Best Practices Regarding Homelessness and Mental Illness

Preliminary research indicates that homelessness is a growing problem in the United States, especially in Rhode Island. It is very common for those who are homeless to also be impacted by a mental illness, which creates an additional barrier for them to overcome. This qualitative research collected stories from homeless individuals in Rhode Island regarding their perceptions of services that work best to overcome homelessness as well as related problems, including mental illness and substance abuse. This is a local and national problem, and understanding the stories from those who “live” the experience of homelessness is valuable for practice and policy considerations. BEST PRACTICES REGARDING HOMELESSNESS AND MENTAL ILLNESS 3 Best Practices Regarding Homelessness and Mental Illness Those who are homeless are commonly also impacted by a mental illness. Homelessness is difficult enough to exit when individuals and families do not have other issues to resolve. Today’s economy makes it especially challenging to exit homelessness, but for those who have a mental illness, it is close to impossible. The combination of homelessness and mental illness is a vicious cycle that one cannot break on their own. There have been various interventions that have been implemented in order to help those who are homeless, such as emergency shelters and subsidized housing, but these solutions, either, are not permanent or do not target the chronically homeless. It is very likely that someone who is mentally ill will find himself in and out of homeless shelters, looking for the next temporary solution. The homeless mentally ill is a population that needs a variety of services, and not solely housing. This issue is very prevalent in the state of Rhode Island. Close to 4,000 people were homeless in 2007, and that number is only growing (Rhode Island Coalition for the Homeless, 2012). In addition, research has shown that between one-fourth and one third of the homeless population has had a mental illness such as major depression, schizophrenia, and bipolar disorder (Folsom, Hawthorne, Lindamer, Gilmer, Bailey, & Golshan, 2005). This means that at least 1,000 people in Rhode Island who are homeless also have a mental illness, which indicates a great need for services. The main issue is deciphering what types of services truly work for this population. Some services such as emergency shelters and subsidized housing do decrease homelessness for a time, but not permanently. Subsidized housing is directed towards those who can actually pay for housing, which are very few constituents. In addition, many homeless shelters do not provide the services that the mentally ill need; therefore, if their needs are not being met they are likely to return to homelessness. A revised approach to emergency homeless BEST PRACTICES REGARDING HOMELESSNESS AND MENTAL ILLNESS 4 shelters called Critical Time Intervention, stresses the importance of intervening during a crisis and providing a transition out of the intervention. This has shown to reduce homelessness for a longer amount of time, but it is still only a temporary solution. The Rhode Island Coalition for the Homeless (2012) is aware that the services that the homeless mentally ill need are permanent housing, with other available services and resources. If this occurs then they are more likely to obtain a job, maintain financial stability, and be less likely to return to homelessness. However, the lack of funding in the state of Rhode Island has is a major barrier that impedes on the ability for these services to be implemented. If these types of services prove to be working, then they will be much more cost effective in the long run than both subsidized housing and emergency shelters. A program in Rhode Island that was recently implemented allows those who are homeless to have permanent home and other services that will support their variety of needs. The homeless mentally ill is a severely oppressed population. The purpose of social work is to advocate for oppressed populations and provide them with resources or direct services that meet their needs and support their human rights. This program gives people the tools to promote the overall well-being of families and individuals who have been faced with many obstacles. It provides this population with a home, and offers additional voluntary services for those who feel that they need more support in fulfilling their needs to promote their well-being. The programs that will succeed most are the ones that are based on empowerment and self-determination so that the constituents are able to support themselves in their own, unique way with the tools that the program provides. These principles are what social work is based on. This study will explore the effectiveness of such programs for those that have a mental illness and are homeless. Representatives from this population will be asked to tell their story of BEST PRACTICES