Mental illness and drug use regarding homelessness

On any given night in Australia it is estimated that over 100,000 people are homeless and living without essential human rights. (MHCA, 2009. p.5) While the reasons for people’s homelessness are varying, the abuse of alcohol, drugs and other harmful substances can exacerbate the situation and lead to further problems. The use of harmful substances by many homeless people is often seen as “functional”, this meaning that the use of these substances is helping them cope with their situation, and provide them with a sense of belonging in the Australian street culture. While many of the homeless people may start using ‘soft drugs’ , this often opens the gateway to harder substances to which they can come completely reliant upon. The prevalence of heroin use in the homeless community is ten times higher than the general Australian community. (Australian National Council on Drugs, 2008) (Johnson & Chamberlin, 2008, p.347)

Australia’s homeless population, exhibit higher rates of emotional and physical health issues, anxiety, poor nutrition and difficulties in maintaining relationships (Lady Bowen Trust).

1 in 200 Australians in today’s society don’t have access to adequate housing and employment. It is estimated that 75 percent of this homeless population is suffering from some kind of mental illness, (MHCA, 2009, p.5) and that at least forty three percent engaged in substance abuse. (Johnson & Chamberlin, 2008, p.347)

A safe and secure environment is essential to physical and mental health. Mental health symptoms can often be worsened by unstable housing and social isolation. Homelessness significantly affects a person’s ability to successfully maintain employment and relationships.

When referring to mental illness, generally speaking it is an illness that has some kind of influence and effect on how a person, thinks, feels and acts. (MHCA, 2009, p.10) These can include mental health issues such as depression, anxiety personality disorders, schizophrenia and stress disorders. It is estimated that 1 in 5 people will experience a mental illness of varying degrees at some point in their lives. (MHCA, 2009, p.10) Although the exact cause of many mental illnesses are unknown, along with biological factors it is believed that environmental factors, stressful and abusing situations, substance or drug abuse and negative thought patterns all contribute to a person’s mental health.

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Domestic violence, mental health, unemployment and substance abuse are among the leading causes of homelessness in Australia, along with critical shortages of affordable housing. However it is important to note that there are many contributing factors to a person becoming homeless such as family breakdown, sexual assault, gambling, mental illness, financial difficulties and social isolisation and broader social processes. (Homelessness Australia, 2010)

Having a mental illness reduces a person’s quality of life; the symptoms can make it difficult for individuals to cope with the daily demands of work and home life. In some cases this can lead to people becoming socially isolated, and even losing their jobs. This loss of employment often means people are no longer able to afford housing and a lack of social support can mean these people may become homeless. The unemployed are also less likely to receive medical treatment for symptoms of mental illness. If they do seek treatment of these illnesses they then face the problems of being able to pay for expensive prescriptions. (www.informahealthcare.com)

The current economic climate has also placed increased stress on individuals and there has been “a spike in Medicare claims for mental health consultations due to unemployment” (Dragon, 2009).

Studies have shown that homeless people have a higher prevalence of mental illness and substance abuse, with a Melbourne study showing 30 percent of homeless people surveyed had mental health issues and 43 percent suffered substance abuse issues. (MHCA, 2009, p.14)

Substance abuse is also linked to homelessness, unemployment and mental illness, as substance abuse can take hold and damage a person’s quality of life. Substance abuse begins to interfere with a individuals work and social life and this commonly leads to the destruction of relationships and loss of employment. Rather than this slide from positive relationships and employment being instant, many people tend to slide into homelessness as a result of their substance abuse. As they begin to come more dependent on these substances the transition becomes more rapid. ((Johnson & Chamberlin, 2008, p.348)

Having a mental illness can increase a person’s likelihood of abusing drugs, which may in the short term make the symptoms of their mental illness feel better, while other people’s drug use can trigger the symptoms of mental illness. (MHCA, 2009, p.22) The link can also be made in terms of unemployment and homelessness, if a person is unemployed they can experience financial difficulties that can result in being homeless, alternatively if a person is homeless it becomes difficult to gain employment and break the cycle.

The relationship between homelessness and substance abuse is well researched and documented; there is debate however on the direction of this relationship, and whether substance abuse is the cause or consequence of an individual becoming homeless.

The focus of substance abuse as a consequence of homelessness is the social adaption model. Entering into homelessness often exposes individuals to a subculture where substance abuse is accepted and common place. This model also identifies that many people start to abuse substances as a method of coping with their situation, which can often be very stressful, uncertain and traumatic. (Johnson & Chamberlin, 2008, p.343)

Johnson and Chamberlain (2008, p.350) report that thirty four percent of individuals have engaged in substance abuse before becoming homeless, while sixty six percent first start abusing substances after becoming homeless.es as they struggle to pay for their addiction. Loss of employment then leads individuals looking for alternative income which can often lead to ‘bad loans’ and illegal behaviours. (Johnson & Chamberlin, 2008, p.p347-350)

The social selection approach focuses on substance abuse as a cause of homelessness rather than a consequence. Substance abuse can be a leading factor into homelessness, as when a person becomes addicted to harmful substances they tend to start self damaging behaviours which affect social and work relationships. As their substance abuse increases, this often leads to financial difficulties and destruction of social networks.

Psychological trauma and post traumatic stress disorder have been found to be contributing factors for many of the homeless population.

