2. Why is mental illness so high among people experiencing homelessness?

The reasons why mental illness (or more broadly, mental health problems) is so high for people experiencing homelessness is intricately related to the prevalence rates. This means that we have already considered some of the reasons already. We have seen, for instance, that there is a lot of stress, violence, and trauma that accompanies the experience of homelessness. We have also seen that the use of substances is related to mental illness for many, although not all, people who experience homelessness. These are key factors that contribute to high rates of mental health problems for this population. However, there is much more we can say about these and other contributing factors. We invite you at this moment to pause and consider why you think mental illness is high among people who experience homelessness. You may use the space below to record your thoughts before proceeding through the section. 

 

How to complete this activity and save your work: Type your response to the question in the box below. When you are done answering the question navigate to the ‘Export’ page to download and save your response. If you prefer to work in a Word document offline you can skip right to the Export section and download a Word document with this question there.

 

In the previous section, we explored the prevalence rates of mental health issues and found that the estimates vary widely. There is no precise statistic that we can point to because studies that have attempted to record these figures have varied in their inclusion criteria. What we do know is that people who experience homelessness have higher rates of mental illness than people who are housed. The reasons for why this occurs are equally complex, as it can be difficult to identify “which came first.” For many people, mental health challenges exist prior and are then exacerbated by losing their housing and experiencing the trauma that accompanies homelessness. In the first video of this section, Dr. Tim Aubry explains further. 

 

Dr. Tim Aubry: Why is mental illness so high among people experiencing homelessness?

In this video, Dr. Tim Aubry explains that some people are more vulnerable to becoming homeless because of their mental health problems. He notes that once a person experiences homelessness, their mental health often gets worse due to the poor living conditions. Dr. Aubry notes that part of the way we think about mental health today involves substance use, which is more commonly related to single adult and youth homelessness, than family homelessness. He argues that mental illness is high among people experiencing homelessness because they are in a crisis situation, trying to survive every day, and they have the stress and uncertainty of not knowing how they will get out. This video is 3:21 in length and has closed captions available in English.

Key Takeaways – Dr. Tim Aubry: Why is mental illness so high among people experiencing homelessness?

  1. The question of what comes first, mental illness or homelessness, is not simple. Some people are more vulnerable to becoming homeless because of their mental health problems.
  2. Once a person experiences homelessness, their condition often gets worse because they are living in cramped and unsafe spaces with people they do not know.
  3. Part of the way we think about mental health today also involves substance use. Some people experiencing homelessness consume high rates of substances.
    • Family homelessness is different in that we see depression and anxiety, but substance use is not commonly related. Often family homelessness is related to economic factors.
  4. Mental illness is high among people who experience homelessness because individuals are in a crisis situation, trying to survive every day, and they have the stress and uncertainty of not knowing how they will get out.
    • These factors put people at very high risk for mental health problems, and for the exacerbation of any they may have already had.

 

In the preceding video, Dr. Aubry explained that mental health challenges can arise as people live in constant states of crisis, trying to meet their daily needs amidst great uncertainty. To understand why this has occurred we must travel back through history to the deinstitutionalization of psychiatric patients in the 1970s and 1980s. During this period, people who had previously been placed in asylums were released with the idea that they could receive pharmaceuticals and mental health care while living in the community. While treatment in asylums was highly problematic – a discussion beyond the scope of this chapter – it is noteworthy that deinstitutionalization raised many issues as well.

 

Below we present a brief video, created by Dr. Pashak, about deinstitutionalization and its effect on contemporary homelessness. While this video contains American statistics, the timeline and outcomes are very similar to what occurred historically in Canada. As you watch this video, we encourage you to think about the idea raised in the previous section that every person who experiences homelessness should be considered part of a disenfranchised mental health population.

