Homelessness and Mental Health Linkages: Review of National and International Literature
1.4 Prevalence of mental illness among homeless people
- Executive summary
1. Review of national and international literature- 1.1 Introduction
- 1.2 Definition of homelessness
- 1.3 Definition of mental illness
- 1.4 Prevalence of mental illness among homeless people
1.5 Risk factors for homelessness- 1.6 Intersectoral Collaboration
- 1.7 Evaluation of intersectoral interventions for people who are homeless and living with a mental illness
- 2. Consumer perspective
- 3. Priority groups
- 4. Conclusion
- 5. Bibliography
Mental illness and homelessness are intertwined in terms of cause and effect. It may be that the experience of being homeless, the constant fear, danger and victimisation results in people becoming emotionally distressed. At a societal level, lack of employment options, housing, stigma and discrimination may all interact with the individual risk factors that lead to homelessness. This may in turn exacerbate the original condition. While a person with a pre-existing illness may be more vulnerable to becoming homeless by the nature of their illness, there is also evidence that severe mental disorders, such as psychotic illnesses, are a risk factor, rather than a consequence of homelessness (Herrman & Neil, 1996). Hallucinations, thought disorder, disorientation, paranoia, anxiety, loss of motivation or interest in their own welfare, and other disabilities may contribute to an increased vulnerability to homelessness (Breakey & Thompson, 1997).
People with problematic drug or alcohol use and schizophrenia are less likely to remain in stable accommodation than those without drug and alcohol problems. (Caton, Shrout, Eagle, Opler, & Felix, 1994). Homelessness can occur both as a direct consequence of established mental illness or as a result of problems with coping, social withdrawal and poor occupational performance that characterise the early phases of schizophrenia. The loss of accommodation itself may be less important than the ability of the individual to escape from the condition once it has arisen.
There is strong indirect evidence that severe mental illness can increase the risk of homelessness, independent of long-term hospital stay. A quarter of all severely mentally ill people seen by clinical teams in the London-wide Homeless Mental Health Initiative had lost their permanent accommodation following eviction for disturbed behaviour or non-payment of rent that was a direct result of their mental illness (Craig & Timms, 1995).