Most unhoused people suffering from mental health disorders: study

The authors say the relationship between mental health disorders and homelessness is symbiotic

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More than two-thirds of people experiencing homelessness suffer from a mental-health disorder, finds a new study by researchers at the University of Calgary.

The study, published in the American Medical Association, reviewed 85 studies from 1980 to 2021, analyzing cases of unhoused people and finding a strong link between homelessness and mental-health disorders in countries including the U.S., Canada and Germany.

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A majority of these people have personality and substance-use disorders, while more than a quarter suffer from serious mental illnesses such as schizophrenia, psychotic disorder and bipolar disorder — more than eight times as high as the general population.

The authors say the relationship between mental-health disorders and homelessness is symbiotic: people’s addiction leads them down the path of losing shelter. Or, when people can no longer afford housing, they start using drugs to alleviate the trauma of being homeless and may develop an anti-social personality disorder as a reaction to their situation.

Researchers found the combined presence of the two problems is rising, but couldn’t definitively say whether that’s because the issue is getting worse, or institutions are better at detecting them.

“Most people sort of understand that there’s some sort of relationship between mental-health concerns and homelessness for a number of people, although it’s really hard to understand the extent to which mental-health conditions are present in people who are homeless,” senior author of the report Dr. Dallas Seitz said.

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But Seitz, a psychiatrist and professor at the University of Calgary, is no stranger to the issues facing homeless individuals. He sees the issue on the streets of Bridgeland where he lives, but also encounters unhoused people in his practice at the Foothills Medical Centre and Rockyview Hospital.

“It’s difficult to see,” he said. “It’s really hard to ignore that when you’re seeing it in your community.”

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Calgary Homeless Foundation has housing, outreach programs to provide support

One of the challenges of the report is defining homelessness. Many unhoused people experience what is called hidden homelessness, in which they are provisionally accommodated with the help of friends and relatives but aren’t counted among official statistics.

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A count taken on a particular day in 2022 estimated that 2,782 people were unhoused. As of April 17, 2,257 individuals and families are on the “co-ordinated access and assessment triage list,” which is the system the Calgary Homeless Foundation uses to match people experiencing homelessness with appropriate supports.

Homeless camp in Calgary
One of several homeless camps along the Bow River near Sunnyside was photographed on April 27, 2022. Gavin Young/Postmedia

More than 70 per cent have a self-disclosed mental-health issue, while more than 44 per cent experience tri-morbidity — a mix of substance use disorders, and psychological and physical health concerns — according to the Calgary Homeless Foundation.

The organization also hosts several housing and outreach programs for a wide range of people, including youth, adults and families.

“These supports may include future counselling sessions, other community supports, or referral to brief or longer-term counselling with mental health counsellors at our partner agency, CUPS,” CHF said in an emailed statement.

“All program models are designed as recovery-orientated supportive housing programs for people experiencing homelessness. We understand recovery is a complex, non-linear process for every individual and family, and that it can be difficult for people experiencing homelessness to address their mental health needs when they do not have a home.”

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Advocate points to barriers to health care, cycle of homelessness

However, advocates have said barriers to health care continue to exist. Many experiencing homelessness and substance-use disorders are turned away from hospitals, says Chaz Smith, CEO and founder of BeTheChangeYYC, an advocacy group for unhoused people.

“When you don’t have a family doctor and you don’t have access to a home, a shower or laundry, it’s difficult to wait in a hospital for six hours — I have heard many folks express that they feel discriminated against, because of the way they look or the way they smell.”

Chaz Smith, CEO of BeTheChangeYYC
Chaz Smith, CEO and founder of BeTheChangeYYC homeless street outreach speaks with media at the Calgary Housing Crisis conference at the Telus Convention Centre on Thursday, December 7, 2023. Gavin Young/Postmedia

Many have stopped trusting hospitals altogether, and Smith believes sending outreach teams to unhoused people is a better way to address the issue. As for treating their substance-use disorders, many have to undergo a detoxification process in which they abstain from substances for a few weeks.

Smith said people have to wait long periods before they can be admitted into these processes, and once completed, they have to wait again for treatment. “Then the ultimate question is, is it OK for someone to detox, go to treatment and then be discharged back into homelessness,” Smith said.

The authors conclude their report by recommending “housing first” strategies, among various health initiatives, so that unhoused people are given a home as they are admitted into treatment.

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