons

● Patient-centered care (individual autonomy, tailored practice and stable housing status) (Chrystal et al., 2015)

“Barriers to [accessing] health care for the homeless are discrimination, hours of business,

appointment procedures, and financial disincentives for practitioners”

(World Health Organization, 2005)

What Do We Do?Need to collaborate with

other stakeholders and existing strategies to work

from a socio-political framework that addresses

environmental, financial and interactional barriers to access the appropriate health care services.

Prevalence

● The number of people with personality disorders and psychotic illnesses is much higher among the homeless (Fazel, Khosla, Doll, & Geddes, 2008)

● Most common mental disorders among homeless are alcohol and drug dependency

● Chronic homeless (homeless for over a year) = more common mental illness (Fazel, Geddes, & Kushel, 2014)

The Community

Representative

● Relay information to the community

● Bring forth issues to be addressed from the community to other stakeholders

● Provide personal experiences from among the community for the other stakeholders to consider when creating interventions

The Role of The Community

Rep.Influence the rest of the community and encourage:

● Donations to food banks● Understanding the effects of

mental health and homelessness; that it is not their faultThis will decrease stigma and lessen the social pressures of

homelessness on the individual

This past February, employees at a Tim Horton’s in Vancouver dumped cold water on two homeless men sitting outside the restaurant (CBC News, 2015)

Example that society still has stigma towards the homelessStigma towards the homeless population is detrimental to their mental health

Example: Incident at Tim Horton’s

The Role of The Government

● Considered to be the “Big Players” when it comes to dealing with complex problems.

● An important role in implementing policies.

● However, when implementing effective policies they need to encompass the three main levels of government (Municipal, Provincial and Federal)

An integrated

approach to homelessness & mental

health?

What Is The Underlying Problem?

● Lack of affordable housing is the main problem.

● According to the Ottawa Charter of Health Promotion, Shelter is recognized as a fundamental condition and resource for health (World Health Organization, 2015).

● Canada has long been experiencing an affordable housing crisis.

● Initiated by the dismantlement of Canada’s national housing strategy in the mid-1990s.

Most profound impact on homelessness has been the reduction in the investment in, and

overall supply of affordable housing

The Government Policy Maker

Main Role: To coordinate housing policies,

programs and services for a shared goal by working between ministries and

across all levels of government

(Whole-of-Government Approach)

Possible Interventions ● Focal Point for Government Officials: Prevention

○ Create affordable housing initiatives (Permanent Supportive Housing)

■ Permanent housing that costs less than 30% of total household income for low-and moderate-income families (Gaetz et al. 2014)

● Working as a System: Collaborative Initiatives○ Treatment: Case Management Services ○ Patient-Centered & Harm-Reduction Strategies○ How can we work together?

■ National Prevention Strategy→ collecting and sharing data, statistics in vulnerable regions regarding homelessness and mental health; coordinate treatment and rehab facilities between other stakeholders to alleviate health care utilization costs

Housing Needs

SES Social Supports

Stigma & Discriminatio

nPoverty

Built Environme

ntAccess to Resources

Education

Employment

Burden

Affordable Housing Communit

y Supports

Food Insecurit

y

Healthy

Eating

Malnutrition

Health Care

Services Substance Abuse

Programs

Traumatic Events

Early Childhood

Development

The System of Homelessness & Mental Health

Homelessness & Mental

Health

Our Take Home MessageTo avoid labelling homeless people as

being bad and keeping in mind the multiple array of factors that contribute

to one being homeless.A collective impact approach is very

crucial in tackling this social problem and that building more affordable housing is

NOT the only solution. We need to build a national prevention strategy that can

collect relevant data on the exact number of homeless people and giving them the

help they need.

ReferencesCastellow, J., Kloos, B., & Townley, G. (2015). Previous homelessness as a risk factor for recovery from

serious mental

illnesses. Community Mental Health Journal. doi:10.1007/s10597-014-9805-9

Chrystal, J. G., Glover, D. L., Young, A. S., Whelan, F., Austin, E. L., Johnson N. K., … Kertesz, S. G. (2015,

February 6).

Experience of primary care among homeless individuals with mental health conditions. PLOS ONE,

10(2), 1-14.

doi:10.1371/journal.pone.0117395

Darkwah, V., Yamane, H., Richter, S., Caine, V., Maina, G., Chambers, T., & Johnson, L. (2012). A systematic

review on the

intersection of homelessness and healthcare in Canada. Journal of Nursing & Care, (1)5.

doi:10.4172/2167-1168.1000115

Fazel, S., Geddes, J., & Kushel, M. (2014). The health of homeless people in high-income countries:

descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet,

384(9953), 1529-1540. doi:10.1016/S0140-6736(14)61132-6

ReferencesFazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless

in western countries: Systematic review and meta-regression analysis. PLOS Medicine, 5(12), 1641-

1642. doi:10.1371/journal.pmed.0050225

Gaetz, S., Donaldson, J., Richter, T., & Gulliver, T. (2013). The state of homelessness in Canada 2013.

Retrieved from http://www.homelesshub.ca/sites/default/files/SOHC2103.pdf

Gaetz, S., Gulliver, T., & Richter, T. (2014). The state of homelessness in Canada 2014. Retrieved from

http://www.homelesshub.ca/sites/default/files/SOHC2014.pdf

The Homeless Hub. (2015). What is homelessness? Retrieved from

http://www.homelesshub.ca/about-homelessness/homelessness-101/what-homelessness

Kirkpatrick, S. (2015, January 12). Lecture on Thinking In Systems. Personal Collection of S. Kirkpatrick,

University of Waterloo, Waterloo, ON.

ReferencesMetraux, S., Clegg, L., Daigh, J., Culhane, D., & Kane, V. (2013). Risk factors for becoming homeless among a

cohort of veterans who served in the era of the Iraq and Afghanistan conflicts. American Journal of

Public Health, 103(S2), S255-S261. doi: 10.2105/AJPH.2013.301432

Pauly, B. (2008). Shifting moral values to enhance access to health care: Harm reduction as a context for

ethical nursing

practice. International Journal of Drug Policy, 19(3), 195-204. doi:10.1016/j.drugpo.2008.02.009

World Health Organization. (2005). How can health care systems effectively deal with the major health care

needs of

homeless people? Retrieved from

http://www.euro.who.int/__data/assets/pdf_file/0009/74682/E85482.pdf?ua=1

World Health Organization. (2014). Mental health: A state of well-being. Retrieved from

http://www.who.int/features/factfiles/mental_health/en/

World Health Organization. (2015). The Ottawa charter for health promotion. Retrieved from

http://www.who.int/healthpromotion/conferences/previous/ottawa/en/