Deinstitutionalization moved people out of asylums and into the community without proper planning or consideration for where they would go. In the following video Dr. Nick Kerman, a Post-Doctoral Fellow at The Centre for Addiction and Mental Health (CAMH), explains how the effects of deinstitutionalization are still felt in Canada today. If you are interested in learning more about deinstitutionalization, and about how CAMH has transitioned through it, we encourage you to watch the video “If These Walls Could Talk” found in the “Want to Learn More?” section of this chapter. 

 

Dr. Nick Kerman: Why is mental illness so high among people experiencing homelessness?

In this video Dr. Nick Kerman explains how the history of deinstitutionalization in Canada in the 1970s and 1980s led to the closure of psychiatric hospitals, resulting in a large number of people who had nowhere to go for support. He notes that the effects of these policy decisions have been seen through decades of over-representation of people with serious mental illness in the homeless population. Dr. Kerman discusses the complex relationship between mental illness and homelessness, noting that mental illness can be a pathway into homelessness but can also be a consequence of the victimization and trauma that often result from homelessness. Dr. Kerman concludes by noting that two of the basic building blocks of mental health – sleep and nutrition – are often compromised as well for people who are sleeping in shelters on an ongoing basis. This video is 6:00 in length and has closed captions available in English.

Key Takeaways – Dr. Nick Kerman: Why is mental illness so high among people experiencing homelessness?

  1. To understand the relationship between mental illness and homelessness, we need to go back to the 1970s and 1980s when deinstitutionalization occurred in Canada and psychiatric hospitals were closed down.
    • These hospitals closed for several well-intentioned reasons.
      • There was more information about mental illness and how people could live meaningful lives in the community.
      • Better treatments, such as pharmaceuticals, became available.
      • There was more awareness of the very poor conditions within psychiatric hospitals at the time.
    • Closing psychiatric hospitals led to large amounts of people leaving these institutions with nowhere to go and be supported.
    • The effects of these policy decisions have been seen through decades of over-representation of people with serious mental illness in the homeless population because there were no options in the community to provide the supports they needed to be securely housed.
  2. There are different ways that mental illness and homelessness intersect.
    • Mental illness can be a pathway into homelessness, such as a crisis that emerges from job loss, relationship problems, or prolonged hospitalizations.
    • Mental illness can be a consequence of homelessness. Victimization and trauma that often accompany experiences of homelessness can cause or exacerbate mental health problems.
  3. One of the most basic building blocks that impacts mental health is sleep. People who stay in shelters, or are otherwise unhoused, do not get a good night’s rest, often on an ongoing basis. They often are not getting proper nutrition as well.

 

Dr. Kerman has researched mental health and homelessness in contemporary society, finding that the way services are organized today allows people to survive but keeps them marginalized such as through limited access to nutritional food, sustained social isolation, and insufficient incomes to participate in recreational activities (Kerman & Sylvestre, 2020). The history of deinstitutionalization has shaped our modern homelessness infrastructure and contributed to the high rates of homelessness across the country, as people were released into the community without the proper supports in place. This occurred at a time when the Federal government was decreasing their role in building affordable housing, which you read more about in the chapter on Politics, Policy, & Housing in Canada. Dr. Cheryl Forchuk refers to this as a perfect storm of policy changes that occurred at the same time and contributed to the high rates of homelessness we see today. She explains further in the video that follows. 

 

Dr. Cheryl Forchuk: Why is mental illness so high among people who experience homelessness?

In this video, filmed at a hospital during the COVID-19 pandemic, Dr. Cheryl Forchuk explains that the question of why mental illness is high amongst people experiencing homelessness is complex because it is a “chicken and egg” scenario of considering what comes first. She notes that we need to consider the perfect storm of policy changes that occurred when the Federal government withdrew from funding social housing, income supports were reduced, and deinstitutionalization closed psychiatric facilities with no housing provisions. Dr. Forchuk argues that people who experience mental illness are the most discriminated and stigmatized group in society and that people who become homeless often lack the social supports that might keep others with the same issues housed. Dr. Forchuk concludes by noting that addiction issues can also be a “chicken and egg” situation, such that if a person does not have an addiction issue prior to homelessness, they are likely to have one afterward. This video is 3:21 in length and has closed captions available in English.

