Psychiatric disorders can lead to many types of problems. These problems can range from housing instability to disease, and even death. Having a disorder and lack of stable living conditions most often further complicates the overall health and the care this is a bit confusing for a homeless adult. Without the proper health care, the mind will become even more unstable. This does not automatically follow logically. Individuals with severe mental illness soften most times with homelessness because of their inability to accomplish daily tasks and earn money. Mental illness is serious and severe and can have a domino effect on one’s life and those surrounding the individual. The hand in hand relationship that homelessness shares with mental illnesses are disturbing. One of the many mental disorders that can lead to homelessness is Schizophrenia.
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Stating that an individual has a mental illness can be interpreted many ways, however, it is usually defined and understood as a psychological disease or disorder. The severity of the illness determines how much of an individual’s daily functioning will be affected. The ability to care for one’s self, a home or household and the ability to maintain an intimate relationship are lost. Homeless people with mental disorders remain homeless for longer periods of time and begin to have less contact with family and friends. Mental illnesses, such as schizophrenia or severe depression, can cause a strain on family and other social relationships (Hawkins and Abrams 2007). Studies have examined what the quality of life is like after discovering that one has a mental illness, those who become homeless and other studies focus mainly on treatment options. Suffering from a mental illness makes it more difficult to gain employment. Having poor health also cripples the individual’s desire to seek help, and whether they can receive help or not is another issue.
Studies that take a deeper look into the rates of homelessness could lead to better treatment and help. It is especially important to study mentally ill homeless individuals that have substance abuse since these individuals are one of the most disadvantaged groups among homeless persons (Levine and Huebner 1991). There is no one explanation as to why an individual who is mentally ill will begin abusing their bodies with drugs, it is known though that when substance abuse and mental illness are combined contact with law enforcement is inevitable. All people with mental disorders, including those who are homeless, require ongoing access to a full range of treatment and rehabilitation services to lessen the impairment and disruption produced by their condition (U.S. Department of Health and Human Services, 2003). Most people with the mental disorder do not need hospitalisation, what they do need is better housing options and more treatment options and but can live in the community with the appropriate supportive housing options. Further studies do show however that these community-based services are far and few in between and there is not enough housing to accommodate the growing number of patients affected by a mental illness.
The hardest challenge to face with helping mentally ill patients is that the illness causes other cognitive problems. Dr Yuodelis Flores states that “the most serious barrier to treatment is lack of insight,” persons with serious mental illness may not understand that they are ill and need care. Severe and persistent mental illnesses (SPMI) – including schizophrenia, bipolar disorder, major depression and dementia – impair judgment, conceptual understanding and the capacity to make appropriate behaviour decisions (HCH Clinician’s Network, 2000). A patient, who is now learning of their illness, reacts irrationally and with anger and then instead of trying to understand the illness they just shut out those closest to them.
Schizophrenia is a serious disorder of the mind and brain but it is also highly treatable. There is a constant flow of improvement on the medications for this illness. In addition to that, there are many new and improving psychosocial treatments and cognitive therapies for schizophrenia that are being tested and approved for use. One of the theories of what causes schizophrenia is that it is a result of a genetic predisposition combined with environmental exposures and or stress (The Internet Mental Health Initiative, 1996-2010). Stress can trigger a preexisting illness into existence, which in the case of Schizophrenia makes sense in terms of one having a genetic predisposition to the disease. Schizophrenia-like most other illnesses do not develop until after the age of 18, however, an age range is given due to the fact that illnesses have developed earlier in some. Men tend to develop schizophrenia slightly earlier than women; whereas most males become ill between 16 and 25 years old, most females develop symptoms several years later, and the incidence in women is noticeably higher in women after age 30 (The Internet Mental Health Initiative, 1996-2010). Taking a closer look at an individual’s support system also determines if a homeless result is possible. Mental illnesses, such as schizophrenia or severe depression, can cause a strain on family and other social relationships (Hawkins and Abrams 2007).
Society is well aware of homeless people, but many are unaware of the reasons why and then many do not care to know the reason. When a homeless individual is seen many shy away especially if that homeless individual is acting out. This passive attitude towards the homeless does not help them nor does it help society. In 2002 the cost of schizophrenia was estimated to be $62.7 billion, with $22.7 billion excess direct health care cost $7.0 billion outpatient, $5.0 billion drugs, $2.8 billion inpatients, and $8.0 billion long-term care (The Internet Mental Health Initiative, 1996-2010). Being out of sight and out of mind, these numbers do not reflect the homeless. About 1% of the population is affected by Schizophrenia (The Merck Manuals, 2008). Schizophrenia affects men and women equally having no racial or socioeconomic preference. In the United States, schizophrenia accounts for about 1 of every 5 Social Security disability days and 2.5% of all health care expenditures (The Merck Manuals, 2008).
