I was asked recently why so many of our homeless community are struggling with mental illness. Although there is a common perception that the mental illness leads to the homelessness, there is another side to this answer that needs to be discussed.
We are all aware of the increasing number of folks struggling with untreated mental illnesses who have fallen through cracks in our system. We see this everyday. The folks we may not see are the less visible. Far too often, we may not assess the person who lost his job and is now living in a shelter because he cannot afford to pay rent. Many of the folks in our homeless community are there because of negative circumstances, loss of relationships, loss of family members, loss of home, income etc. When someone experiences loss and a significant change of circumstances feelings of sadness, fear and anxiety are common reactions. In many cases this person can become very overwhelmed, feel depressed and have thoughts of suicide. This is referred to as an adjustment disorder or a situational crisis. There can be a significant risk involved for this person's safety.
When someone is sleeping in a shelter or outside, their sleeping patterns become interrupted. Lack of sleep and poor nutrition can also lead to irritability and difficulty coping. In severe cases, sleep deprivation can even lead to a form of psychosis. Fortunately, this will improve quickly with a hospital admission and adequate rest.
As homelessness service providers, it is very important to look beyond the physical presentation and general health concerns. We cannot do a complete assessment without addressing their mental health and coping. For someone in a situational crisis, this may be a new experience and they will not offer the information to us. We need to ask the questions!
I would encourage all outreach providers to include a comprehensive mental health assessment with your intake and assessment. We have funding and resources to address the physical health needs but it is very important that we expand our current practice. There is no easy answer for what came first, the homelessness or the mental health struggles.