Key Takeaways – Dr. Cheryl Forchuk: Why is mental illness so high among people who experience homelessness?

  1. Why mental illness is high amongst people experiencing homelessness is a very complex question in some ways, because it is also the “chicken and egg” question of what comes first.
  2. We can consider the historical perfect storm of policy changes that have occurred and led to high rates of mental illness amongst people experiencing homelessness.
    • First the Federal withdrawal from social housing, downloading of responsibility to provinces, and in Ontario further downloading to municipalities.
    • At the same time incomes supports were threated under the omnibus bill by the Mike Harris government in Ontario.
    • This occurred at the same time as deinstitutionalization in the mental health system, where psychiatric beds were reduced by almost 90%. Having people live in the community is better, but from a planning perspective being in the hospital provided housing, which was unavailable in the community.
  3. People who experience mental illness are discriminated against and face stigma in society. This has impacts on a range of issues, including relationships, housing, and employment opportunities.
  4. Homelessness is related to the kinds of social supports a person has in place. Most people with mental illness, including addiction, do not become homeless because they have someone to turn to in a crisis. People who experience homelessness often lack these natural supports.
  5. The “chicken and egg” can also apply to addictions. If a person does not have an addiction issue before experiencing homelessness they are at high risk of having that problem develop while experiencing homelessness.

 

It is a recurring theme throughout this book that historical decisions, such as those related to housing and other social policies, have an impact on contemporary rates of homelessness. However, we can also see that homelessness is related to a range of additional factors that serve to create the conditions and prevent people from being able to find stability in their lives. As Dr. Forchuk noted in the previous video, homelessness is related to the kinds of social supports a person has in place and whether they have people they can turn to for help. Many people who experience homelessness lack the kinds of strong social connections that might prevent those with stronger networks from falling into homelessness during a crisis situation. 

 

Quote Source

 

The lack of strong social supports, such as friends and family members, can have very negative effects on a person’s mental health and well-being. Jones et al., (2020) have found that social isolation may have roots in the brain, as they examined 60 people experiencing homelessness and found that those with larger amygdala and central nucleus volumes had a larger social network. A key factor to consider is that people who experience homelessness have often had adverse childhood experiences (Smith, Milaney, Henderson, & Crowshoe, 2021) which can alter the brain’s neural pathways. The video that follows entitled, “Childhood Trauma and the Brain” was created by the UK Trauma Council and explains this association further. 

 

Researchers who conducted a cross-sectional study using national data from 2,235 adults with mental illness experiencing homelessness in Canada found that on average these individuals reported 4 adverse childhood experiences, such as maltreatment, sexual abuse, neglect, divorce, and/or household dysfunction (Liu et al., 2021). Their data also indicated that these adverse childhood experiences were higher among women, and that they can be linked to poor mental health outcomes (Liu et al., 2021). The effects of trauma can persist over time and those experienced during childhood continue to impact people into adulthood. We see this clearly when we consider how many people experiencing homelessness also report mental illness and childhood trauma (LĂ©vesque & Abdel-Baki, 2020). 

aqua icon for website linkInterested in learning more about Adverse Childhood Experiences? Check out this extensive collection of resources from the Centres for Disease Control and Prevention.

Adverse Childhood Experiences (ACEs) (cdc.gov) 

 

Social isolation and loneliness are both causes and consequences of being mentally unwell. They are also risk factors for suicidal ideation (i.e. considering suicide) and for committing suicide. This is evident from a body of research on homelessness and mental health. For instance, a study of 455 people who were formerly or currently homeless showed that 16% reported suicidal ideation and 7% had attempted suicide (Gentil, Grenier, & Fleury, 2021). The same study showed a complex association with mental health disorders and substance use. Notably, suicidal ideation was higher for those with generalized anxiety disorder, substance use disorders, and schizophrenia spectrum and other psychotic disorders (Gentil et al., 2021). Higher rates of suicide attempts were reported by those with higher functional disability, more frequent hospitalizations, and those with substance use and mental health disorders (Gentil et al., 2021).