REGARDING HOMELESSNESS AND MENTAL ILLNESS 5 how they came into homelessness. The information sought is what circumstances brought them to seek services, what services were provided for them, and whether or not these services actually met their needs. The most valuable information comes from those who are affected by these issues because they are the ones who know exactly what they need and the best way for them to meet those needs. Further insights can be discovered on how they were treated during their services and if they felt their opinions were valued. Literature Review Homelessness in Rhode Island Homelessness is a significant issue in the state of Rhode Island, and the rate of homelessness has only been growing. According to the Rhode Island Coalition for the Homeless, there were 3,926 people who were homeless in 2007 and 4,410 people who were homeless in 2011, an increase of 484 people (RI Coalition for the Homeless, 2012). Those who are homeless in the state of Rhode Island include, children, families, individuals, and elderly. In 2010, 51 percent of the homeless population experienced homelessness for the first time. About 40 percent of this population were families in which 13 percent were children, 5 years old or younger. Forty-one percent were female, and 13 percent were unemployed (RI Coalition for the Homeless, 2012). About 18% of Rhode Island’s homeless population is considered to be chronically homeless. This means they have either been homeless several years at a time, or multiple times. People who are chronically homeless can also be limited by various problems that inhibit them from finding and keeping housing. Some of these boundaries include having a physical disability, mental illness, and issues with substance abuse (RI Coalition for the Homeless, 2012). BEST PRACTICES REGARDING HOMELESSNESS AND MENTAL ILLNESS 6 According to the Rhode Island Coalition for the Homeless (2012), the significant lack of affordable housing, partnered with low income, has greatly contributed to homelessness in Rhode Island. In fact, this state is one of the least affordable places to live in the United States. Rhode Island has suffered the second largest increase in the country for the greatest gap between the income its residents earn and the cost to rent a home (RI coalition for the homeless, 2012). A person that is working at the minimum wage must work 102 hours per week and 52 weeks per year just to afford a two-bedroom apartment in Rhode Island (RI Coalition for the Homeless, 2012). Therefore, for many residents of Rhode Island, housing is simply unaffordable. This scarcity of affordable housing increases the difficulty of exiting homelessness and also increases the possibility of homelessness for low-income individuals and families. In addition to the lack of affordable housing and low incomes, the State of Rhode Island also had to make extensive cuts in service programs in order to balance its budget (RI Coalition for the Homeless, 2012). In 2009, it was reported to CNN that in an attempt to fill a $350 million budget gap, Rhode Island cut community service grants that assist the elderly, the youth, and the poor in half (Luhby, 2009). The state also cut other service programs such as health care, childcare, housing subsidies, and food assistance (RI coalition for the homeless, 2012). Approximately 6.8 percent of Rhode Island residents are living in deep poverty, with an income of less than half of the poverty threshold, which is $9,601 for a family of three (The Economic Progress Institute, 2012). A family of three with a total income of $9,601 is likely not meeting all of their basic needs. When low income families are struggling to meet their basic needs, these service cuts can easily lead to homelessness. It would be common that many of the residents are unemployed as well, which means these services would be sought out more than ever. The November 2008 unemployment rate of BEST PRACTICES REGARDING HOMELESSNESS AND MENTAL ILLNESS 7 9.3 percent was the second highest in the country. In December of 2008, the unemployment rate was 10 percent, which was the highest in thirty years and more than twice the rate in 2007. As if these employment rates were not enough to increase homelessness, the foreclosure rate in 2009 was 3.18 percent, which was the tenth highest rate in the nation (Luhby, 2009). With the state of Rhode Island’s economy, and these record high rates of unemployment and foreclosure, it is inevitable that the rate of homelessness will also rise until a solution is found to end this vicious cycle. The only two ways to get out of unemployment are to drop out of the labor force or find a job. Unfortunately, in this recession there is a higher probability that discouraged workers will drop out of the labor force than find a job (Tasci & Burgen, 2012). It is also reasonable to deduce that the population which had to drop out of the labor force is more likely to develop a mental illness such as anxiety and depression, due t