Brandt (1995) studied how actively working with homeless who are suffering from schizophrenia can better their lives. He focused on the “bag ladies” as they are deemed social outcast as they have a tendency to act out when help is offered. Quite outspoken about his distaste on societies role in helping those in need, he began to roam the streets gathering individuals to be a part of his study. 35 homeless individuals were chosen between the ages of 22 and 70 and consisted of 17 women and 18 men. The results were significant enough to show that being proactive with these individuals is helpful no matter the age or gender. The only remaining issue however with treating homeless individuals just like with any other patient, is the need to want treatment. When someone is in need of help in whatever form of therapy needed, it is the patient that makes the initiative and this is unable to be the case with homeless individuals. Brandt (1995) acknowledged that “Many different groups must be involved in the work. [This includes], psychiatrists, hospitals, general practitioners and the entire social welfare system. And the best possible contact must be maintained with the patient” (p. 1).
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Antipsychotic drugs, rehabilitation, and psychotherapy are the major parts of treatment. Community support activities, such as job coaching, teach the skills needed to survive in the community. These skills enable people with schizophrenia to work, shop, care for themselves, manage a household, and it also rehabilitates their social abilities. Hospitalisation is seen more when patients relapse. Forced hospitalisation is also rare and is only seen when the individual is a threat to themselves or others (National Coalition for the Homeless, 2006). The death rate for homeless people is about four times greater than the rate for the general population and among young homeless men, the rate is even higher (National Coalition for the Homeless, 2006). According to the National Coalition for the Homeless (2006), “average homeless adults die twenty years earlier than their non-homeless counterparts. Over half of homeless adults die violently and one-quarter of those is murdered” (p.2). The appropriate housing can provide the framework necessary to end homelessness for many individuals (National Coalition for the Homeless, 2006).
A study done in 2002 by Folsom, McCahill, Bartels, Lindamer, Ganiats and Jeste not only examined the death rate in schizophrenic homeless individuals, but they then compared the preventative and primary care to those with severe depression. While depression is a mental illness, it does not cripple one’s abilities the way that schizophrenia does. The stages of withdrawal from friends and family are the same, however an individual with depression is more likely able to describe their feelings to a doctor, and there is no stigma placed on this illness like those with schizophrenia. Schizophrenic patients can go undiagnosed for years and then when they are, many providers are uncomfortable with treating them and some do not even see a point. Folsom et al state that (2002) “serious mental illnesses, including schizophrenia, are much more common among homeless people than in the general population. Investigations have consistently found higher rates of substance abuse, schizophrenia, bipolar disorder, and major depression among homeless people than in the general population” (p.1). This is why preventive treatment is very important along with better housing. The growing number of homeless people is unknown, implementing better shelters that can provide the mental treatment needed will be a big step in helping these people. Folsom et al also noted that there is a direct correlation with schizophrenia and homelessness with death, “the age-adjusted mortality rate for people with schizophrenia is about two times that of the general population; cardiovascular disease is the most common cause of death among people with schizophrenia. Homeless people have been reported to have a mortality rate [that is] 3.5 times as high as that of the general population” (p.1).
With this study and with all studies, the best care depends on the patient to supply the proper medical history along with any medical symptoms. Middle-aged and older homeless people with schizophrenia received less primary and preventive health care and were treated for fewer chronic medical problems than a comparison group with depression (Folsom, McCahill, Bartels, Lindamer, Ganiats, & Jeste, 2002). Going forward with other research, monitoring the health care of schizophrenics should be compared to all the different types of mental illnesses as well as comparing them to those who have no mental illness at all.
Any one of the homeless people that you see on a daily basis can be suffering from a mental illness, that fact is quite disturbing. It is something that should not be taken lightly for it comes in many forms and can affect anybody. Being able to identify the symptoms and seeking help is a key fundamental towards regaining your health back. There still is great difficulty in caring for schizophrenics and the only way for it to get better is to continue the research and find ways for all the branches in the healthcare system to work together so that the patient can have the best treatment available. In the next 20 years hopefully, there will be a cure for all types of mental illness that we see today until being able to understand what it means for those who are suffering is just as important.
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