 

Amongst youth, the risks of suicidal ideation and attempts have been found to be even higher. Researchers conducting the first national survey on youth homelessness collected 1,103 responses from young people accessing homelessness services in 42 communities across Canada and found that 42% reported at least one suicide attempt and 85% were in high psychological distress (Kidd, Gaetz, & O’Grady, 2017). These risks were particularly evident amongst those who experienced homelessness for the first time at an early age, were female gender, and identified as lesbian, gay, bisexual, transgender, queer or questioning, or two-spirit [LGBTQ2S+] (Kidd et al., 2017). The second survey, conducted four years later, included 1,375 youth accessing homelessness services in 49 communities and found that 35% reported at least one suicide attempt and 33% had a drug overdose that required hospitalization (Kidd et al., 2021). Dr. Kaitlin Schwan was a researcher on the national youth homelessness survey project and lead author on a proposal for improving mental health care for these young people in Canada (Schwan, Kidd, Gaetz, O’Grady, & Redman, 2017). Here she speaks more about the findings and the implications homelessness has for the mental health of young people.

 

Dr. Kaitlin Schwan: The stress of youth homelessness

In this video, Dr. Kaitlin Schwan discusses the results from a survey conducted by the Canadian Observatory on Homelessness with 1,100 youth experiencing homelessness across Canada. She notes that many young people report huge increases in health challenges, such as lacking a place to rest and wash, experiencing high rates of stress, and not recovering from illness as quickly. Dr. Schwan explains that this survey showed high rates of nutritional vulnerability and that 30% of respondents indicated they did not have access to clean water on a daily basis. She further notes that mental health and addictions challenges were found to be high, with 42% having attempted suicide and 85% in high symptom distress categories. Dr. Schwan explains that despite public misconceptions, these youth are much more likely to be the victims of crime than the offenders. She concludes by arguing that all of these conditions make it difficult for young people to be healthy and well, which is why we need to focus on successfully exiting them out of homelessness and into secure housing. This video is 4:31 in length and has closed captions available in English.

Key Takeaways – Dr. Kaitlin Schwan: The stress of youth homelessness

  1. The Canadian Observatory on Homelessness conducted a survey with 1,100 youth experiencing homelessness across Canada.
  2. Many young people report huge increases in health challenges.
    • They often lack access to basic necessities, such as a place to rest and wash. They also experience high rates of stress.
    • These conditions impair the body’s ability to recover, so that even a minor illness can be prolonged and/or turn into something more severe.
  3. Respondents in this study reported lacking access to food and clean water.
    • Nutritional vulnerability means they cannot access food that gives them the nutrients to do well, stay in school, transition into employment, or any of the things that we hope young people can achieve.
    • Even when staying in shelters, food that is nutritious is not available in abundance.
    • In the study, 30% of youth said they do not have access to clean drinking water on a daily basis. This is astounding in a wealthy country like Canada.
  4. There are enormous increases in mental health and addictions challenges young people face, in part due to the trauma and stress of lacking adequate housing.
    • The survey showed 42% of the youth had attempted suicide and 85% were in a high symptom distress category with high levels of stress and psychological challenges.
    • Mental health and addictions challenges can result from sexual exploitation, violence, and general abuse on the streets.
    • There is a public misconception that people experiencing homelessness are perpetrators of crime, but this study showed 63% had been the victim of a violent crime in the past year.
    • These experiences make it very hard for young people to remain in school or employment.
  5. Supporting people to exit homelessness and get into stable housing is critically important.