There is no specific way in which each of these social detriments of health contributes to each other. For example, mental health issues may contribute or lead to people becoming homeless, while for others their mental health issues may be a result of being homeless or compounded by it. (MHCA, 2009, p.22)

The homeless population can face discrimination when trying to find and apply for housing, especially when they have experienced a mental illness. (DHA, 2005) Many landlords are something about having people with a mental illness in their accommodation, due to the negative stigma that is attached with mental illness.

Having a mental illness or past substance abuse problem can also follow a person and impact upon their lives even after they have overcome these issues. As in today’s society many jobs and housing applications require police, credit and background checks. (MHCA, 2009, p.18)

Webster (2007) reports that drug abusers with mental illnesses are likely to experience high rates of employment difficulties. Stating that individuals with mental illnesses have fewer work-related skills, poor interpersonal skills, impulse control and poor time management, therefore having less success in the workforce than individuals without mental illness and substance abuse issues. (Webster et al., 2007)

Webster (2007) also reports that employment is a key factor in breaking the cycle of drug abuse, as employment occupies time, increases self esteem, promotes a sense of belonging and responsibility and provides structure. (Webster et al., 2007)

In Australian society a quarter of the homeless population are children aged between 12 and 18, as these children age and mature they are at a higher risk of unemployment and being stuck in a vicious cycle of homelessness, unemployment, substance abuse and mental illness. (Graham, 2010, p.24)

Children are more likely to face unemployment if they are from low socioeconomic status, left school early leading to low literacy and numeracy skills, are indigenous, live with one or more unemployed person, or live in remote areas. (Graham, 2010, p.20)

A longitudinal study of Australian youth with mental health issues found that they did not suffer from mental health issues prior to unemployment. This shows the importance of employment and the effect that unemployment can have. (Graham, 2010, p.23)

In 1991, Fischer & Breakey developed three pathways into homelessness. The first being social selection which involves “a breakdown in the capacity for living independently due to mental illness. The second pathway details socioeconomic adversity in which a person experiences unemployment, low levels of education and declining income. The third pathway described involves the inability to develop “socially normative roles and support systems”. (Kim & Ford, 2010, p.40)

The sociological imagination uses a sociological approach to analysing issues such as homelessness, substance abuse, unemployment and mental illness. This approach analyses associations of public issues and personal problems by looking at the Historical, structural, critical and cultural factors which contribute to a person experiencing issues such as homelessness. A better understanding of the causes can be found and thus leading to a better understanding of how to return to normal societal function and reducing the risk of relapse into past behaviours. . (Germov, 2009, p.7).

The amount of structure and agency an individual holds in situations of homelessness, drug abuse, unemployment and mental illness is also important to note. The structure agency debate explores the amount of control a individual has over their behaviour and how much influence the social structure to which they belong plays. (Germov, 2009, p.7). Children that have grown up in an environment which is socioeconomically disadvantaged, high levels of drug abuse and unemployment, and poor work ethic, are more likely to follow in this pattern than children that have been brought up in higher socioeconomic conditions and have been instilled with a strong work ethic.

Sue is 17 years of age and has been living away from home for two years, having left her family home due to conflict and violence with parents and physical assault between siblings. In the past two years Sue has lived a typically transient lifestyle, residing in crisis accommodation, various boarding arrangements and in an accommodation program to assist young people who are homeless and in need of specialist support. Sue has lived independently in a small unit as well as with a number of friends in their accommodation and in squats.

Over the past two years Sue has engaged in self-harming behaviour and been violent and aggressive towards peers, herself and family, which has on occasion resulted in ‘cautions’ from the legal system. Sue has also engaged in petty theft, auto-theft and ‘break and enters’, all resulting in legal ‘cautions’. Sue uses alcohol, marijuana and amphetamines and has been diagnosed with depression resulting in anti-depressants being prescribed

(Mission Australia, 2005).

In December 2008, the Australian Government released a “White Paper on Homelessness: The Road Home: A National Approach to Reducing Homelessness”. This paper recognises that maintaining the current approach to homelessness will see the homeless population of Australia significantly increase in the coming years. The paper takes a holistic view and aims to find solutions in address the varying needs of the homeless population, for example employment needs, education and training, health and social support. This report has three main initiative areas. They are to ensure that services intervene early to stop people becoming homeless, making services more connected and responsive across a range of areas not limited to housing, such as health and economic and social participation and strategies to assist people who become homeless to move quickly through the crisis system to stable housing, and providing the support they need so that they do not re-enter homelessness. Through the implementation on many straggles under these initiatives and 1.2 billion dollars in funding the Australian Government aims to have a fifty percent reduction in homelessness by 2020. (MHCA, 2009, pp.12-13)

Today’s society has negative stigma and labelling associated with homelessness. Due to this attributes, the skills they poses, their personality, past achievements are often disregarded and overrun by the fact they are homeless. (Mission Australia, 2005)

As homelessness is not a ‘social norm’, it can be seen is deviant behaviour. With the rise of the medical model of health, importance is placed on the individual receiving treatment in order to restore health and conformity. (Roach Anleu, 2010, pp.242-260)

Under the ‘therapeutic model deviant individuals which can include the homeless, mentally ill, drug and alcohol abusers and those experiencing ‘adjustment problems’ require psychiatric intervention, with little emphasis in the social and environmental conditions that contribute to these issues. (Roach Anleu, 2010, pp.242-260)

Homelessness, unemployment, drug use and mental illness are all intricately connected in today’s society. These social determinants of health all coexist and can each weigh largely upon another. These linkages can lead to a viscous cycle which can be hard to break.

Conclusion

What was discussed

Reaffirm argument

http://www.health.qld.gov.au/research_information/social_determinants.asp