 

In the second national survey on youth homelessness, of which Dr. Schwan speaks, sexual violence emerged as a key factor in the identification of youth experiencing the greatest distress (Kidd et al., 2021). These researchers also found high rates of suicidality and mental health challenges, particularly for females, Indigenous youth, and those who identify as LGBTQ2S+ (Kidd et al., 2021). In the next video, Dr. Alex Abramovich explains how the daily stigma and discrimination LGBTQ2S+ young people face escalates their risk of mental health challenges. 

 

Dr. Alex Abramovich: LGBTQ2S youth, stigma, and mental health supports

In this video, Dr. Alex Abramovich explains that LGBTQ2S+ youth experiencing homelessness face high levels of stress and stigma, which has a negative effect on their mental health. He notes that amongst this population there are significantly higher rates of depression, anxiety, substance use, suicidality, and suicide completion compared to heterosexual and cisgender youth. Dr. Abramovich is clear to note that these mental health challenges stem from the daily stigma, discrimination, and violence these youth experience in society, and not from their gender or sexual identities. He concludes by arguing that more specialized mental health assessments and supports are needed for this population of young people. This video is 1:37 in length and has closed captions available in English.

Key Takeaways – Dr. Alex Abramovich: LGBTQ2S youth, stigma, and mental health supports

  1. The stress and stigma that results for LGBTQ2S+ young people who do not have a safe place to live, has a severe negative impact on their mental health.
  2. Amongst this population, there are significantly higher rates of depression, anxiety, substance use, suicidality, and suicide completion compared to heterosexual and cisgender youth.
  3. The higher rates of mental health issues amongst LGBTQ2S+ youth experiencing homelessness are not because of their gender and sexual identities, but because of the stigma, discrimination, and violence they experience daily in society.
  4. Providing more specialized mental health assessments and supports is key for this population.

 

Social support is key to people’s well-being. Without a strong network of friends, family, or community members, individuals often feel isolated and lonely. This message was clear in a study conducted with 76 youth experiencing homelessness and residing across 8 shelters (Gauvin, Labelle, Daigle, Breton, & Houle, 2019). Researchers found that youth who had not attempted suicide perceived more social support (both tangible assistance and guidance) whereas those who had attempted suicide reported using more non-productive coping strategies like keeping to themselves, isolation, and self-blame (Gauvin et al., 2019). Humans are social beings and having others to turn to is critically important for mental wellness. There is a pervasive and deeply harmful stigma associated with experiencing homelessness that serves to keep people isolated, subsequently decreasing their already poor mental health.

 

Even when people move out of homelessness and into secure housing, one of the biggest challenges they continue to face is reintegrating into the community around them. Research with youth transitioning out of homelessness in Toronto demonstrates that as young people work through this transition and seek to be more socially integrated, they grapple with their identity (Thulien, Gastaldo, McCay, & Hwang, 2019). This sense of inclusion can be challenging as they follow a non-linear path, from the street to social integration, that can leave them feeling bogged down, confused, and exhausted by the competing aims of feeling integrated and trying to meet their basic needs (Thulien, Gastaldo, Hwang, & McCay, 2018). Dr. Naomi Thulien and her team have studied the pathways young people take in exiting homelessness and the mental struggles of trying to feel connected and socially included through the process. In the next video, Dr. Thulien discusses this research further.

 

Dr. Naomi Thulien: Loneliness, social isolation, and relationship building

In this video, Dr. Naomi Thulien argues that relationship building is critically important in supporting people experiencing homelessness and should be actively cultivated. Without trusting relationships, she notes, support can unravel. Dr. Thulien explains that loneliness and boredom are linked to homelessness, poor mental health, and addictions in an existential kind of way. She notes that trying to keep busy is a reminder of how socially isolated people can be and changes the way they experience the passing of time. Dr. Thulien concludes that housing people is important, but we must also ensure they have meaningful activities to fill their time. This video is 7:08 in length and has closed captions available in English.

Key Takeaways – Dr. Naomi Thulien: Loneliness, social isolation, and relationship building

  1. Relationship building is critically important in supporting people experiencing homelessness.
    • Providing people with support requires actively cultivating relationships. This can be done informally, such as through serving food during shelter mealtimes.
    • Without relationships and trust, support can unravel.
  2. Loneliness and boredom, in an existential way, are linked to homelessness, poor mental health outcomes, and addiction.
    • Trying to keep busy is a reminder of how socially isolated people may be. It can also change the way people experience time, such as being awake at night and sleeping during the day.
    • Housing people is important, but we have to help provide them with meaningful activities. This kind of support may be less tangible than more standard housing measures.

 

How well integrated a person feels within their community is dependent on a range of factors related to the housing itself, such as the neighbourhood safety and location, whether people are using substances, and the housing quality (Ecker & Aubry, 2017). However, community integration can also be related to personal factors, such as whether a person feels they have meaningful activity in which to engage that helps prevent boredom (Marshall, Keogh-Lim, Koop, Barbic, & Gewurtz, 2020a). In the preceding video, Dr. Thulien spoke about the kind of existential boredom that people can experience once they are housed but have no meaningful activities to fill their time. There is limited research on boredom and homelessness, but a scoping review has found themes related to coping strategies, the impact of boredom, the environment as a determinant, and possible interventions (Marshall et al., 2020b).

 

Boredom is something we all inevitably face. You may have found yourself at times having nothing to do and wondering how to fill the time or, dare we say it, sitting through a class that does not hold your interest (of course not this one!). This kind of boredom is common and not what we mean here. Many people who experience homelessness do not have activities, like work, to fill their time. They also often lack money to engage in leisure activities. With endless time, limited social contacts, and no money to spend, the hours stretch on. People may continue to use service agencies, and many spend time volunteering, but these require transportation which also costs money.


What do you think?

human head with light bulb as brain graphicPreventing boredom and finding meaningful activities are key for helping people who have experienced homeless feel socially integrated into their community. Consider the area where you live. What kinds of activities are available for people that do not cost money and are open to anyone who wants to join? What other programs might be needed to increase opportunities for people to get involved without costing money? 


When experiencing homelessness and even after obtaining housing, people’s mental well-being is often dependent on having meaningful activities that allow them to engage with others and develop relationships within the community. In this section’s featured reading we present an article from Dr. Thulien and her team about a pilot study that explored the feasibility of improving socio-economic inclusion for young people transitioning out of homelessness by bolstering their identity capital, such as their sense of purpose and control, self-efficacy, and self-esteem. We invite you now to learn more about Dr. Thulien’s research in the featured reading below. 


Featured Reading:

open book graphic

Thulien, N. S., Wang, A., Mathewson, C., Wang, R., & Hwang, S. W. (2021). Tackling exclusion: A pilot mixed method quasi-experimental identity capital intervention for young people exiting homelessness. PLOS ONE


Helping individuals increase their identity capital is a promising approach for building upon and offering them assistance as they transition out of homelessness and into secure housing (Thulien et al., 2021). Addressing issues such as a person’s sense of inclusion and identity are critical for improving mental health and achieving long-term housing stability. This is particularly important for people who experience homelessness because, as we have seen, they face considerable stigma and discrimination. Research has shown that there is an urgent need to identify strategies and policies to reduce the stigma and discrimination that people who experience homelessness and mental illness go through (Mejia-Lancheros et al., 2020). We need to recognize and acknowledge the loss they experience as well. Consider, for instance, the impact that losing one’s home, family, workplace, and community might have on a person’s sense of self-identity. 

 

Quote Source

 

Homelessness is deeply harmful to people’s mental health because it is grounded in loss. It is right there in the word – a person is not only less a home but also less all the social relations that go along with it. We encourage you to pause for a moment and reflect upon how you identify your own sense of self. Are you someone’s significant other? Do you have children and identify as a parent? Do you refer to yourself as someone’s brother or sister? Do you have a job that you relate with your sense of identity? When a person experiences homelessness they lose many of the markers they previously identified with, which has a negative impact on their mental well-being. In the video that follows Dr. Sean Kidd explains the importance of recognizing identity and identity loss in understanding why people who experience homelessness are often in poor mental health. 

 

Dr. Sean Kidd: Why is mental illness so high among people who experience homelessness?

In this video, Dr. Sean Kidd explains that people have different experiences and trajectories of homelessness, but that a common factor driving people’s physical and mental health outcomes is the social determinants of health. He notes that for many people who experience homelessness, their challenges began while they were housed. For youth this is often in the form of trauma or neglect within the home or school. For adults, this may be related to job loss, divorce, and/or mental health and addictions issues. Dr. Kidd notes that when a person loses their housing they also often lose their identities such as tied to being employed, someone’s spouse, or a homeowner. These identities may be replaced with assumptions that they are now dangerous, lazy, and/or a criminal. These labels create new mental health challenges that lead to a vicious cycle. Dr. Kidd concludes that this cycle demonstrates the importance of homelessness prevention, so people’s problems do not become compounded. This video is 4:53 in length and has closed captions available in English.

Key Takeaways – Dr. Sean Kidd: Why is mental illness so high among people who experience homelessness?

  1. People have different experiences and trajectories of homelessness.
  2. Beyond genes and heredity, the social determinants of health are what drive physical and mental health outcomes.
    • Social determinants include factors such as having adequate shelter, nutritious food, good relationships, access to employment, meaningful activities, and generally being able to get what you need in the world.
    • We can also consider factors related to being empowered, feeling safe, and being able to take care of one’s own and other people’s wellness.
  3. For many people who experience homelessness, the challenges began before they lost their housing.
    • Mental health challenges may date to childhood experiences of trauma or neglect, within their homes or schools.
    • Being bullied at school, having an unrecognized learning disorder, being pushed out of opportunities, and the onset of mental health and addictions challenges can be lead-ins that get compounded when a person then subsequently experiences homelessness.
    • Adults may have factors in their lives that lead to homelessness, such as job loss or divorce, and the stressors are amplified on the street with increased exposure to violence.
  4. A person who is be struggling with issues such as depression and/or addiction and loses their housing may also lose their forms of identity, such as being a person who is employed, someone’s spouse, or a homeowner.
    • Because of the stigmas attached to homelessness, these identities that held worth for the person are often replaced with assumptions that they are now dangerous, lazy, and/or a criminal. These labels create new mental health challenges.
  5. The term ‘vicious cycle’ is an accurate description. The further a person gets from supports and the social determinants of health, the worse their situation becomes and the harder it is to intervene.
    • This is why preventing homelessness is so important. If we can help people with their challenges while they are housed, they will not have the issues compounded.

 

The loss of identity has profound implications for a person’s mental well-being, as Dr. Kidd has explained. We encourage you to think about this key takeaway message as you watch a brief documentary created by CBC Docs about a man named Roger who lost his job, wife, and child and has struggled with recurrent episodes of homelessness in Toronto. 

 

 

The experience of homelessness is stressful, isolating, and traumatic. It is not surprising then that many people, if not all, who experience homelessness will also have poor mental health and potentially a severe mental illness. Yet, we also must recognize that surviving through this experience takes a great deal of personal strength. We began this section by discussing the deinstitutionalization of asylums that saw mass numbers of people removed from institutions and put out in the community with nowhere to go. In the decades since, there remains a lack of adequate mental health services to treat what Dr. Cheryl Forchuk has called a disenfranchised mental health population. We conclude this section with a video of Dr. John Ecker that brings these ideas together. Today, 60 years past deinstitutionalization, we still have much work to do to coordinate systems responses like hospital discharge, but we also need to recognize the strength people show amidst these institutional failures. 

 

Dr. John Ecker: Mental health challenges and supports

In this video, Dr. John Ecker explains that mental health challenges can happen prior to homelessness, as a result of homelessness, or in combination. He notes that structural and systemic failures need to be considered, such as inadequate mental health and financial supports, as well as the lack of coordinated discharge practices from hospital. Dr. Ecker explains that experiencing homelessness can be traumatic and have negative consequences for physical and mental health. He concludes by noting that we must also recognize the strength and resourcefulness of people who experience homelessness, and the importance of the social bonds they create with others, which can help buffer mental health challenges. This video is 3:18 in length and has closed captions available in English.

Key Takeaways – Dr. John Ecker: Mental health challenges and supports

  1. Mental health challenges can happen prior to homelessness, as a result of homelessness, or in combination.
    • Structural and systemic factors can increase the risk of homelessness, such as a lack of affordable and accessible mental health supports, and the lack of adequate financial supports for individuals on disability support programs.
  2. The lack of adequate hospital discharge procedures can increase the risk of someone who experiences mental health challenges being discharged into homelessness.
  3. Experiencing homelessness can be very traumatic and have negative physical consequences, such as violence and victimization, and mental health consequences, such as higher rates of depression, despair, and hopelessness.
  4. It is also important to consider the strength and resourcefulness of individuals experiencing homelessness, and the bonds that are created with others in the same situation. These social bonds can often act as a buffer to mental health challenges.

 

People who experience homelessness face tremendous adversity but still show remarkable resilience, strength, and positivity despite these hardships (Shankar, Gogosis, Palepu, Gadermann, & Hwang, 2019). We set out in this section to identify why mental illness is so high among this population and found that there are many complex reasons. While we may be tempted to ask the chicken and egg question of what comes first, the reality for many people is that they cannot be so easily teased apart. People may be mentally unwell and have difficulties maintaining their housing as a result. Once in shelter, moving between temporary accommodations, or on the street, the stress of living in a constant state of crisis makes their mental health worse.

 

Historically when people were mentally ill they would be sent to live in an asylum. These places, while deeply problematic, created a new problem when they closed in the 1970s and 1980s. Deinstitutionalization occurred as they closed their doors and moved people out into the community with the notion that they could receive pharmaceuticals and mental health treatment outside the hospitals. However, this occurred at the same time the Federal government stopped funding new social housing, creating a lack of affordable places for these patients to live, and Provincial governments decreased the income supports they would provide. These policies and decisions created a situation that left mass numbers of people unhoused, living in deep poverty, and without access to the same levels of mental health services.

 

This sense of disconnection from society and social supports has carried through to the current day. Having people that one can count on – whether family, friends, or support workers – is critical to good mental health. However, when people experience homelessness they often feel isolated and cut off from others. As we saw in this section, this social exclusion leads to high rates of suicidal ideation and suicide attempts. This is particularly true for young people, with those who identify as LGBTQ2S+ at the highest risk. People who experience homelessness often feel a deep sense of loneliness and express the need to find meaningful activities to fill their time. The sense of boredom that accompanies homelessness, and which follows people even after they are housed, can weigh heavily on their minds, and ultimately threaten their housing security.

 

When people lose their housing they also lose the sense of identity that is tied into it, like being a homeowner, spouse, parent, or worker in a particular job. Not only do people lose the identities they have, but they are often substituted for stereotypes such as that the person must be a criminal or dangerous because they are homeless. The loss of identity and the discrimination that people face is a key reason why mental illness is so high among this population. In the time since the deinstitutionalization movement, we have continued to see institutional failures, yet amidst these conditions, many people who experience homelessness demonstrate remarkable personal strength. The question we need to ask is not what comes first, mental illness or homelessness, but rather how we can help make both better so that we do not need to wonder at all.

 

Podcast: Why is mental illness so high among people experiencing homelessness? (27:27)

Click the link below to listen to all of the researchers answer the question “Why is mental illness so high among people experiencing homelessness?” in audio format on our podcast!

 


 

License

Icon for the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Understanding Homelessness in Canada Copyright © 2022 by Kristy Buccieri, James Davy, Cyndi Gilmer, and Nicole Whitmore is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, except where otherwise noted.

Share This Book